Salat C, Holler E, Kolb H J, Pihusch R, Reinhardt B, Hiller E
Med. Klinik III Klinikum Grosshadern, Munich, Germany.
Bone Marrow Transplant. 1997 May;19(9):909-14. doi: 10.1038/sj.bmt.1700767.
To investigate endothelial cell alterations in BMT recipients developing acute graft-versus-host disease (aGVHD) we determined levels of the endothelial cell markers von Willebrand factor (VWF) and thrombomodulin (TM) in 57 patients undergoing BMT. Before conditioning VWF and TM levels did not differ significantly between transplant recipients who later developed no or mild (grade I) aGVHD (group A, allogeneic n = 22, autologous n = 7; VWF 136.0 +/- 44.1%; TM 29.5 +/- 18.0 ng/ml), and those with moderate or severe (grade II or III) aGVHD (group B, n = 28; VWF 142.2 +/- 37.6%; TM 35.2 +/- 20.1 ng/ml). A first significant rise of both VWF and TM level was noted after conditioning (day 0) both in group A (VWF 197.0 +/- 113.3%; P < 0.001; TM 39.3 +/- 23.3 ng/ml; P < 0.01) as well as in group B (VWF 201.7 +/- 53.3%; P < 0.0001; TM 43.5 +/- 23.5 ng/ml; P < 0.05). Subgroup analysis of autografted patients revealed no significant increase after conditioning in these patients. At the time of engraftment and onset of aGVHD (day 21), when VWF and TM levels within the groups were significantly elevated as compared with baseline (day -8) levels, group B patients (62.7 +/- 38.5 ng/ml) had significantly higher (P < 0.01) TM levels than patients of group A (37.4 +/- 19.6 ng/ml). This significant elevation also persisted at the end of the investigational period (day 28; group B: 56.0 +/- 37.6 ng/ml; group A: 38.2 +/- 23.7 ng/ml; P < 0.01). An elevation of endothelial cell markers is found in the course of BMT, particularly after conditioning and at the time of engraftment. This increase is pronounced in patients with aGVHD suggesting not only epithelial cell but also endothelial cell injury during aGVHD.
为了研究发生急性移植物抗宿主病（aGVHD）的骨髓移植（BMT）受者的内皮细胞变化，我们测定了57例接受BMT患者的内皮细胞标志物血管性血友病因子（VWF）和血栓调节蛋白（TM）水平。在预处理前，后来未发生或发生轻度（I级）aGVHD的移植受者（A组，异基因移植n = 22，自体移植n = 7；VWF 136.0 +/- 44.1%；TM 29.5 +/- 18.0 ng/ml）与发生中度或重度（II级或III级）aGVHD的受者（B组，n = 28；VWF 142.2 +/- 37.6%；TM 35.2 +/- 20.1 ng/ml）之间，VWF和TM水平无显著差异。在预处理后（第0天），A组（VWF 197.0 +/- 113.3%；P < 0.001；TM 39.3 +/- 23.3 ng/ml；P < 0.01）和B组（VWF 201.7 +/- 53.3%；P < 0.0001；TM 43.5 +/- 23.5 ng/ml；P < 0.05）的VWF和TM水平均首次出现显著升高。自体移植患者的亚组分析显示，预处理后这些患者无显著升高。在植入和aGVHD发作时（第21天），与基线（第-8天）水平相比，各组内的VWF和TM水平均显著升高，B组患者（62.7 +/- 38.5 ng/ml）的TM水平显著高于A组患者（37.4 +/- 19.6 ng/ml）（P < 0.01）。这种显著升高在研究期结束时（第28天）也持续存在（B组：56.0 +/- 37.6 ng/ml；A组：38.2 +/- 23.7 ng/ml；P < 0.01）。在BMT过程中发现内皮细胞标志物升高，尤其是在预处理后和植入时。这种升高在aGVHD患者中更为明显，提示在aGVHD期间不仅上皮细胞而且内皮细胞也受到损伤。
