Vaccaro Francesco, Mulè Giuseppe, Cottone Santina, Soresi Maurizio, Giannitrapani Lydia, Vadalà Anna, Sparacino Vito, Calabrese Sergio, Picone Francesco P, Montalto Giuseppe, Cerasola Giovanni
Department of Internal Medicine, Cardiovascular and Renal Disease, Chair of Internal Medicine, University of Palermo, Palermo, Italy.
Arch Med Res. 2007 Jul;38(5):534-8. doi: 10.1016/j.arcmed.2007.01.013. Epub 2007 Apr 16.
Patients with chronic renal failure (CRF) suffer from a series of complications linked to the atherosclerotic process in which the endothelial dysfunction mediated by the activation of some adhesion molecules plays an important role. This study aims to evaluate circulating levels of intercellular adhesion molecules-1 (ICAM-1) and vascular cell adhesion molecules-1 (VCAM-1) in patients with predialysis CRF, on maintenance hemodialysis (HD) and after kidney transplantation (KTx) and to correlate them with some inflammation and nutritional indexes.
Thirty two patients with predialysis CRF, 30 on maintenance HD, 36 after KTx and 28 subjects as a control group (C) were included in this study. Circulating levels of ICAM-1 and VCAM-1 were assayed using a specific sandwich ELISA kit. As inflammation indexes, TNFalpha and C-reactive protein (CRP) and, as nutritional indexes, body mass index (BMI), serum albumin, cholesterol, triglycerides, and fibrinogen (F) were evaluated.
Serum levels of ICAM-1 and VCAM-1 were progressively higher from C to KTx patients, to those with CRF and those on HD (ANOVA for both; p <0.001). TNFalpha values were lower in HD subjects than in CRF patients, even if in both groups TNFalpha levels were greater than in Tx and control subjects. F and CRP were higher in CRF and HD vs. Tx and control subjects (ANOVA for both p <0.001). No significant correlations were observed between soluble adhesion molecules, albumin and cholesterol, whereas significant correlations were found between CRP and ICAM-1 (r = 0.41; p <0.01), CRP and VCAM-1 (r = 0.39; p <0.01) and between CRP and TNFalpha (r = 0.42; p <0.01). These correlations remained statistically significant even after adjustment for age and blood pressure (all p <0.01). BMI did not differ in the three patient groups.
Circulating levels of adhesion molecules in our study correlated positively with the stage of disease and with one of the inflammatory indexes (CRP), but not with nutritional indexes such as BMI, cholesterol and albumin. The clinical significance of our findings warrants further investigation.
慢性肾衰竭（CRF）患者会出现一系列与动脉粥样硬化进程相关的并发症，其中一些黏附分子激活介导的内皮功能障碍起着重要作用。本研究旨在评估透析前CRF患者、维持性血液透析（HD）患者及肾移植（KTx）后患者血浆中细胞间黏附分子-1（ICAM-1）和血管细胞黏附分子-1（VCAM-1）的水平，并将其与一些炎症和营养指标进行关联分析。
本研究纳入了32例透析前CRF患者、30例维持性HD患者、36例KTx后患者以及28例作为对照组（C）的受试者。使用特异性夹心ELISA试剂盒检测ICAM-1和VCAM-1的血浆水平。作为炎症指标，评估肿瘤坏死因子α（TNFα）和C反应蛋白（CRP）；作为营养指标，评估体重指数（BMI）、血清白蛋白、胆固醇、甘油三酯和纤维蛋白原（F）。
从对照组到KTx患者，再到CRF患者和HD患者，ICAM-1和VCAM-1的血清水平逐渐升高（两者均采用方差分析；p<0.001）。HD患者的TNFα值低于CRF患者，尽管两组的TNFα水平均高于肾移植患者和对照组。CRF和HD患者的F和CRP高于肾移植患者和对照组（两者均采用方差分析，p<0.001）。可溶性黏附分子与白蛋白和胆固醇之间未观察到显著相关性，而CRP与ICAM-1（r=0.41；p<0.01）、CRP与VCAM-1（r=0.39；p<0.01）以及CRP与TNFα（r=0.42；p<0.01）之间存在显著相关性。即使在调整年龄和血压后，这些相关性仍具有统计学意义（所有p<0.01）。三组患者的BMI无差异。
在我们的研究中，黏附分子的循环水平与疾病阶段及一种炎症指标（CRP）呈正相关，但与BMI、胆固醇和白蛋白等营养指标无关。我们研究结果的临床意义值得进一步研究。
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