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目的探讨老年糖尿病及糖尿病伴微量蛋白尿患者止、凝血变化及其临床意义。方法分别检测老年糖尿病组（包括正常蛋白尿组和微量蛋白尿组）和对照组止凝血指标，包括：血浆凝血酶-抗凝血酶Ⅲ复合物（TAT）、血管性血友病因子抗原（vWF）、蛋白C抗原（PC：Ag）、蛋白S抗原（PS：Ag）、P-选择素（P－Selection）、组织纤溶酶原激活物活性（tPA:A）、纤溶酶原激活剂抑制剂（PAI－1：A）及D-二聚体（D－D）。结果老年糖尿病组的vWF、TAT、PC:Ag、PS:Ag、t－PA:A、D－D和P-选择素均高于正常对照组（P＜0．05）。糖尿病组中，微量蛋白组vWF、TAT、t－PA:A、PAI和P-选择素高于正常蛋白尿组（P＜0．05）。结论老年糖尿病组患者，尤其是伴微量蛋白尿者，止、凝血功能异常主要表现为血管内皮损伤、凝血系统激活、血小板的激活和纤溶亢进。这些止凝血的变化与糖尿病的血管并发症密切相关。
Objective To investigate the changes of clotting and coagulation in elderly patients with diabetes mellitus and diabetic with microalbuminuria and its clinical significance. Methods The indexes of hemostasis in senile diabetes mellitus (including normal proteinuria and microalbuminuria) and control group were detected, including plasma thrombin-antithrombin Ⅲ complex (TAT), von Willebrand factor antigen vWF, PC: Ag, PS: Ag, P-Selection, tissue plasminogen activator (tPA: A), plasminogen activator Agent Inhibitors (PAI-1: A) and D-Dimer (D-D). Results The levels of vWF, TAT, PC: Ag, PS: Ag, t-PA: A, D-D and P-selectin in elderly diabetic patients were significantly higher than those in normal controls (P <0.05). In the diabetic group, the levels of vWF, TAT, t-PA: A, PAI and P-selectin in the microprotein group were higher than those in the normal proteinuria group (P <0.05). Conclusion The elderly patients with diabetes mellitus, especially those with microalbuminuria, coagulation dysfunction mainly manifested as vascular endothelial injury, coagulation system activation, platelet activation and fibrinolysis. These changes in coagulation are closely related to vascular complications of diabetes.