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目的 探索一氧化氮 (NO)及血小板活化异常与糖尿病肾病 (DN)的关系。方法 74例 2型糖尿病 (DM)患者测定了血清 NO,其中 6 2例同时测定了血浆α-颗粒膜蛋白 (GMP140 )的水平 ,并依据 2 4小时尿白蛋白排出率(UAER)将其分为正常白蛋白尿组 (DM1 )、微量白蛋白尿组 (DM2 )、大量白蛋白尿组 (DM3 ) ,并与 37例正常人对照(NC)。结果 血清 NO在 DM1 较 NC明显升高 ,但 DM2 、DM3 却较 NC有显著性的降低 ;血浆 GMP140在 DM各组均较NC升高 ,特别是 DM2 、DM3 组较 NC明显升高。DM合并高血压者血 NO较无高血压者明显降低 ,而 GMP140均较无高血压者为高 (P<0 .0 5 )。血 NO与 GMP140呈显著负相关 (rs=- 0 .5 2 ,P<0 .0 5 )。结论 NO在 2型 DM早期升高 ,引起肾小球高灌注状态 ,后期下降 ,导致血小板活化增加。NO水平的异常及血小板活化的增强与 DN的发生、发展密切有关
Objective To explore the relationship between nitric oxide (NO), abnormal platelet activation and diabetic nephropathy (DN). Methods Seventy-four patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. Serum NO was measured in 62 patients, and the plasma level of α-granule membrane protein (GMP140) was measured simultaneously. Based on 24-hour urinary albumin excretion rate (UAER) (DM1), microalbuminuria group (DM2), large albuminuria group (DM3), and 37 normal controls (NC). Results Serum NO was significantly higher in DM1 than NC, but DM2 and DM3 were significantly lower than those in NC. Plasma GMP140 was higher than NC in DM group, especially in DM2 and DM3 group. Compared with those without hypertension, the blood levels of NO in DM with hypertension were significantly lower than those without hypertension (P <0.05). There was a significant negative correlation between blood NO and GMP140 (rs = - 0.52, P <0.05). Conclusions NO increased early in type 2 DM, causing high glomerular perfusion and decreasing in late stage, leading to increased platelet activation. The abnormal level of NO and the enhancement of platelet activation are closely related to the occurrence and development of DN