Malatino L S, Stancanelli B, Cataliotti A, Bellanuova I, Fatuzzo P, Rapisarda F, Leonardis D, Tripepi G, Mallamaci F, Zoccali C
Division of Internal Medicine, Department of Medicine and Systemic Disease, Hypertension Centre, University of Catania, Ragusa, Italy.
J Intern Med. 2007 Oct;262(4):479-87. doi: 10.1111/j.1365-2796.2007.01841.x.
E-selectin is a key adhesion molecule which plays a fundamental role in endothelial progenitor cell-dependent reparative mechanisms in experimental ischaemia and it serves to anchor leucocytes to the endothelium in inflammatory processes. Inflammation is one of the strongest risk factors for death and cardiovascular (CV) events in end-stage renal disease (ESRD).
The objective of the current study was to evaluate whether E-selectin is a useful biomarker of clinical outcome in ESRD patients. We tested the prediction power of circulating E-selectin for mortality and CV events in a cohort of 265 ESRD patients.
During the follow-up, 59 patients died and 58 had CV events. All-cause mortality was inversely related to serum E-selectin, the risk of death being the lowest in patients in the third E-selectin tertile (HR: 1, reference group), intermediate in those in the second tertile (HR: 1.30) and the highest in patients in the first tertile (HR: 2.02, P = 0.01). Similarly, the risk of fatal and nonfatal CV events followed an inverse pattern being lowest in the third tertile (reference group) and highest in the first tertile (HR: 1.73, P = 0.03). The prediction power of E-selectin for death and CV events was confirmed in a Cox regression analysis where E-selectin emerged as an inverse predictor of these outcomes, particularly so in patients with severe inflammation.
These data are in keeping with the hypothesis that in systemic inflammation altered E-selectin shedding may play a role in arterial damage and implicates this adhesion molecule in atherosclerotic complications in a high-risk condition like ESRD.
E-选择素是一种关键的黏附分子，在实验性缺血中内皮祖细胞依赖性修复机制中起重要作用，并且在炎症过程中可将白细胞锚定在内皮上。炎症是终末期肾病（ESRD）患者死亡和心血管（CV）事件的最强危险因素之一。
本研究的目的是评估E-选择素是否是ESRD患者临床结局的有用生物标志物。我们在一组265例ESRD患者中测试了循环E-选择素对死亡率和CV事件的预测能力。
随访期间，59例患者死亡，58例发生CV事件。全因死亡率与血清E-选择素呈负相关，在E-选择素三分位数第三组的患者中死亡风险最低（HR：1，参照组），第二组患者中风险中等（HR：1.30），第一组患者中风险最高（HR：2.02，P = 0.01）。同样，致命和非致命CV事件的风险也呈相反模式，在三分位数第三组中最低（参照组），在第一组中最高（HR：1.73，P = 0.03）。E-选择素对死亡和CV事件的预测能力在Cox回归分析中得到证实，其中E-选择素是这些结局的反向预测因子，在严重炎症患者中尤其如此。
这些数据与以下假设一致，即在全身炎症中，E-选择素释放改变可能在动脉损伤中起作用，并使这种黏附分子与ESRD这种高危情况下的动脉粥样硬化并发症相关。
