CAJ | 학술논문

目的：观察糖尿病微血管病变患者血浆血栓调节蛋白（TM）和D-二聚体（D-D）水平的变化，了解这两种因子在糖尿病微血管病变发病中的意义。方法将100例糖尿病患者按有无糖尿病微血管病变分为2组：无糖尿病微血管病变组患者38例和糖尿病微血管病变组患者62例，另选健康者30例作为正常对照组，测定各组血浆TM浓度及D-D浓度，观察各组变化，同时研究TM与D-D有无相关性。结果①糖尿病组血浆TM水平均明显高于正常对照组（P＜0.05），而且合并微血管病变的糖尿病组血浆TM水平高于无微血管病变糖尿病组（P＜0.05），②无微血管病变的糖尿病组D-D水平与正常对照组比较无统计学差异（P＞0.05），而合并微血管病变的糖尿病组D-D水平高于无微血管病变的糖尿病组与正常对照组（P＜0.05）。③血浆TM与D-D呈显著正相关（r=0.583，P＜0.001）。结论①检测血浆TM水平可以帮助评价糖尿病患者血管内皮细胞损伤的情况；②随着糖尿病患者病情加重，微血管病变的出现，血中D-D水平升高，提示糖尿病微血管病变患者体内存在高凝状态、血栓形成和继发纤溶亢进；③糖尿病患者血浆TM与D-D密切相关，表明TM也反映体内高凝状态。
목적：관찰당뇨병미혈관병변환자혈장혈전조절단백（TM）화D-이취체（D-D）수평적변화，료해저량충인자재당뇨병미혈관병변발병중적의의。방법장100례당뇨병환자안유무당뇨병미혈관병변분위2조：무당뇨병미혈관병변조환자38례화당뇨병미혈관병변조환자62례，령선건강자30례작위정상대조조，측정각조혈장TM농도급D-D농도，관찰각조변화，동시연구TM여D-D유무상관성。결과①당뇨병조혈장TM수평균명현고우정상대조조（P＜0.05），이차합병미혈관병변적당뇨병조혈장TM수평고우무미혈관병변당뇨병조（P＜0.05），②무미혈관병변적당뇨병조D-D수평여정상대조조비교무통계학차이（P＞0.05），이합병미혈관병변적당뇨병조D-D수평고우무미혈관병변적당뇨병조여정상대조조（P＜0.05）。③혈장TM여D-D정현저정상관（r=0.583，P＜0.001）。결론①검측혈장TM수평가이방조평개당뇨병환자혈관내피세포손상적정황；②수착당뇨병환자병정가중，미혈관병변적출현，혈중D-D수평승고，제시당뇨병미혈관병변환자체내존재고응상태、혈전형성화계발섬용항진；③당뇨병환자혈장TM여D-D밀절상관，표명TM야반영체내고응상태。
Objective To measure the plasma levels of thrombomodulin(TM) and D-dimer in patients with diabetic microangiopathy and to study the significance of TM and D-dimer in the pathogenesis of diabetic microangiopathy.Methods 100 cases of diabetic patients were divided into two groups, including 38 cases of no diabetic microangiopathy group, and 62 cases of diabetic microangiopathy group, while 30 cases of normal people were also checked as the control group. The plasma levels of TM and D-dimer were examined, The relationship between TM and D-dimer was also investigated.Result①The plasma TM level in diabetes group was higher than those in the control group(P<0.05) . and the plasma TM level was higher in diabetic microangiopathy group than those in no diabetic microangiopathy group(P<0.05).②No statistical difference in D-dimer between no diabetic microangiopathy group and control group. The plasma D-dimer level was higer in diabetic microangiopathy group than those in no diabetic microangiopathy group and control groups(P<0.05).③There was positive correlation between TM and D-dimer(r=0.583,P<0.001).Conclusion①Clinical determination of plasma TM level in patients of diabetes can help evaluate diabetic vascular endothelial cell injury.②The levels of plasma D-dimer in patients of diabetes increased as microangiopathy progressed, the result demonstrates that both coagulation and fibrinolysis are enhanced concomitantly in diabetic microangiopathy patients.③There was positive correlation between TM and D-dimer, the level of plasma TM also demonstrates that there is hypercoagulation in diabetic patients.