Jude E B, Abbott C A, Young M J, Anderson S G, Douglas J T, Boulton A J
Department of Medicine/Diabetes, Manchester Royal Infirmary, UK.
Diabetologia. 1998 Mar;41(3):330-6. doi: 10.1007/s001250050911.
Cross-sectional studies have shown plasma cell adhesion molecules (CAMs) to be increased in patients with diabetes-related complications. In the first prospective study of CAMs, we have shown that plasma CAMs may be a predictor of the development of diabetic neuropathy. We followed up 28 diabetic patients (13 neuropathic) over a 5 year period, starting from 1991. All patients had peroneal nerve conduction velocity (PNCV), vibration perception threshold and plasma CAMs measured at baseline and follow-up. We found P-selectin and intercellular adhesion molecule-1 (ICAM-1) to be increased at baseline in patients with neuropathy compared to non-neuropathic patients. P-selectin and E-selectin were also found to be significantly higher at baseline in patients who at follow-up showed deterioration in PNCV of more than 3 m/s (p<0.05; p=0.01; respectively). P-selectin and ICAM-1 strongly correlated with PNCV. Univariate and multivariate regression analyses showed a significant inverse association between increasing log P-selectin, log E-selectin and log ICAM-1 with decreasing PNCV, and remained significant even after adjustment for glycaemic control. P-selectin and E-selectin, odds ratios of 8.8 (95% CI: 1.1-68.8; p=0.038) and 12.5 (95% CI: 1.2-132.1; p=0.036), respectively, were significantly associated with the risk of deterioration of PNCV after 5 years. This study suggests that plasma cell adhesion molecules may play an important role in the development and progression of peripheral neuropathy in diabetes mellitus.
横断面研究表明，糖尿病相关并发症患者的血浆细胞黏附分子（CAMs）水平升高。在第一项关于CAMs的前瞻性研究中，我们发现血浆CAMs可能是糖尿病神经病变发生的一个预测指标。从1991年开始，我们对28例糖尿病患者（13例有神经病变）进行了为期5年的随访。所有患者在基线期和随访期均测量了腓总神经传导速度（PNCV）、振动觉阈值和血浆CAMs。我们发现，与无神经病变的患者相比，有神经病变的患者在基线期P选择素和细胞间黏附分子-1（ICAM-1）水平升高。在随访期PNCV下降超过3 m/s的患者中，基线期P选择素和E选择素水平也显著更高（分别为p<0.05；p=0.01）。P选择素和ICAM-1与PNCV密切相关。单因素和多因素回归分析显示，log P选择素、log E选择素和log ICAM-1升高与PNCV降低之间存在显著的负相关，即使在调整血糖控制后仍具有显著性。P选择素和E选择素的比值比分别为8.8（95%CI：1.1-68.8；p=0.038）和12.5（95%CI：1.2-132.1；p=0.036），与5年后PNCV恶化的风险显著相关。这项研究表明，血浆细胞黏附分子可能在糖尿病周围神经病变的发生和发展中起重要作用。
