Modelska-Ziółkiewicz Anna, Gembicki Maciej, Bednarek Janusz, Sowiński Jerzy
Katedra i Klinika Endokrynologii, Przemiany Materii i Chorób Wewnetrznych AM im. K. Marcinkowskiego w Poznaniu.
Pol Arch Med Wewn. 2003 May;109(5):469-75.
Inflammatory process is connected with the increased expression on cells of adhesion molecules, also including intercellular adhesion molecule-1 (ICAM-1) and endothelial leukocyte adhesion molecule-1 (ELAM-1). In active ophthalmopathy (GO) this process, of various severity, is progressing in orbital tissue. This is reflected by the increase in blood of these molecules soluble forms. The aim of the project was to study sELAM-1 and sICAM-1 concentrations in sera of patients with GO in the course of Graves' disease (GD) gratified to glucocorticoid therapy, as well as the analysis of this treatment influence on both adhesion molecules with taking into consideration their prognostic role in an applied treatment. The analysis included 25 subjects with eye changes in the class at least 2c (ATA). The duration of GO did not exceed 2 years. Patients received 3 i.v. "pulses" of methyloprednisolone (1 g/d, every second day), followed by oral administration of prednisone during 3 months (60 mg/d, with gradual dose reduction). The blood was taken before treatment, next day after the last methyloprednisolone infusion, after 2 week of prednisone therapy and after completing of glucocorticoid treatment. As a result of the applied therapy 15 subjects obtained clinical improvement (group 1A), on the contrary 10 persons did not gain positive effects after finishing prednisone (group 1B). Before starting the treatment sICAM-1 and sELAM-1 levels in group 1A were lower than those in group 1B. After methyloprednisolone therapy sICAM-1 and sELAM-1 concentrations declined in both groups. This was related in the most of patients to clinical improvement, which occurred at that time. After 2 weeks of prednisone application concentrations of both adhesion molecules were still decreased. After completing of glucocorticoid therapy in patients with clinical improvement (group 1A) sICAM-1 concentration remained suppressed, in the range of concentrations present in sera of healthy subjects (group 2). In patients without clinical response (group 1A), with gradual recurrence of inflammatory symptoms together with reduction of prednisone dose sICAM-1 concentration increased again to values comparable to initial levels. sELAM-1 concentration in group 1A still did not markedly change after completing of glucocorticoid therapy, on the contrary--in group 1B the level of this adhesion molecule slightly increased. These values, in contradistinction to sICAM-1, did not drop during therapy to concentrations characteristic for normal range. According to the results it may be concluded, that clinical improvement after glucocorticoid therapy is connected with lower adhesion molecules concentrations before treatment. Glucocorticosteroids are causing decrease of sICAM-1 and sELAM-1 concentrations in patients with GO in the grade dependent on the dose of medication, on the contrary changes in sELAM-1 concentration are less significant. Maintenance of decreased sICAM-1 concentration during glucorticoid therapy is a positive prognostic factor.
炎症过程与细胞表面黏附分子表达增加有关，这些黏附分子还包括细胞间黏附分子 -1（ICAM -1）和内皮白细胞黏附分子 -1（ELAM -1）。在活动性眼病（GO）中，这一程度各异的过程在眼眶组织中进展。这表现为这些分子可溶性形式在血液中的增加。该项目的目的是研究格雷夫斯病（GD）并发GO且接受糖皮质激素治疗的患者血清中可溶性ELAM -1（sELAM -1）和可溶性ICAM -1（sICAM -1）的浓度，以及分析这种治疗对这两种黏附分子的影响，并考虑它们在应用治疗中的预后作用。分析纳入了25名眼部病变至少为2c级（ATA）的受试者。GO病程不超过2年。患者接受了3次静脉注射甲泼尼龙“冲击”治疗（1 g/d，隔日一次），随后在3个月内口服泼尼松（60 mg/d，剂量逐渐减少）。在治疗前、最后一次甲泼尼龙输注后的次日、泼尼松治疗2周后以及糖皮质激素治疗结束后采集血液。应用该治疗后，15名受试者获得临床改善（1A组），相反，10人在完成泼尼松治疗后未获得积极效果（1B组）。治疗开始前，1A组的sICAM -1和sELAM -1水平低于1B组。甲泼尼龙治疗后，两组的sICAM -1和sELAM -1浓度均下降。这在大多数患者中与当时出现的临床改善相关。应用泼尼松2周后，两种黏附分子的浓度仍降低。临床改善的患者（1A组）完成糖皮质激素治疗后，sICAM -1浓度仍受到抑制，处于健康受试者血清中存在的浓度范围内（2组）。在无临床反应的患者（1B组）中，随着炎症症状逐渐复发以及泼尼松剂量减少，sICAM -1浓度再次升高至与初始水平相当的值。1A组完成糖皮质激素治疗后，sELAM -1浓度仍无明显变化，相反，1B组中这种黏附分子的水平略有升高。与sICAM -1不同，这些值在治疗期间未降至正常范围的特征浓度。根据结果可以得出结论，糖皮质激素治疗后的临床改善与治疗前较低的黏附分子浓度有关。糖皮质激素可使GO患者的sICAM -1和sELAM -1浓度降低，降低程度取决于药物剂量，相反，sELAM -1浓度的变化较小。糖皮质激素治疗期间维持sICAM -1浓度降低是一个积极的预后因素。
