冠心病并糖尿病患者血栓形成前状态分子标志物变化及机制研究  

Change and significance of molecular markers of prethrombotic state in coronary artery disease patients with diabetes mellitus

作　　者：马建林[1] 李新明[1] 苏哲坦[1] 李斌[1] 陈关良[1] 王天松[1] 黄白丽[1] 王青[1] 钟文菲[1] 黄雪茹[1] 

机构地区：[1]海南省人民医院心内科,海口570311

出　　处：《临床心血管病杂志》2003年第8期468-471,共4页Journal of Clinical Cardiology

基　　金：海南省自然科学基金资助课题 (No .39812 )

摘　　要：目的 :观察冠心病 (CHD)并 2型糖尿病 (NIDDM)患者血栓形成前状态 (PTS)分子标志物的变化 ,并探讨其机制。方法 :对 2 0例稳定型心绞痛 (SAP)、2 0例不稳定型心绞痛 (UAP)、2 8例UAP并NIDDM患者以及2 0例正常人体内PTS分子标志物、血管内皮功能以及脂质过氧化物水平进行系列检测。结果 :CHD患者尤其是并NIDDM患者体内存在明显的PTS分子标志物变化 ,并且以并糖尿病 (DM)微血管病变者或伴有心脏事件发生者更为明显 ,与此同时 ,这些患者的内皮功能障碍及脂质过氧化损伤明显。Logistic回归分析表明心脏事件发生与血管性假血友病因子、抗凝血酶Ⅲ、血浆血小板颗粒膜糖蛋白 14 0、血浆纤维蛋白原变化尤其密切 ,并且后者变化与内皮功能失调及脂质过氧化损伤密切相关。结论 :CHD尤其是并NIDDM患者存在明显的PTS分子标志物变化 ,这种变化在DM微血管病变者尤其明显 ,并与心脏事件发生密切相关。其产生机制可能与血管内皮功能障碍。Objective:To observe the changes of molecular markers of prethrombotic state (PTS) in coronary artery disease (CHD)patients with non insulin dependent diabetes mellitus (NIDDM). Methods:Molecular markers of PTS, vascular endothelial function and lipid peroxidate were measured in 20 patients with stable angina pectoris, 20 patients with unstable angina pectoris(UAP), 28 UAP pateints with NIDDM and 20 normal cases. Results:There were significant changes of molecular markers of PTS in CHD patients, especially in those with NIDDM, which were more pronounced in those with diabetic microvascular disease and those with cardiac events. Meanwhile,there were significant endothelial disfunction and injury of lipid peroxide in those patients. Logistic regression analysis showed that there were close relationships between cardiac events and vWF, ATⅢ, GMP 140, Fbg, which were closely related with endothelial disfunction and injury of lipid peroxide. Conclusion:There were significant changes of molecular markers of PTS in CHD patients especially in those with NIDDM, which were even more pronounced in those with diabetic microvascular disease and were closely related with cardiac events. The mechanisms may be related with endothelial disfunction and injury of lipid peroxide.

关 键 词：冠状动脉疾病 糖尿病 血栓形成 

分 类 号：R543.3[医药卫生—心血管疾病]