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Physiological inhibitors of blood coagulation and prothrombin fragment F 1+2 in type 2 diabetic patients with normoalbuminuria and incipient nephropathy

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Abstract

Microalbuminuria and haemostasis derangements have been considered as independent risk factors for cardiovascular death in type 2 (non-insulin-dependent) diabetic patients. Few studies have assessed coagulation inhibitors in type 2 diabetic patients with normoalbuminuria and microalbuminuria. Therefore, 32 type 2 diabetic patients with normoalbuminuria (albumin excretion rate, AER<20 mg/min, mean 7±1) and 28 type 2 diabetic patients with microalbuminuria (AER 20–200 mg/min, mean 84±11) were studied. The patients were matched for age, sex, disease duration and treatment, body mass index (BMI), blood pressure and glycohaemoglobin. Protein C and S activity, antithrombin III, thrombomodulin and prothrombin fragments 1+2 (F 1+2) were assessed together with fibrinogen, triglycerides, total and high density lipoprotein (HDL)-cholesterol concentrations. Fibrinogen, total and low density lipoprotein (LDL) concentrations were similar in the two groups, while a significant difference was observed for triglycerides (normoalbuminuric group: 128±10 mg/dl, microalbuminuric group: 184.1±17 mg/dl;P<0.007) and HDL-cholesterol (normoalbuminuric group: 45±2 mg/dl, microalbuminuric group: 39±2 mg/dl;P<0.05). The coagulation parameters were as follows: normoalbuminuric group: protein C activity 109%±5%, protein S 95.4%±5%, thrombomodulin 49.3±3 ng/ml, antithrombin III 93.3%±3%, F 1+2 1.05±0.04 nmol/l; microalbuminuric group: protein C activity 107%±4%, protein S 98.4%±4%, thrombomodulin 64.4±4 ng/ml, antithrombin III 93.3%±3%, F 1+2 1.03±0.05 nmol/l. The difference was significant for thrombomodulin (P<0.007). A significant direct correlation was observed in the microalbuminuric group between AER and thrombomodulin (r=0.38,P<0.05). In conclusion, our data do not support the hypothesis that a reduction in the activity of anticoagulant physiological inhibitors (protein C, protein S, antithrombin III) could contribute to explain the higher cardiovascular risk in type 2 diabetic patients with microalbuminuria. The elevation of plasma thrombomodulin concentration in type 2 diabetic patients could be the consequence of widespread vascular damage in diabetic patients with incipient nephropathy.

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Author notes

  1. M. Veglio

    Present address: , Via Mancini 15, I-10131, Torino, Italy

Authors and Affiliations

  1. Institute of Internal Medicine, University of Torino, Torino, Italy

    M. Veglio, G. Gruden & P. Cavallo-Perin

  2. Haematologic Laboratory, USSL 40, Ivrea, Italy

    A. Mormile, M. Girotto, P. Rossetto & P. D. Este

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  1. A. Mormile
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  2. M. Veglio
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  3. G. Gruden
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  4. M. Girotto
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  5. P. Rossetto
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  6. P. D. Este
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  7. P. Cavallo-Perin
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Mormile, A., Veglio, M., Gruden, G. et al. Physiological inhibitors of blood coagulation and prothrombin fragment F 1+2 in type 2 diabetic patients with normoalbuminuria and incipient nephropathy. Acta Diabetol 33, 241–245 (1996). https://doi.org/10.1007/BF02048551

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  • DOI: https://doi.org/10.1007/BF02048551

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