Circulating tissue factor procoagulant activity and thrombin generation in patients with type 2 diabetes: Effects of insulin and glucose
Circulating tissue factor procoagulant activity and thrombin generation in patients with type 2 diabetes: Effects of insulin and glucose
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DOI：
10.1210/jc.2007-0933
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发表时间：
2007-11-01
影响因子：
5.8
通讯作者：
Rao, A. Koneti
中科院分区：
文献类型：
--
作者：
Boden, Guenther;Vaidyula, Vijender R.;Rao, A. Koneti
背景：2 型糖尿病 (T2DM) 是一种高凝状态。组织因子（TF）是凝血的主要引发剂。目的：我们的目的是检查高血糖和高胰岛素血症对 T2DM 凝血 TF 途径的影响。设计：使用了三种研究方案：1）急性纠正高血糖（静脉注射胰岛素），然后 24 小时血糖正常，2）24 小时选择性高胰岛素血症，3）24 小时联合治疗地点：该研究在临床研究中心进行。研究参与者：参与者包括 18 名 T2DM 患者和 22 名非糖尿病对照者。结果：基础 TF 促凝血活性 (TF-PCA)、单核细胞 TF mRNA、血浆凝血因子 VII (FVIIc) 和凝血酶-抗凝血酶复合物在 T2DM 中高于非糖尿病对照者，表明慢性促凝血状态。在 2-4 小时内使高血糖急剧正常化会导致 TF-PCA 小幅（类似于 7%）但显着下降，并且在 24 小时内不再进一步下降。单独提高胰岛素水平会使 TF-PCA 增加 30%，而同时提高胰岛素和葡萄糖水平会增加 TF-PCA（增加 80%）、凝血酶-抗凝血酶复合物和凝血酶原片段 1.2。血浆 FVIIa 和 FVIIc 随着 TF-PCA 的增加而下降。结论：我们的结论是，高血糖和高胰岛素血症的结合（常见于控制不佳的 T2DM 患者）导致促凝血状态，可能使这些患者容易发生急性心血管事件。
Context: Type 2 diabetes mellitus ( T2DM) is a hypercoagulable state. Tissue factor ( TF) is the principal initiator of blood coagulation.Objective: Our objective was to examine the effects of hyperglycemia and hyperinsulinemia on the TF pathway of blood coagulation in T2DM.Design: Three study protocols were used: 1) acute correction of hyperglycemia ( with iv insulin) followed by 24 h of euglycemia, 2) 24 h of selective hyperinsulinemia, and 3) 24 h of combined hyperinsulinemia and hyperglycemia.Setting: The study took place at a clinical research center.Study Participants: Participants included 18 T2DM patients and 22 nondiabetic controls.Results: Basal TF-procoagulant activity ( TF-PCA), monocyte TF mRNA, plasma coagulation factor VII ( FVIIc), and thrombin-antithrombin complexes were higher in T2DM than in nondiabetic controls, indicating a chronic procoagulant state. Acutely normalizing hyperglycemia over 2-4 h resulted in a small ( similar to 7%) but significant decline in TF-PCA with no further decline over 24 h. Raising insulin levels alone raised TF-PCA by 30%, whereas raising insulin and glucose levels together increased TF-PCA ( by 80%), thrombin-antithrombin complexes, and prothrombin fragment 1.2. Plasma FVIIa and FVIIc declined with increases in TF-PCA.Conclusion: We conclude that the combination of hyperglycemia and hyperinsulinemia, common in poorly controlled patients with T2DM, contributes to a procoagulant state that may predispose these patients to acute cardiovascular events.