Sabry Alaa A, Elbasyouni Sherief Refat, Kalil Abdalla M, Abdel-Rahim Mona, Mohsen Tareek, Sleem Aml
Department of Nephrology and Internal Medicine, Mansoura University, Egypt.
Nephrology (Carlton). 2006 Aug;11(4):329-35. doi: 10.1111/j.1440-1797.2006.00573.x.
Cardiovascular events are markedly increased in systemic lupus erythematosus (SLE) and the mechanism of atherogenesis remains poorly understood. Low-grade inflammation and endothelial dysfunction play pivotal roles in the initiation, progression and propagation of the atherosclerotic process. Several methods have been employed to assess endothelial function, among them the measurement of biomarkers of endothelial activation and dysfunction (intercellular adhesion molecule (ICAM)-1). Since then, it has been reported that such biomarkers play a more important role than traditional risk factors in cardiovascular disease.
To measure (tumour necrosis factor (TNF)-alpha, interleukin (IL)-6 and ICAM-1) levels as markers of inflammation and atherosclerosis in 40 Egyptian patients with SLE with various degrees of activity in comparison with 20 healthy volunteers, and to investigate their relationship to disease activity and hypertension.
Sixty subject (40 with SLE and 20 healthy controls) were the subject of this study, their clinical disease activity was scored according to the SLE Disease Activity Index (SLEDAI), and serum sampling was obtained for TNF-alpha, IL-6 and ICAM-1 level assay. Renal biopsy was carried out and examined by light microscopy. The mean level of TNF-alpha, IL-6 and ICAM-1 were significantly higher in SLE patients with active disease (766.95 +/- 357.82 Pg/mL, 135.4 +/- 54.23 Pg/mL, 826.05 +/- 367.1 Pg/mL) when compared with those with inactive disease (314.01 +/- 100.87 Pg/mL, 47.33 +/- 18.61 pg/mL, 441.33 +/- 225.19 Pg/mL) and healthy control volunteers (172.7 +/- 39.19 Pg/mL, 21.15 +/- 10.99 Pg/mL, 111.5 +/- 17.36 Pg/mL), respectively. Furthermore, these levels were significantly higher in hypertensive (614.08 +/- 333.05 Pg/mL, 107.86 +/- 54.96 Pg/mL and 862.13 +/- 333.29 Pg/mL) compared to normotensive patients (267.5 +/- 112.72 Pg/mL, P = 0.008, 35.75 +/- 20.26 Pg/mL, P = 0.02I, and 337.25 +/- 235.62 Pg/mL, P = 0.02) for TNF-alpha, IL-6 and ICAM, respectively. There were no statistically significant difference regarding age, sex, smoking, cholesterol and high-density lipoprotein (HDL) levels between hypertensive and normotensive patients.
A high concentration of soluble ICAM-1 in Egyptian patients with SLE and nephritis is reported here for the first time. Our finding of increased concentrations of TNF-alpha, IL-6 and ICAM-1 in Egyptian patients with SLE and lupus nephritis underlines the importance of inflammation and endothelial involvement in this disorder, but their predictive value in the disease monitoring needs to be further studied.
系统性红斑狼疮（SLE）患者心血管事件显著增加，动脉粥样硬化的发病机制仍知之甚少。低度炎症和内皮功能障碍在动脉粥样硬化过程的起始、进展和传播中起关键作用。已采用多种方法评估内皮功能，其中包括测量内皮激活和功能障碍的生物标志物（细胞间黏附分子（ICAM）-1）。此后，有报道称这些生物标志物在心血管疾病中比传统危险因素发挥更重要的作用。
测量40例不同活动程度的埃及SLE患者的（肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6和ICAM-1）水平，作为炎症和动脉粥样硬化的标志物，并与20名健康志愿者进行比较，同时研究它们与疾病活动度和高血压的关系。
本研究纳入60名受试者（40例SLE患者和20名健康对照），根据SLE疾病活动指数（SLEDAI）对其临床疾病活动度进行评分，并采集血清样本检测TNF-α、IL-6和ICAM-1水平。进行肾活检并通过光学显微镜检查。与非活动期疾病患者（314.01±100.87Pg/mL、47.33±18.61pg/mL、441.33±225.19Pg/mL）和健康对照志愿者（172.7±39.19Pg/mL、21.15±10.99Pg/mL、111.5±17.36Pg/mL）相比，活动期疾病的SLE患者中TNF-α、IL-6和ICAM-1的平均水平显著更高（分别为766.95±357.82Pg/mL、135.4±54.23Pg/mL、826.05±367.1Pg/mL）。此外，与血压正常的患者（TNF-α为267.5±112.72Pg/mL，P = 0.008；IL-6为35.75±20.26Pg/mL，P = 0.021；ICAM为337.25±235.62Pg/mL，P = 0.02）相比，高血压患者（TNF-α为614.08±333.05Pg/mL、IL-6为107.86±54.96Pg/mL和ICAM为862.13±333.29Pg/mL）中这些水平显著更高。高血压患者和血压正常患者在年龄、性别、吸烟、胆固醇和高密度脂蛋白（HDL）水平方面无统计学显著差异。
首次报道了埃及SLE和肾炎患者中可溶性ICAM-1浓度较高。我们发现埃及SLE和狼疮性肾炎患者中TNF-α、IL-6和ICAM-1浓度升高，突出了炎症和内皮参与该疾病的重要性，但其在疾病监测中的预测价值有待进一步研究。
