Acute, short-term hyperglycemia enhances shear stress-induced platelet activation in patients with type II diabetes mellitus

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• 作者：Paolo Gresele ; Giuseppe Guglielmini ; Massimiliano De Angelis ; Silvia Ciferri ; Marco Ciofetta ; Emanuela Falcinelli ; Carlo Lalli ; Giovanni Ciabattoni ; Giovanni Davì ; ; Geremia B. Bolli
• 关键词：AHA/ACC ; Conference Proceedings ; myocardial infarction ; acute ; diagnosis ; treatment
• 刊名：Journal of the American College of Cardiology
• 出版年：2003
• 出版时间：19 March 2003
• 年：2003
• 卷：41
• 期：6
• 页码：1013-1020
• 全文大小：232 K

文摘

The aim of our study was to assess whether acute, short-term hyperglycemia affects platelet reactivity in patients with Type II diabetes mellitus (T2DM).

Background

Hyperglycemic spikes are thought to precipitate ischemic events in T2DM. Previous studies have shown in vivo platelet activation in diabetes; however, no studies have assessed whether acute in vivo hyperglycemia induces further activation of platelets.

Methods

In a cross-over, randomized, double-blind study, 12 patients with T2DM underwent 4 h of either acute hyperglycemia (13.9 mmol/l, 250 mg/dl) or euglycemia (5.5 mmol/l, 100 mg/dl). Shear stress-induced platelet activation, P-selectin and lysosomal integral membrane protein (LIMP) expression on platelets in the bleeding-time blood, urinary 11-dehydro-thromboxane B₂ (TxB₂) excretion, von Willebrand factor:antigen (vWF:Ag), and von Willebrand factor:activity (vWF:activity) were measured before and after hyperglycemia or euglycemia.

Results

Shear stress-induced platelet activation, P-selectin and LIMP expression on platelets in the bleeding-time blood, and urinary 11-dehydro-TxB₂ excretion increased significantly after hyperglycemic clamping, whereas no changes were observed after euglycemic clamping. Plasma vWF:Ag and vWF:activity increased strikingly in parallel fashion after hyperglycemic clamping, whereas no changes were observed after euglycemic clamping.

Conclusions

Our data demonstrate that acute, short-term hyperglycemia induces an increased activation of platelets exposed to high shear stress conditions in vitro (filtration method) or in vivo (bleeding time). In vivo platelet activation is reflected by an increased urinary excretion of 11-dehydro-TxB₂. The increased levels of vWF in the circulation correlate with the increase in platelet activation markers and may indicate some degree of causation. Acute, short-term hyperglycemia in T2DM may precipitate vascular occlusions by facilitating platelet activation.