Dissertation
Dissertation > Medicine, health > Internal Medicine > Endocrine diseases and metabolic diseases > Islet disease > Diabetic coma and other complications

The Relativity of Platelet Membrane Proteins on Type Ⅱ Diabetes Mellitus Combined with Arteriosclerosis Obliterans of Lower Extremity at Different Site and Degree

Author ShaoMingZhe
Tutor FuWeiGuo;XuXin;FanLongHua
School Fudan University
Course Surgery
Keywords arteriosclerosis obliterans platelet function platelet membrane glycoprotein platelet-derived growth factor platelet aggregation test platelet adhesional test diabetes mellitus
CLC R587.2
Type PhD thesis
Year 2007
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Objectives:1. To explore the expression and relativity of platelet membrane proteins on type 2 diabetes mellitus combined with arteriosclerosis obliterans of lower extremity at different site and degree.2. To explore the expression of platelet-derived growth factor and its receptors in arterioscerosis plaque on type 2 diabetes mellitus combined with arteriosclerosis obliterans of lower extremity.3. To explore the effects of antiplatelet agents, aspirin and clopidogrel on expression of platelet membrane glycoproteins in patients of type 2 diabetes mellitus with arteriosclerosis obliterans of lower extremityMethods:1. Seventy-five patients with arteriosclerosis obliterans were Assigned into two groups by with or without diabetes mellitus. CD62P, CD63, CD61, CD41a, CD42b, fibrinogen and platelet aggregation were measured in blood by flow Cytometry of the two groups, and the results are compared with spss 10.0. Eighty patients with arteriosclerosis obliterans and type 2 diabetes mellitus are randomly assigned into two groups by different site and degree based on CTA or MRA and its’ clinical behavior. CD62P, CD63, CD61, CD41a, CD42b, fibrinogen and platelet aggregation were measured in blood by flow Cytometry of the two groups, and the results are compared with spss 10.0.2. The arteriosclerotic plaques in arteriosclerosis obliterans patients of lower extremity are taken from either intervention or open operation, or the amputations of lower extremity below knee . The samples are stored in 4% formaldehyde fluid and Liquid nitrogen immediately after operation respectively. One are dyed with HE and immunohistochemical staining to research platelet-derived growth factor receptors, the other are detected the A and B chain mRNA express of platelet-derived growth factor by RT-PCR. And the results are compared with spss 10. 0.3. To explore the effects of antiplatelet agents, aspirin and clopidogrel on expression of platelet membrane glycoproteins in patients of type 2 diabetes mellitus with arteriosclerosis obliterans of lower extremity. Fifty patients with arteriosclerosis obliterans and type 2 diabetes mellitus were randomly assigned into aspirin group (n=25) and clopidogrel group (n=25). They were treated with aspirin and clopidogrel, 100mg?d-1 and 75 mg?d-1, respectively for 1wk. CD62P, CD63, CD61, CD41a, CD42b, fibrinogen and platelet aggregation were measured in two groups before and after taking aspirin or clopidogrel. To compare the antiplatelet effect of aspirin and clopidogrel and find the effective index of antiplatlet agents. And the results are compared with spss 10.0.Results:1 . The express of CD62p and CD63 were apparently increased in arteriosclerosis obliterans patients of lower extremity combined with type2 diabetes mellitus compared to patients without diabetes mellitus (P<0.01). And so the same result about fibrinogen in plasma (P<0.05). The others have no difference.2. The express of CD62p and CD63 in arteriosclerosis obliterans patients of lower extremity were highly correlate to body weight index (p<0.01), the correlate index was 0. 813 and 0. 562. CD62p was correlate with CD63 and the index was 0. 686(p<0.01), CD62p was negatively correlate with CD41a and the relevant index was 0.562(p<0.05). No the same correlation results was appeared in patients without diabetes mellitus3. The express of CD62p and CD63 in arteriosclerosis obliterans patients of lower extremity combined with type 2 diabetes mellitus who were mainly occluded with iliac or femoral artery were significantly increasing with that of occluded with below knee artery. The were no significantly difference on platelet aggregation test, and the counts of platelet .4. A little lipid invasion can be found by Hematoxylin Eosin stain in femoral artery plaque of arteriosclerosis obliterans patients without type 2 diabetes mellitus. And so little express with platelet-derived growth factor receptorαandβwere in femoral artery plaque by immunohistochemistry stain. However in popliteal artery plaque, large lipid invasion and overproliferation of vascular smooth muscle cells in HE stain and a few platelet-derived growth factor receptorαandβexpress in immunohistochemistry stain can be seen.5. The quantity of platelet-derived growth factor A chain mRNA has no difference in iliac or femoral artery plaques between arteriosclerosis obliterans patients combined with type 2 diabetes mellitus and no diabetes mellitus patients. But The quantity of platelet-derived growth factor B chain mRNA was significantly increased compared to no diabetes mellitus patients.6. For no enough samples, the mean quantity of platelet-derived growth factor A and B chain mRNA in iliac or femoral artery plaques of arteriosclerosis obliterans patients with type 2 diabetes mellitus was mild increased compared to those of popliteal artery plaques without diabetes mellitus patients. But there have no difference in statistics between them.Conclusions:1. The platelet membrane glycoprotein CD62p and CD63 were over-expressed in arteriosclerosis obliterans patients with type 2 diabetes mellitus. So the platelet was over-active in these patients. But the change of platelet function has no correlation with the severity of patients artery occlusion. The express of CD62p and CD63 has correlation with the sites of artery occlusion in arteriosclerosis obliterans patients with type 2 diabetes mellitus.2. The traditional tests, such as the count of platelet, thrombocytocrit, mean platelet volume, platelet distribution width, platelet aggregation test and platelet adhesion test could not reflect the real function state on arteriosclerosis obliterans patients with type 2 diabetes mellitus. CD62p and CD63 have more value to reflect the platelet state. We can reduce the costs of these unnecessary tests and save money.3. The traditional antiplatelet agents such as aspirin have little effect on platelet aggregation and the express of platelet membrane glycoproteins. So can not effectively reduce the activity of platelet. Clopidogrel, the new antiplatelet drug, can effectively reduce the platelet aggregation and the express of platelet membrane glycoprotein such as CD62p and CD63. But the long results need further following-up. This can effectively deduce the cost of drugs and made the basement on the future clinical therapy.4 . Platelet-derived growth factor receptorβwas overexpressed in peripheral artery occlude diseases combined with type 2 diabetes mellitus. This explored it is critical in the developing of arterioclerosis. This give us a clue about the future research in drug therapy and the new monitoring index.5. Platelet-derived growth factor B chain mRNA were more large in popliteal artery plaque in arteriosclerosis obliterans with type 2 diabetes mellitus than that of no diabetes. And this explored it play a key role in the development of arteriosclerosis.

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