Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China.
BMC Pulm Med. 2023 May 26;23(1):183. doi: 10.1186/s12890-023-02486-5.
To investigate the changes and clinical significance of vascular endothelial injury markers in type 2 diabetes mellitus (T2DM) complicated with pulmonary embolism (PE).
This prospective study enrolled patients with T2DM hospitalized in one hospital from January 2021 to June 2022. Soluble thrombomodulin (sTM) (ELISA), von Willebrand factor (vWF) (ELISA), and circulating endothelial cells (CECs) (flow cytometry) were measured. PE was diagnosed by computed tomography pulmonary angiography (CTPA).
Thirty participants were enrolled in each group. The plasma levels of sTM (151.22 ± 120.57 vs. 532.93 ± 243.82 vs. 1016.51 ± 218.00 pg/mL, P < 0.001) and vWF (9.63 ± 2.73 vs. 11.50 ± 2.17 vs. 18.02 ± 3.40 ng/mL, P < 0.001) and the percentage of CECs (0.17 ± 0.46 vs. 0.30 ± 0.08 vs. 0.56 ± 0.18%, P < 0.001) gradually increased from the control group to the T2DM group to the T2DM + PE group. sTM (OR = 1.002, 95%CI: 1.002-1.025, P = 0.022) and vWF (OR = 1.168, 95%CI: 1.168-2.916, P = 0.009) were associated with T2DM + PE. sTM > 676.68 pg/mL for the diagnosis of T2DM + PE achieved an AUC of 0.973, while vWF > 13.75 ng/mL achieved an AUC of 0.954. The combination of sTM and vWF above their cutoff points achieved an AUC of 0.993, with 100% sensitivity and 96.7% specificity.
Patients with T2DM show endothelial injury and dysfunction, which were worse in patients with T2DM and PE. High sTM and vWF levels have certain clinical predictive values for screening T2DM accompanied by PE.
探讨 2 型糖尿病（T2DM）合并肺栓塞（PE）患者血管内皮损伤标志物的变化及临床意义。
本前瞻性研究纳入 2021 年 1 月至 2022 年 6 月期间在我院住院的 T2DM 患者。采用酶联免疫吸附法（ELISA）检测可溶性血栓调节蛋白（sTM）、血管性血友病因子（vWF），采用流式细胞术检测循环内皮细胞（CEC）。采用计算机断层肺动脉造影（CTPA）诊断 PE。
每组纳入 30 例患者。sTM（151.22±120.57 比 532.93±243.82 比 1016.51±218.00 pg/mL，P<0.001）和 vWF（9.63±2.73 比 11.50±2.17 比 18.02±3.40 ng/mL，P<0.001）以及 CECs 百分比（0.17±0.46 比 0.30±0.08 比 0.56±0.18%，P<0.001）逐渐从对照组增加到 T2DM 组再增加到 T2DM+PE 组。sTM（OR=1.002，95%CI：1.002-1.025，P=0.022）和 vWF（OR=1.168，95%CI：1.168-2.916，P=0.009）与 T2DM+PE 相关。sTM>676.68 pg/mL 诊断 T2DM+PE 的 AUC 为 0.973，而 vWF>13.75 ng/mL 的 AUC 为 0.954。sTM 和 vWF 高于其截断值的联合 AUC 为 0.993，具有 100%的敏感性和 96.7%的特异性。
T2DM 患者存在内皮损伤和功能障碍，T2DM 合并 PE 患者更严重。高 sTM 和 vWF 水平对筛查 T2DM 合并 PE 具有一定的临床预测价值。
