Tehrani Sara, Jörneskog Gun, Ågren Anna, Lins Per-Eric, Wallén Håkan, Antovic Aleksandra
Sara Tehrani, MD, Division of Medicine, Danderyd Hospital, 18288 Stockholm, Sweden, Tel.: +46 8 123 55000, Fax: +46 8 123 56187, E-mail:
Thromb Haemost. 2015 Feb;113(2):312-8. doi: 10.1160/TH14-05-0404. Epub 2014 Oct 16.
The increased risk of vascular complications in type 1 diabetes may in part be explained by changes in haemostatic function. In the present study, we investigated the fibrin clot properties in patients with type 1 diabetes in relation to sex and microvascular complications. The study included 236 patients (107 women) aged between 20-70 years and without any history of cardiovascular disease. Fibrin clot properties, assessed by determination of the permeability coefficient (Ks) and turbidimetric clotting and lysis assays, did not differ between men and women. Compared with men, women had worse glycaemic control as well as higher levels of prothrombin fragment 1+2 and peak thrombin generation in vitro, indicating increased thrombin generation both in vivo and in vitro. Subgroup analyses of patients younger than 30 years revealed less permeable fibrin clots and prolonged lysis time in females compared with age-matched men. Patients with microvascular complications had higher fibrinogen concentrations and denser and less permeable fibrin clots. Thus, we conclude that in vitro fibrin clot properties in patients with type 1 diabetes without cardiovascular disease are not different between the sexes, but associate with prevalence of microvascular complications. Tighter fibrin clot formation in younger women, as suggested by our results, may affect their future cardiovascular risk and should be investigated in a larger population.
1型糖尿病患者血管并发症风险增加，部分原因可能是止血功能的改变。在本研究中，我们调查了1型糖尿病患者的纤维蛋白凝块特性与性别及微血管并发症之间的关系。该研究纳入了236名年龄在20至70岁之间、无心血管疾病史的患者（107名女性）。通过测定渗透系数（Ks）以及比浊法凝血和溶解试验评估的纤维蛋白凝块特性，在男性和女性之间并无差异。与男性相比，女性的血糖控制较差，并且体外凝血酶原片段1+2水平及凝血酶生成峰值更高，表明体内和体外的凝血酶生成均增加。对30岁以下患者的亚组分析显示，与年龄匹配的男性相比，女性的纤维蛋白凝块渗透性更低，溶解时间更长。患有微血管并发症的患者纤维蛋白原浓度更高，纤维蛋白凝块更致密且渗透性更低。因此，我们得出结论，无心血管疾病的1型糖尿病患者的体外纤维蛋白凝块特性在性别上并无差异，但与微血管并发症的患病率相关。我们的结果表明，年轻女性中更紧密的纤维蛋白凝块形成可能会影响她们未来的心血管风险，应在更大规模的人群中进行研究。
