Girón-González J A, Martínez-Sierra C, Rodriguez-Ramos C, Rendón P, Macías M A, Fernández-Gutiérrez C, Díaz F, Martín-Herrera L
Internal Medicine, Hospital Universitario Puerta del Mar, ES-11009 Cádiz, Spain.
Scand J Gastroenterol. 2005 Feb;40(2):217-24. doi: 10.1080/00365520510011470.
Endothelial activation plays an active role in modifications of the circulatory status of cirrhotic patients. Soluble endothelial adhesion molecules, induced by pro-inflammatory cytokines, could be considered markers of endothelial activation. Their role in the natural history of cirrhosis and portal hypertension has not been reported. Our objective was to analyze the prognostic value of soluble adhesion molecules in cirrhotic patients.
Serum concentrations of soluble CD14, soluble receptors of tumor necrosis factor alpha and adhesion molecules ICAM-1 (intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule 1) as well as mean blood pressure, plasma renin activity, aldosterone, vasopressin and norepinephrine concentrations were determined in 64 cirrhotic patients (Child-Pugh class: A 48.4%, B 34.4%, C 17.2%), without any evidence of infection, and in 25 healthy controls. Patients were followed-up for a mean of 36.4 (range 6-60) months.
Increased concentrations of soluble CD14, tumor necrosis factor receptors and ICAM-1 and VCAM-1 were detected in cirrhotic patients when compared with healthy controls. Tumor necrosis factor receptors and adhesion molecule concentrations were both significantly higher in advanced phases of cirrhosis (Child Pugh class C and B versus A). Fifteen patients died as a related consequence of liver cirrhosis. Multivariate analysis demonstrated that Child-Pugh score and serum levels of tumor necrosis factor receptor I and ICAM-1 were associated with mortality.
In addition to the classic factor implicated in mortality (Child-Pugh class), alterations in inflammation-related components and soluble adhesion molecules, as representatives of hemodynamic alterations, are of prognostic significance in cirrhotic patients.
内皮细胞激活在肝硬化患者循环状态改变中起积极作用。由促炎细胞因子诱导产生的可溶性内皮黏附分子可被视为内皮细胞激活的标志物。其在肝硬化和门静脉高压自然病程中的作用尚未见报道。我们的目的是分析可溶性黏附分子在肝硬化患者中的预后价值。
测定了64例无感染证据的肝硬化患者（Child-Pugh分级：A级48.4%，B级34.4%，C级17.2%）以及25例健康对照者血清中可溶性CD14、肿瘤坏死因子α可溶性受体、黏附分子ICAM-1（细胞间黏附分子-1）和VCAM-1（血管细胞黏附分子1）的浓度，同时测定了平均血压、血浆肾素活性、醛固酮、血管加压素和去甲肾上腺素浓度。患者平均随访36.4（6 - 60）个月。
与健康对照者相比，肝硬化患者血清中可溶性CD14、肿瘤坏死因子受体、ICAM-1和VCAM-1浓度升高。肝硬化晚期（Child-Pugh C级和B级与A级相比）肿瘤坏死因子受体和黏附分子浓度均显著升高。15例患者死于肝硬化相关并发症。多因素分析表明，Child-Pugh评分以及肿瘤坏死因子受体I和ICAM-1的血清水平与死亡率相关。
除了与死亡率相关的经典因素（Child-Pugh分级）外，作为血流动力学改变代表的炎症相关成分和可溶性黏附分子的改变在肝硬化患者中具有预后意义。
