Research Department, Royal College of Surgeons in Ireland, PO Box 15503, Adliya, Bahrain.
Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK.
Cardiovasc Diabetol. 2022 Oct 6;21(1):202. doi: 10.1186/s12933-022-01639-w.
Severe hypoglycemia is associated with increased cardiovascular death risk, and platelet responses to hypoglycemia (hypo) have been described. However, the impact of deep transient hypo (deep-hypo) versus prolonged milder hypo (mild-hypo) on platelet response is unclear.
Two hypo studies were compared; firstly, mild-hypo in 18-subjects (10 type-2-diabetes (T2D), 8 controls), blood glucose to 2.8mmoL/L (50 mg/dL) for 1-hour; secondly deep-hypo in 46-subjects (23 T2D, 23 controls), blood glucose to < 2.2mmoL/L (< 40 mg/dL) transiently. Platelet-related protein (PRP) responses from baseline to after 1-hour of hypo (mild-hypo) or at deep-hypo were compared, and at 24-hours post-hypo. Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement was used to determine PRP changes for 13 PRPs.
In controls, from baseline to hypo, differences were seen for four PRPs, three showing increased %change in deep-hypo (Plasminogen activator inhibitor-1(PAI-1), CD40 ligand (CD40LG) and Protein-S), one showing increased %change in mild-hypo (von Willebrand factor (vWF)); at 24-hours in controls, %change for Protein-S remained increased in deep-hypo, whilst % change for vWF and plasminogen were increased in mild-hypo. In T2D, from baseline to hypo, differences were seen for 4 PRPs, three showing increased %change in deep-hypo (PAI-1, platelet glycoprotein VI and Tissue factor), one showing increased %change in mild-hypo (CD40LG); at 24-hours in T2D, %change for CD40LG remained increased, together with vWF, in deep-hypo.
Both mild-hypo and deep-hypo showed marked PRP changes that continued up to 24-hours, showing that both the severity and duration of hypoglycemia are likely important and that any degree of hypoglycemia may be detrimental for increased cardiovascular risk events through PRP changes.
严重低血糖与心血管死亡风险增加相关，并且已经描述了低血糖对血小板的反应。然而，深度短暂性低血糖（深度低血糖）与较长时间的轻度低血糖（轻度低血糖）对血小板反应的影响尚不清楚。
比较了两项低血糖研究；首先，18 名受试者（10 名 2 型糖尿病（T2D）患者，8 名对照者）发生轻度低血糖，血糖降至 2.8mmol/L（50mg/dL）持续 1 小时；其次，46 名受试者（23 名 T2D 患者，23 名对照者）发生深度低血糖，血糖短暂降至<2.2mmol/L（<40mg/dL）。比较轻度低血糖（轻度低血糖）或深度低血糖后 1 小时（深度低血糖）和低血糖后 24 小时的血小板相关蛋白（PRP）反应，并使用慢脱靶修饰适体（SOMA）-扫描血浆蛋白测量法测定 13 种 PRP 的变化。
在对照组中，从基线到低血糖，有四种 PRP 出现差异，其中三种在深度低血糖时显示出更高的 %变化（纤溶酶原激活物抑制剂-1（PAI-1）、CD40 配体（CD40LG）和蛋白-S），一种在轻度低血糖时显示出更高的 %变化（血管性血友病因子（vWF））；在对照组中，24 小时时，深度低血糖时蛋白-S 的变化仍持续增加，而 vWF 和纤溶酶原在轻度低血糖时增加。在 T2D 患者中，从基线到低血糖，有四种 PRP 出现差异，其中三种在深度低血糖时显示出更高的 %变化（PAI-1、血小板糖蛋白 VI 和组织因子），一种在轻度低血糖时显示出更高的 %变化（CD40LG）；在 T2D 患者中，24 小时时，CD40LG 的变化持续增加，与深度低血糖时的 vWF 一起增加。
轻度低血糖和深度低血糖均显示出明显的 PRP 变化，这些变化可持续至 24 小时，这表明低血糖的严重程度和持续时间都可能很重要，任何程度的低血糖都可能通过 PRP 变化增加心血管风险事件。
