Clausen P, Jacobsen P, Rossing K, Jensen J S, Parving H H, Feldt-Rasmussen B
Department of Nephrology and Endocrinology, State University Hospital, Copenhagen, Denmark.
Diabet Med. 2000 Sep;17(9):644-9. doi: 10.1046/j.1464-5491.2000.00347.x.
Elevated urinary albumin excretion is associated with macrovascular atherosclerotic complications in Type 1 diabetes mellitus. Adhesion molecules mediate leucocyte adhesion to the endothelium early in the atherosclerotic process. The present study tests the hypothesis that microalbuminuria and diabetic nephropathy are associated with elevated plasma concentrations of soluble vascular adhesion molecule (sVCAM)-1, soluble intercellular adhesion molecule (sICAM)-1, and soluble E-selectin (sE-selectin) aiming to illustrate factors of potential pathogenetic relevance for the excess cardiovascular disease in diabetic patients with renal complications.
Soluble adhesion molecule concentrations were measured by enzyme-linked immunosorbent assays (ELISA) in healthy controls (n = 16) and in 59 Type 1 diabetic patients: group 1-patients with normoalbuminuria (n = 16); group 2-patients with microalbuminuria (n = 15); group 3-patients with macroalbuminuria and normal serum creatinine (n = 15), group 4-patients with macroalbuminuria and moderately elevated serum creatinine (n = 13).
Plasma concentrations of sVCAM-1 and sICAM-1 were similar in healthy controls and normoalbuminuric Type 1 diabetic patients, but the concentrations were increased by the presence of microalbuminuria and overt nephropathy (P < 0.001 and P < 0.0001, ANOVA). Concentrations of sE-selectin did not differ between diabetic patients and controls.
Plasma concentration of sICAM-1 is elevated in Type 1 diabetic patients with microalbuminuria and the concentrations of sICAM-1 as well as sVCAM-1 are elevated in patients with macroalbuminuria and normal s-creatinine. The elevated plasma concentrations of these soluble adhesion molecule concentrations in patients with renal complication can be of pathogenetic importance for the development of atherosclerosis and plasma soluble adhesion molecule concentrations may provide additional information on cardiovascular risk.
1型糖尿病患者尿白蛋白排泄增加与大血管动脉粥样硬化并发症相关。黏附分子在动脉粥样硬化过程早期介导白细胞黏附于内皮细胞。本研究检验了以下假设：微量白蛋白尿和糖尿病肾病与可溶性血管细胞黏附分子（sVCAM）-1、可溶性细胞间黏附分子（sICAM）-1和可溶性E-选择素（sE-选择素）的血浆浓度升高有关，旨在阐明糖尿病肾病患者心血管疾病过多的潜在发病相关因素。
采用酶联免疫吸附测定（ELISA）法检测16例健康对照者及59例1型糖尿病患者的可溶性黏附分子浓度。1组为正常白蛋白尿患者（n = 16）；2组为微量白蛋白尿患者（n = 15）；3组为大量白蛋白尿且血清肌酐正常的患者（n = 15）；4组为大量白蛋白尿且血清肌酐中度升高的患者（n = 13）。
健康对照者和正常白蛋白尿的1型糖尿病患者的sVCAM-1和sICAM-1血浆浓度相似，但微量白蛋白尿和显性肾病患者的浓度升高（方差分析，P < 0.001和P < 0.0001）。糖尿病患者和对照组的sE-选择素浓度无差异。
微量白蛋白尿的1型糖尿病患者sICAM-1血浆浓度升高，大量白蛋白尿且血清肌酐正常的患者sICAM-1和sVCAM-1浓度升高。肾并发症患者这些可溶性黏附分子浓度的升高对动脉粥样硬化的发生可能具有发病学意义，血浆可溶性黏附分子浓度可能为心血管风险提供额外信息。
