Lee P, Jenkins A, Bourke C, Santamaria J, Paton C, Janus E, Best J
University Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
Diabet Med. 1993 Mar;10(2):122-8. doi: 10.1111/j.1464-5491.1993.tb00028.x.
Increased urinary albumin loss in patients with Type 1 diabetes is associated with accelerated atherosclerosis. Prothrombotic factors known to be associated with cerebrovascular and coronary artery disease in the general population, antithrombotic factors, were studied in 52 patients with Type 1 diabetes and varying urinary albumin loss and 24 non-diabetic control subjects. Fibrinogen increased from 2.5 g l-1 (95% confidence interval 2.3-2.8) in control subjects and 2.8 g l-1 (2.6-3.0) in diabetic patients without microalbuminuria to 3.1 g l-1 (2.7-3.5) with microalbuminuria (p < 0.005 vs control; p < 0.001 vs without microalbuminuria). Factor VIIc increased from 81% (75-86% in non-diabetic control subjects and 84% (78-90%) in diabetic patients without microalbuminuria to 103% (89-117%) with microalbuminuria (p < 0.005 vs control; p < 0.05 vs without microalbuminuria) and 118% (86-150%) with albuminuria (p < 0.005 vs control and p < 0.001 vs without microalbuminuria). Levels of the antithrombotic factors protein C, protein S, and antithrombin III also rose in the diabetic patients with evidence of renal damage. Elevation of prothrombotic factors has been associated with increased risk of microvascular disease, whereas elevation of antithrombotic factors has no known protective effect. Therefore, this pattern of alteration of haemostatic factors in diabetic renal disease may contribute to the increased risk of vascular disease associated with both microalbuminuria and albuminuria.
1型糖尿病患者尿白蛋白流失增加与动脉粥样硬化加速有关。在52例1型糖尿病且尿白蛋白流失情况各异的患者以及24名非糖尿病对照受试者中，研究了在普通人群中已知与脑血管和冠状动脉疾病相关的促血栓形成因子及抗血栓形成因子。纤维蛋白原在对照受试者中为2.5 g l-1（95%置信区间2.3 - 2.8），无微白蛋白尿的糖尿病患者中为2.8 g l-1（2.6 - 3.0），有微量白蛋白尿时升至3.1 g l-1（2.7 - 3.5）（与对照相比p < 0.005；与无微白蛋白尿相比p < 0.001）。因子VIIc在非糖尿病对照受试者中为81%（75 - 86%），无微白蛋白尿的糖尿病患者中为84%（78 - 90%），有微量白蛋白尿时升至103%（89 - 117%）（与对照相比p < 0.005；与无微白蛋白尿相比p < 0.05），有白蛋白尿时为118%（86 - 150%）（与对照相比p < 0.005，与无微白蛋白尿相比p < 0.001）。抗血栓形成因子蛋白C、蛋白S和抗凝血酶III的水平在有肾损害证据的糖尿病患者中也有所升高。促血栓形成因子升高与微血管疾病风险增加有关，而抗血栓形成因子升高尚无已知的保护作用。因此，糖尿病肾病中这种止血因子的改变模式可能导致与微量白蛋白尿和白蛋白尿相关的血管疾病风险增加。
