Lo Iacono Oreste, Rincón Diego, Hernando Ana, Ripoll Cristina, Catalina Maria Vega, Salcedo Magdalena, Clemente Gerardo, Gomez Judith, Nuñez Oscar, Matilla Ana, Bañares Rafael
CIBEREHD and Servicio de Aparato Digestivo, Sección de Hepatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Liver Int. 2008 Sep;28(8):1129-35. doi: 10.1111/j.1478-3231.2008.01763.x. Epub 2008 May 15.
In patients with liver cirrhosis, serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) have been associated with increasing fibrosis and are related to angiogenesis.
To assess the possible correlation between sVCAM-1 and splanchnic and systemic haemodynamic and clinical staging of cirrhotic patients.
We assessed, using immunoassays, the serum levels of sVCAM-1, in the peripheral and hepatic vein, in all consecutive patients with liver cirrhosis, who underwent a haemodynamic study as part of its routine clinical work-up.
We studied 86 patients [61 M/25 F; age 51.1 (8.3) years] with alcoholic (31) or viral (HBV:6, HCV:49) cirrhosis, 10 of them with hepatocellular carcinoma (Milan criteria). The mean follow-up was 391(187) days; 29 patients died or underwent transplantion during follow-up. A strong correlation in serum levels of sVCAM-1 was observed between the peripheral and the hepatic vein (r=0.8; P=0.0001). There was no correlation between levels of sVCAM-1 and hepatic venous pressure gradient. At univariate analysis, sVCAM-1 was inversely related with mean arterial pressure (r=-0.292; P=0.007), systemic vascular resistance (SVR) (r=-0.37; P=0.005) and serum sodium levels (r=-0.326; P=0.002). In multivariate linear regression only SVR remained as an independent variable associated to sVCAM-1. A correlation of sVCAM-1 with Child-Pugh scores, model for end-stage liver disease (MELD) and the clinical stage proposed in the Baveno IV consensus conference was also observed. Finally, patients who died or underwent transplantion during follow-up had significantly greater values of sVCAM-1 at baseline than those who did not [3505(1329) vs. 2488(1208) P=0.001].
This study supports a potential role of sVCAM-1 as a marker of hyperdynamic circulation, closely related to the different stage of liver cirrhosis.
在肝硬化患者中，血清可溶性血管细胞黏附分子-1（sVCAM-1）水平与肝纤维化加重相关，且与血管生成有关。
评估sVCAM-1与肝硬化患者内脏和全身血流动力学及临床分期之间的可能相关性。
我们采用免疫分析法，对所有连续的肝硬化患者进行血流动力学研究，作为其常规临床检查的一部分，检测外周血和肝静脉中sVCAM-1的血清水平。
我们研究了86例患者[61例男性/25例女性；年龄51.1（8.3）岁]，病因包括酒精性（31例）或病毒性（乙肝：6例，丙肝：49例）肝硬化，其中10例为肝细胞癌（符合米兰标准）。平均随访时间为391（187）天；29例患者在随访期间死亡或接受了移植。外周血和肝静脉中sVCAM-1的血清水平之间存在强相关性（r = 0.8；P = 0.0001）。sVCAM-1水平与肝静脉压力梯度之间无相关性。单因素分析显示，sVCAM-1与平均动脉压（r = -0.292；P = 0.007）、全身血管阻力（SVR）（r = -0.37；P = 0.005）和血清钠水平（r = -0.326；P = 0.002）呈负相关。多因素线性回归分析中，只有SVR仍然是与sVCAM-1相关的独立变量。还观察到sVCAM-1与Child-Pugh评分、终末期肝病模型（MELD）以及巴韦诺IV共识会议提出的临床分期之间存在相关性。最后，随访期间死亡或接受移植的患者基线时sVCAM-1值显著高于未死亡或未接受移植的患者[350（1329）对2488（1208），P = 0.001]。
本研究支持sVCAM-1作为高动力循环标志物的潜在作用，与肝硬化的不同阶段密切相关。
