Aoki I, Shimoyama K, Aoki N, Homori M, Yanagisawa A, Nakahara K, Kawai Y, Kitamura S I, Ishikawa K
Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
J Am Coll Cardiol. 1996 Mar 1;27(3):560-6. doi: 10.1016/0735-1097(95)00518-8.
This study sought to assess the usefulness of platelet-dependent thrombin generation as an index of coagulability in diabetes and to determine the effect of glycemic control on coagulability in diabetes.
It is important to investigate the interaction of platelets and the coagulation factors to clarify the processes of the coagulation system in detail.
Platelet-rich plasma (150 X 10(9)/liter), 0.5 ml, was prepared, and 40 mmol/liter of calcium chloride was added to initiate clotting. S-2238 was added to each sample in a microtiter plate every 10 min, and the absorbance of the released color product at 2 min was measured spectrophotometrically at a wavelength of 405 nm using a microtiter plate reader as thrombin generation. We measured the platelet-independent thrombin generation in patients with non-insulin-dependent diabetes mellitus grouped according to glycemic control.
Platelet-dependent thrombin generation at 30 min after calcium chloride addition was significantly higher in 23 patients with poorly glycemic-controlled non-insulin-dependent diabetes mellitus without complications, such as diabetic retinopathy, nephropathy and neuropathy (hemoglobin [Hb] A1c >/= 9.0%) than in 46 healthy normal subjects (448 +/- 75 vs. 165 +/- 28 mU/min, p < 0.001). Thrombin generation in 31 well controlled diabetic patients without complications (Hb A1c < 9.0%) was intermediate (240 +/- 72 mU/min) between those of the poorly controlled group and healthy normal subjects. Platelet-poor plasma from diabetic patients increased platelet-dependent thrombin generation in normal subjects.
Coagulability is evidently enhanced in patients with non-insulin-dependent diabetes mellitus compared with that in healthy normal subjects on the basis of assessments of the platelet-dependent thrombin generation, and good glycemic control may help to correct a hypercoagulable state in diabetic patients.
本研究旨在评估血小板依赖性凝血酶生成作为糖尿病患者凝血能力指标的实用性，并确定血糖控制对糖尿病患者凝血能力的影响。
详细研究血小板与凝血因子之间的相互作用对于阐明凝血系统的过程很重要。
制备富含血小板的血浆（150×10⁹/升），取0.5毫升，加入40毫摩尔/升氯化钙以启动凝血。每隔10分钟向微量滴定板中的每个样品中加入S-2238，并使用微量滴定板读数器在波长405纳米处通过分光光度法测量2分钟时释放的有色产物的吸光度，作为凝血酶生成量。我们对非胰岛素依赖型糖尿病患者按血糖控制情况分组，测量其非血小板依赖性凝血酶生成量。
在23例无糖尿病视网膜病变、肾病和神经病变等并发症的血糖控制不佳的非胰岛素依赖型糖尿病患者（糖化血红蛋白[Hb]A1c≥9.0%）中，添加氯化钙30分钟后的血小板依赖性凝血酶生成量显著高于46名健康正常受试者（448±75对165±28毫国际单位/分钟，p<0.001）。31例无并发症的血糖控制良好的糖尿病患者（Hb A1c<9.0%）的凝血酶生成量介于血糖控制不佳组和健康正常受试者之间（240±72毫国际单位/分钟）。糖尿病患者的乏血小板血浆增加了正常受试者的血小板依赖性凝血酶生成量。
基于对血小板依赖性凝血酶生成的评估，非胰岛素依赖型糖尿病患者的凝血能力明显高于健康正常受试者，良好的血糖控制可能有助于纠正糖尿病患者的高凝状态。
