Chuljerm Hataichanok, Maneekesorn Supawadee, Thorup Gabriel, Nantakool Sothida, Charoenkwan Pimlak, Rerkasem Kittipan
School of Health Sciences Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand.
Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Int J Mol Sci. 2025 Apr 18;26(8):3842. doi: 10.3390/ijms26083842.
Cardiovascular complications are a major concern in thalassemia patients, primarily driven by endothelial dysfunction. This systematic review and meta-analysis evaluated endothelial biomarkers as indicators of cardiovascular disease risk in thalassemia. A systematic search of PubMed, Scopus, and Embase identified 41 studies comparing biomarkers in thalassemia patients and healthy individuals. The biomarkers analyzed included ICAM-1, VCAM-1, E-selectin, P-selectin, von Willebrand factor (vWF), endothelial microparticles (EMPs), nitric oxide (NO), nitric oxide synthase (NOS), asymmetric dimethylarginine (ADMA), and endothelin-1 (ET-1). Using random effects modeling, pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. The results showed significantly elevated levels of ICAM-1 (SMD 2.15, 95% CI: 1.09-3.22), VCAM-1 (SMD 2.50, 95% CI: 1.35-3.66), E-selectin (SMD 1.21, 95% CI: 0.92-1.50), P-selectin (SMD 1.62, 95% CI: 0.83-2.42), and ET-1 (SMD 1.23, 95% CI: 0.03-2.42) in thalassemia patients. However, NO, ADMA, and vWF showed no significant differences. No studies on NOS were identified, while only one study found significantly elevated EMPs in thalassemia patients. This review highlights ICAM-1, VCAM-1, E-selectin, P-selectin, and ET-1 as key biomarkers for cardiovascular complications in thalassemia. Further research on EMPs and NOS is essential to enhance the understanding of endothelial dysfunction in this population.
心血管并发症是地中海贫血患者的主要担忧，主要由内皮功能障碍引起。本系统评价和荟萃分析评估了内皮生物标志物作为地中海贫血患者心血管疾病风险指标的情况。对PubMed、Scopus和Embase进行系统检索，确定了41项比较地中海贫血患者和健康个体生物标志物的研究。分析的生物标志物包括细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、E-选择素、P-选择素、血管性血友病因子（vWF）、内皮微粒（EMPs）、一氧化氮（NO）、一氧化氮合酶（NOS）、不对称二甲基精氨酸（ADMA）和内皮素-1（ET-1）。使用随机效应模型计算合并标准化均值差（SMD）和95%置信区间（CI）。结果显示，地中海贫血患者的ICAM-1（SMD 2.15，95%CI：1.09-3.22）、VCAM-1（SMD 2.50，95%CI：1.35-3.66）、E-选择素（SMD 1.21，95%CI：0.92-1.50）、P-选择素（SMD 1.62，95%CI：0.83-2.42）和ET-1（SMD 1.23，95%CI：0.03-2.42）水平显著升高。然而，NO、ADMA和vWF没有显著差异。未发现关于NOS的研究，而只有一项研究发现地中海贫血患者的EMPs显著升高。本综述强调ICAM-1、VCAM-1、E-选择素、P-选择素和ET-1是地中海贫血患者心血管并发症的关键生物标志物。对EMPs和NOS进行进一步研究对于增强对该人群内皮功能障碍的理解至关重要。
