CLINICAL-SIGNIFICANCE OF MEASUREMENTS OF URINARY AND SERUM THROMBOMODULINS IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

The aim of our study was to elucidate whether serum thrombomodulin (S- TM) and urinary thrombomodulin (U-TM) levels would reflect the pathoge nesis of diabetic complications. Studies were conducted in 188 patient s with non-insulin-dependent diabetes mellitus (NIDDM) and 132 age-mat ched healthy subjects. TM was measured by a newly developed enzyme imm unoassay. Both S-TM and U-TM levels in NIDDM were much higher than tho se in healthy controls. S-TM values in NIDDM correlated significantly with arte (P < 0.05), HbA(1c) (P < 0.05), serum 1.5 anhydroglucetol (A G) (P < 0.05) and urinary albumin concentration (UAC) (P < 0.01), resp ectively. On the other hand, fasting plasma glucose (FPG) (P < 0.001), HbA(1c) (P < 0.01), serum fructosamine (P < 0.05) and serum 1.5 AG (P < 0.05) were closely correlated with U-TM values in NIDDM. Patients w ith clinical nephropathy showed obviously higher S-TM levels (P < 0.05 ) than patients with latent nephropathy. Furthermore, S-TM values in p atients with diabetic proliferative retinopathy increased significantl y compared with those in patients without diabetic retinopathy (P < 0. 05). When all diabetic patients with normoalbuminuria were studied, no significant changes of S-TM were observed between the no diabetic ret inopathy group and the proliferative diabetic retinopathy group. Concl usions: The present data suggest that an increase in U-TM reflects the grade of glucose metabolism, whereas an increase in S-TM appears to r eveal the advance of diabetic microangiopathy, including nephropathy.