Clinical significance of measurements of serum and urinary thrombomodulin and serum e-selectin in diabetic patients with and without complications

ABSTRACT

Serum and urinary levels of soluble thrombomodulin [TM] and the serum levels of the soluble leucocyte adhesion molecule E-selectin, were measured in 80 diabelic patients. Fourty patients with insulm-dependent diabetes mellitus [IDDM] were divided into 20 non-complicated patients [group I] and 20 complicated patients [group II]. Ten age-matched healthy subjects were used as a control [group III] for the IDDM patients. Another 40 patients with non-insulin-dependent diabetes mellitus [NIDDM] comprised 20 non-complicated patients [group IV] and 20 complicated patients [group V]. Ten more age-matched healthy subjects were selected as a control [group VI] for the NIDDM patients. Serum and urinary concentrations of TM were significantly higher in diabetic patients compared with controls. Moreover, serum and urinary TM levels were significantly increased in complicated IDDM and NIDDM patients compared with the non-complicaied patients and the control subjects. Similarly, serum concentrations of E-selectin were found to be significantly higher in complicated diabetic patients versus the non-complicated patients and the control groups. In all diabetic patients of the four studied groups and in each separale group, serum and urinary levels of TM and serum E-selectin concentrations correlated positively with the duration of diabetes, fasting and postprandial blood glucose, HbA[IC] and urinary albumin excretion. A significant positive correlation was also found between urinary and serum levels of TM in the four studied groups of patients. Furthermore, serum and urinary levels of TM together with serum E-selectin concentrations correlated positively with the frequency of complications in complicated IDDM and NIDDM patients. The results suggest that serum and urinary TM levels could be a sensitive and predictive marker for the generalized vascular endothelial mjury induced by hyperglycemia and/or premicroangiopathy in diabetic patients. The present data point to a functional role for the soluble leucocyte adhesion molecule E-selectin in the development and progressions! complications in diabetic patients. The results also indicate that the concentrations of TM and E-selectin may be retated to metabolic control