银屑病患者血清和皮损中血管内皮细胞粘附分子的对比研究

A Comparative Study on Expression of Adhesion Molecules between Lesional Skin and Sera in Patients with Psoriasis Vulgaris

目的探讨银屑病患者血清和皮损中4种血管内皮粘附分子表达与银屑病疾病活动性之间的关系。方法采用ELISA法检测36例银屑病患者治疗前后和36例健康人的血清中可溶性粘附分子(sICAM-1、sICAM-3、sVCAM-1、sELAM)的浓度;同时用ABC免疫组化染色技术检测了36例银屑病患者皮损和临床治愈处皮肤粘附分子(ICAM-1、ICAM-3、VCAM-1、ELAM)的表达情况。结果与正常人相比,银屑病患者皮损部位4种粘附分子的原位表达呈明显上调(P<0.005),同时患者血清中4种可溶性粘附分子浓度也明显升高(P<0.001),经治疗后银屑病患者皮损部位4种粘附分子的原位表达明显下调(P<0.005),同时血清中4种可溶性粘附分子浓度比治疗前也下降(P<0.05);血清中4种可溶性粘附分子的浓度与银屑病疾病活动严重指数(PASI)均呈正相关,但治疗前后sVCAM-1的水平上升和下降的幅度最大,且与PASI的相关性最好。结论血管内皮细胞粘附分子参与银屑病的发病机制;患者血清中可溶性粘附分子浓度的升高可能与皮损部位血管内皮细胞上相应的粘附分子高表达有关;血清VCAM-1的水平可以作为反映银屑病疾病活动的一个新的敏感指标。

Objective To investigate the correlation between expression of four adhesion molecules in sera and in skin lesions of patients with psoriasis vulgaris, as well as their relevance to clinical severity of the disease. Methods Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum levels of ICAM-1, ICAM-3, VCAM-1 and ELAM-1 in 36 patients with plaque type psoriasis vulgaris and 36 healthy controls. Avidin biotin immunoperoxidase staining system was employed to quantitate expression of the four adhesion molecules in psoriatic skin lesions before and after treatment. Results Significantly increased expression of four adhesion molecules was found in psoriatic skin lesions (P< 0.005). Significantly increased serum levels of ICAM-1, ICAM-3, ELAM and VCAM-1 were also found in psoriatic patients as compared to those in healthy controls (P< 0.001). Serum levels of these adhesion molecules were significantly decreased after treatment. A significant reduction of expression of ICAM-1, ICAM-3, ELAM and VCAM-1 was noted on dermal vascular endothelial cells and infiltrating leukocytes after treatment (P< 0.005). Serum levels of these adhesion molecules were positively correlated to clinical severity of psoriasis assessed by psoriasis area severity index (PASI). Moreover, as compared to other adhesion molecules, VCAM-1 was found to be most significantly increased in sera of patients with psoriasis and to be most significantly correlated to PASI score of the patients. Conclusions The present data suggest that both serum and lesional adhesion molecules be involved in psoriatic inflammatory process. Elevated serum adhesion molecules may be due to the results of shedding off the corresponding adhesion molecules into the blood stream from activated endothelial cells in lesional area of psoriatic patients. Among the four adhesion molecules investigated, VCAM-1 serum level is a novel sensitive marker of monitoring disease activity in psoriatic patients.