Papagianni Aikaterini, Kalovoulos Michalis, Kirmizis Dimitrios, Vainas Andreas, Belechri Anna-Maria, Alexopoulos Efstathios, Memmos Dimitrios
University Department of Nephrology, Hippokration General Hospital, Thessaloniki, Greece.
Nephrol Dial Transplant. 2003 Jan;18(1):113-9. doi: 10.1093/ndt/18.1.113.
Recently emerging evidence suggests that endothelial adhesion molecules may participate in atherogenesis. The aim of the present report was to investigate the probable association of circulating ICAM-1, VCAM-1 and E-selectin with atherosclerotic disease in chronic haemodialysis (HD) patients.
One hundred and twelve HD patients and 50 age- and sex-matched healthy normotensive controls participated in the study. Atherosclerotic disease in both groups was assessed by measuring intima-media thickness (IMT) and plaque score of the common carotid arteries using an ultrasound scanner. In addition, in a follow-up study, the survival of 81 patients after a mean period of 26 months was analysed in relation to ICAM-1 and VCAM-1 levels.
IMT and plaque score were significantly higher in HD patients compared with control subjects (P < 0.001 and P < 0.0001, respectively). The above ultrasonographic indices were correlated with age both in controls (P = 0.0001 and P = 0.002, respectively) and HD patients (P = 0.0001 and P = 0.0001, respectively). A significant relationship was observed between IMT and systolic blood pressure (BP) both in controls and in HD patients (P = 0.002 and P = 0.01, respectively). In HD patients, plaque score was also correlated with systolic BP (P = 0.02). In HD patients, IMT and plaque score were correlated significantly with log CRP values (P = 0.01 and P = 0.01, respectively). Multivariate analysis showed that log CRP values were a strong independent contributor to plaque score (P = 0.01). IMT was significantly correlated with ICAM-1 and VCAM-1 concentrations (P = 0.0001 and P = 0.003, respectively). Multivariate analysis showed that ICAM-1 concentrations were a strong independent correlate of IMT (P = 0.001). E-selectin concentrations did not show any relation with IMT or plaque score. During the follow-up period, 13 of the 81 patients died. Survival analyses showed that patients with increased ICAM-1 had a shorter survival than patients with normal ICAM-1 values and that serum ICAM-1 levels were a strong predictor of death.
In HD patients, carotid atherosclerosis is associated with inflammation and circulating levels of soluble adhesion molecules ICAM-1 and VCAM-1. The correlations between serum ICAM-1 and IMT and ICAM-1 and survival may indicate that this molecule could be a marker of a process that contributes to the high mortality of HD patients.
最近出现的证据表明，内皮黏附分子可能参与动脉粥样硬化的形成。本报告的目的是研究慢性血液透析（HD）患者循环中ICAM-1、VCAM-1和E-选择素与动脉粥样硬化疾病之间可能存在的关联。
112例HD患者和50例年龄及性别匹配的健康血压正常对照者参与了本研究。通过使用超声扫描仪测量颈总动脉的内膜中层厚度（IMT）和斑块评分，评估两组的动脉粥样硬化疾病情况。此外，在一项随访研究中，分析了81例患者平均26个月后的生存率与ICAM-1和VCAM-1水平的关系。
与对照者相比，HD患者的IMT和斑块评分显著更高（分别为P < 0.001和P < 0.0001）。上述超声指标在对照组（分别为P = 0.0001和P = 0.002）和HD患者（分别为P = 0.0001和P = 0.0001）中均与年龄相关。在对照组和HD患者中，均观察到IMT与收缩压（BP）之间存在显著关系（分别为P = 0.002和P = 0.01）。在HD患者中，斑块评分也与收缩压相关（P = 0.02）。在HD患者中，IMT和斑块评分与log CRP值显著相关（分别为P = 0.01和P = 0.01）。多变量分析显示，log CRP值是斑块评分的一个强有力的独立影响因素（P = 0.01）。IMT与ICAM-1和VCAM-1浓度显著相关（分别为P = 0.0001和P = 0.003）。多变量分析显示，ICAM-1浓度是IMT的一个强有力的独立相关因素（P = 0.001）。E-选择素浓度与IMT或斑块评分无任何关系。在随访期间，81例患者中有13例死亡。生存分析显示，ICAM-1升高的患者比ICAM-1值正常的患者生存期更短，且血清ICAM-1水平是死亡的一个强有力的预测指标。
在HD患者中，颈动脉粥样硬化与炎症以及可溶性黏附分子ICAM-1和VCAM-1的循环水平相关。血清ICAM-1与IMT以及ICAM-1与生存率之间的相关性可能表明，该分子可能是导致HD患者高死亡率的一个过程的标志物。
