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Aktivierte zelluläre Hämostase und diabetische Angiopathie

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Zusammenfassung

Gefäßerkrankungen und damit verbundene Akutkomplikationen stellen unverändert die Haupttodesursache des Diabetikers dar. Die Entwicklung der letztlich lebensterminierenden thrombotischen Akutereignisse an endothelialen Läsionsstellen des Gefäßsystems ist verstärkt. Morbidität und Mortalität des Diabetikers hängen damit von den gefäßvermittelten Komplikationen schicksalhaft ab.

Die Integrität des Blutflusses als Voraussetzung einer bedarfsgerechten Organperfusion resultiert aus Vasomotion, Plasmazusammensetzung, Eigenschaften zellulärer Blutelemente, der Gefäßstruktur sowie v. a. aus der ungestörten Interaktion dieser Komponenten an der endothelialen Grenzfläche. Die funktionelle Thromboresistenz des Endothels ist beim Diabetiker vermindert. Neben gesteigerter intravasaler Thrombinbildung und verminderter re-parativer Fibrinolyse führen v. a. primär funktionsgesteigerte Thrombozyten zu einem präthrombotischen Zustand. Im Gegensatz zu hämorrheologischen Mechanismen kann eine thrombotische Diathese zur akuten Strombahnobstruktion führen. Aktivierte Thrombozyten sind dabei dreifach schädigend: 1) primäre Mikroembolisierung der Kapillarstrombahn, 2) lokale Progression von Gefäßwandläsionen durch Sekretion vasokonstriktiver, mitogener und oxydativ wirksamer Substanzen, 3) Auslösung einer arteriellen Akutthrombose.

Aus diesen Gründen liegt eine ergänzende thrombozytenfunktionshemmende Präventionsmedikation bei Diabetikern nahe. Voraussetzung für eine weitere Verbesserung der Nutzen-Risiko-Abwägung solcher Therapieansätze ist die Analyse des individuellen Risikos eines aktivierten zellulären Hämostasesystems z. B. mit der durchflußzytometrischen Aktivierungsmarkeranalyse nach dem Düsseldorf-III-Protokoll („thrombotic risk assessment“).

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