Relationship between endothelial function and platelet hemostasis in patients with a good compensation of type 2 diabetes mellitus and hypertension.

Abstract

Background. Disorders of hemostasis in patients with arterial hypertension and diabetes mellitus type 2 are complex: growing aggregative activity of platelets and red blood cells, activation and degranulation of platelet antiaggregatory potential endothelium; reduced anticoagulant and fibrinolytic activity of blood. Objective. The aim of this study is to determine the relationships between endothelial dysfunction, the degree of renal function damage, lipidemic profile and morphological changes of vascular-platelet hemostasis in patients with good compensation of type 2 diabetes mellitus and arterial hypertension.. Methods. In 69 patients with good glycemic compensation using clinical, laboratory, morphological methods and correlational analysis were identified association between endothelial dysfunction, degree of renal function damage, lipidemic profile and morphological changes of vascular-platelet hemostasis. Results. Results of correlation analysis showed the presence of credible negative relation between the content of unactivated platelets and concentrations of endothelin-1 (r=-0.53; p<0.05), von Willebrand factor (r=-0.68; p<0.05) and thrombomodulin (r=-0.55; p<0.05). The largest number and strength of correlations between morphological indicators of intravascular platelet activation and studied clinical and laboratory parameters were observed with admiration to the activated and aggregated forms of cells. In particular, elevated levels of activated platelets in patients of this contingent had reliable high degree of direct correlation with the content of glycated hemoglobin (r=+0.79), systolic blood pressure (r=+0.63), the concentration of endothelial dysfunction markers, including the level of albuminuria (r=+0.73), as well as with the values of total cholesterol (r=+0.64) and low density lipoprotein cholesterol (r=+0.79). On the level of endothelin-1 and thrombomodulin concentration was found positive linear correlation, but alpha-granules located in shut inverse correlation not only with endothelin-1 (r=-0.57; p<0.05), as well as with the concentration of glycated hemoglobin (r=-0.76; p<0.05) and with dyslipidemic changes. Increased platelet aggregation activity in patients with good glycemic compensation, which was manifested in a twofold increase in the content of circulating small units was significantly correlated with the level of glycated hemoglobin (r=+0.66) and the values of systolic blood pressure (r=+0.58), as well as concentrations of markers of endothelial dysfunction and renal function, but did not have any significant relationships with blood lipids in patients of this contingent. Conclusion. It has been established that in the good glycemic control morphological criteria of platelet hemostasis damage clearly correlated with markers of endothelial dysfunction, but did not show significant relationships with indicators of renal function and blood lipid profile.