Schalekamp M A
Department of Internal Medicine I, University Hospital Dijkzigt, Rotterdam.
Clin Investig. 1993;71(5 Suppl):S3-6. doi: 10.1007/BF00180069.
Endothelial cell damage, which is associated with local thrombin formation and inflammation, can lead to the release of endothelium-synthesized factors into plasma, such as vWFAg, TM, ACE and ET-1. These markers of endothelial damage are increased in some patients with diabetes mellitus, but the differences with normal are often small and not closely correlated with the severity of microvascular disease, as judged from the degree of albuminuria and the severity of retinopathy. Prorenin, which may also be related to abnormal endothelial cell function or endothelial damage, is elevated in many patients with diabetes, both type I and II, and its level is more closely correlated with the severity of microvascular disease. It is already elevated at an early stage. Further studies will reveal whether, in diabetes, an increased plasma prorenin is a reliable predictor of progressive microvascular disease. It is even conceivable that prorenin is not only a marker of diabetic microvascular disease but also has a role in its pathogenesis, via local proteolytic or non-proteolytic prorenin activation.
内皮细胞损伤与局部凝血酶形成及炎症相关，可导致内皮合成因子释放到血浆中，如血管性血友病因子抗原（vWFAg）、血栓调节蛋白（TM）、血管紧张素转换酶（ACE）和内皮素-1（ET-1）。在一些糖尿病患者中，这些内皮损伤标志物会升高，但与正常水平的差异通常较小，且与微血管疾病的严重程度并无密切关联，这可通过蛋白尿程度和视网膜病变严重程度来判断。血管紧张素原，可能也与内皮细胞功能异常或内皮损伤有关，在许多I型和II型糖尿病患者中升高，其水平与微血管疾病的严重程度更密切相关。在疾病早期它就已升高。进一步研究将揭示，在糖尿病中，血浆血管紧张素原升高是否是进行性微血管疾病的可靠预测指标。甚至可以想象，血管紧张素原不仅是糖尿病微血管疾病的标志物，还可能通过局部蛋白水解或非蛋白水解激活血管紧张素原，在其发病机制中发挥作用。
