THROMBOMODULIN AND INDUCED TISSUE FACTOR EXPRESSION ON MONOCYTES AS MARKERS OF DIABETIC MICROANGIOPATHY - A PROSPECTIVE-STUDY ON HEMOSTASISAND LIPOPROTEINS IN INSULIN-DEPENDENT DIABETES-MELLITUS

Vascular complications are the main cause of morbidity in diabetes mel litus, To evaluate lipoprotein and hemostatic parameters and their rel ationship with clinically detectable microangiopathy, we studied 58 in sulin-dependent diabetes mellitus patients and 60 controls matched for age, sex, and body mass index, Thirteen patients presented clinically detectable microangiopathy (8 retinopathy and 5 both retinopathy and microalbuminuria), A cross-sectional study of lipid profile, coagulati on parameters, and a flowcytometric evaluation of tissue factor expres sion in normal monocytes induced by patient plasma were performed, Pat ients were re-evaluated for microangiopathy in a 3-year median follow- up, Patients showed triglyceride enrichment in low (P=0.00002) and hig h density lipoproteins (P=0.004) and increased levels of D-dimer (P<0. 00001), prothrombin fragment 1 + 2 (P < 0.00001), and thrombin-antithr ombin III complex (P = 0.0001), Patients with clinically detectable mi croangiopathy had increased type 1 plasminogen activator inhibitor (P= 0.00001), thrombomodulin (P=0.02), and induced monocyte tissue factor expression (P < 0.00001), Nine patients developed clinically detectabl e microangiopathy in the follow-up and the only predictive variable wa s increased induced tissue factor expression, In conclusion, in these patients elevated thrombin and fibrin generation reflects a hypercoagu lable state but clinically detectable microangiopathy seems related to endothelial cell injury markers and to increased induced tissue facto r expression on monocytes. (C) 1997 Wiley-Liss, Inc.