Suliman Mohamed E, Qureshi A Rashid, Heimbürger Olof, Lindholm Bengt, Stenvinkel Peter
Department of Renal Medicine and Baxter Novum, K56, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden.
Nephrol Dial Transplant. 2006 Jun;21(6):1603-10. doi: 10.1093/ndt/gfl005. Epub 2006 Feb 13.
Inflammation is thought to contribute to initiation and aggravation of atherosclerosis through a process predominantly mediated by adhesion molecules. The aims of this study were to investigate the association between the concentrations of circulating soluble intercellular (sICAM-1) and vascular cellular (sVCAM-1) adhesion molecules and clinical outcome, and to evaluate the effect of antihypertensive drugs on sICAM-1 and sVCAM-1 concentrations in end-stage renal disease (ESRD) patients.
We prospectively investigated 310 (191 males) incident ESRD patients, 53+/-12 years old, shortly before the start of renal replacement therapy. Glomerular filtration rate (GFR) was 6.4 (range 0.8-16.5) ml/min/1.73 m(2). Plasma sICAM-1 and sVCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA) kits. Survival was determined from the day of examination, with a mean follow-up period of 39 (range 1-123) months.
In non-adjusted analysis, high sICAM-1 and sVCAM-1 levels were associated with all-cause and cardiovascular (P<0.001) mortality. After adjusting for age, gender, diabetes mellitus, serum cholesterol, C-reactive protein (CRP), subjective global assessment and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB), the association between high sICAM-1 and mortality remained significant for all-cause (HR 1.9; CI 1.2-2.9, P = 0.004) and cardiovascular (HR 1.8; CI 1.1-3.1, P = 0.02) mortality, and a high sVCAM-1 was associated with all-cause mortality (HR 1.7; CI 1.04-2.7, P = 0.03). Furthermore, the concentration of sICAM-1, but not sVCAM-1, was lower in patients receiving ACEI/ARB (254+/-83 vs 275+/-92 ng/ml; P<0.05) or patients receiving calcium channel blockers (CCB, 251+/-75 vs 273+/-95 ng/ml; P<0.05) than in non-users.
In ESRD patients, sICAM-1 and sVCAM-1 are independent predictors of all cause and cardiovascular death. The use of ACEI/ARB or CCB was associated with decreased concentrations of soluble adhesion molecules.
炎症被认为通过主要由黏附分子介导的过程促成动脉粥样硬化的起始和加重。本研究的目的是调查循环可溶性细胞间黏附分子（sICAM-1）和血管细胞黏附分子（sVCAM-1）浓度与临床结局之间的关联，并评估降压药物对终末期肾病（ESRD）患者sICAM-1和sVCAM-1浓度的影响。
我们前瞻性地调查了310例（191例男性）新发ESRD患者，年龄53±12岁，在开始肾脏替代治疗前不久。肾小球滤过率（GFR）为6.4（范围0.8 - 16.5）ml/min/1.73 m²。采用酶联免疫吸附测定（ELISA）试剂盒测量血浆sICAM-1和sVCAM-1。从检查之日起确定生存率，平均随访期为39（范围1 - 123）个月。
在未调整分析中，高sICAM-1和sVCAM-1水平与全因死亡率和心血管死亡率相关（P<0.001）。在调整年龄、性别、糖尿病、血清胆固醇、C反应蛋白（CRP）、主观全面评估以及血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）后，高sICAM-1与全因死亡率（HR 1.9；CI 1.2 - 2.9，P = 0.004）和心血管死亡率（HR 1.8；CI 1.1 - 3.1，P = 0.02）之间的关联仍然显著，高sVCAM-1与全因死亡率相关（HR 1.7；CI 1.04 - 2.7，P = 0.03）。此外，接受ACEI/ARB的患者（254±83 vs 275±92 ng/ml；P<0.05）或接受钙通道阻滞剂（CCB，251±75 vs 273±95 ng/ml；P<0.05）的患者中sICAM-1的浓度低于未使用者。
在ESRD患者中，sICAM-1和sVCAM-1是全因死亡和心血管死亡的独立预测因素。使用ACEI/ARB或CCB与可溶性黏附分子浓度降低有关。
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