THROMBOMODULIN LEVELS IN INSULIN-DEPENDENT DIABETIC-PATIENTS WITH MICROALBUMINURIA

Thrombomodulin (TM) plays an important role in the regulation of blood coagulation at the endothelial surface. TM is also present in plasma, where an increase of its level seems to reflect endothelial damage. S ince microalbuminuria is associated with an increased atherothrombotic risk and is considered an expression of widespread vascular damage, w e evaluated plasma thrombomodulin levels, blood pressure, and plasma l ipid values in Type 1 diabetic patients with micro- and normoalbuminur ia. Thrombomodulin was measured in 12 microalbuminuric (albumin excret ion rate 20-200 mu g min(-1) in 2 of 3 overnight urine collections) an d in 12 normoalbuminuric (albumin excretion rate < 20 mu g min(-1)) Ty pe 1 diabetic patients matched for age, sex, body mass index, smoking habits, diabetes duration, and glycated haemoglobin. Mean thrombomodul in was significantly higher in micro- than in normalbuminuric group (5 9.34 +/- 3.58 vs 43.56 +/- 3.52 ng ml(-1) p < 0.01). Systolic and dias tolic blood pressure were significantly higher in micro- than in normo albuminuric group (p < 0.05). There was a positive correlation between plasma thrombomodulin and albumin excretion rate (p = 0.013, r = 0.49 ), and between thrombomodulin and diastolic blood pressure (p = 0.023, r = 0.46) in diabetic patients as a whole but not in the individual g roups. These findings suggest the presence of an endothelial injury in microalbuminuric patients.