ICAM-1、VCAM-1及PECAM-1在终末期肾脏病患者血管内皮损伤中的临床意义

Clinical significance of ICAM-1,VCAM-1 and PECAM-1 in vascular endothelial injury of end-stage renal disease patients

目的通过比较维持性透析与非透析终末期肾病(end stage renal disease,ESRD)患者血清细胞间黏附分子1(intercellular adhesion molecule-1,ICAM-1)、血管细胞间黏附分子1(vascular cell adhesion molecule-1,VCAM-1)和血小板内皮细胞黏附分子1(platelet endothelium cell adhesion molecules-1,PECAM-1)的含量,探究透析与未进行透析治疗对ESRD患者血管内皮损伤的影响。方法选择ESRD确诊患者71例,其中透析组(MHD组)35例,非透析组(N-HD组)36例;同时选取正常对照组(C组)20名。正常对照组及非透析组患者晨起空腹状态下抽取静脉血5 mL,透析组患者于透析当日上机前空腹状态下从内瘘侧抽取静脉血5 mL,送至本院生化室常规化验血常规、甲状旁腺素、肝肾功能、血糖、血脂及电解质等;另取4 mL静脉血,采用双抗体夹心酶联免疫法(ELISA)测定ICAM-1、VCAM-1和PECAM-1的值并进行统计分析。结果(1)各组在性别组成、年龄、病因等方面比较差异无统计学意义(均P>0.05),具有可比性。(2)三组患者血液学指标组间比较,组间血红蛋白、甲状旁腺激素、血磷、白蛋白、三酰甘油、总胆固醇、低密度脂蛋白、尿素氮、肌酐、尿酸差异均有统计学意义(均P<0.05)。同时,MHD组上述指标与对照组比较差异均有统计学意义(均P<0.05);N-HD组上述指标与对照组比较差异均有统计学意义(均P<0.05)。N-HD组甲状旁腺激素、尿素氮、肌酐、尿酸与MHD组比较差异有统计学意义(均P<0.05)。MHD组和N-HD组Hb、血钙、血磷、白蛋白、三酰甘油、低密度脂蛋白、高密度脂蛋白差异均无统计学意义(均P>0.05)。(3)MHD组ICAM-1、VCAM-1和PECAM-1高于对照组(均P<0.05)。N-HD组ICAM-1、VCAM-1和PECAM-1高于对照组(均P<0.05)。N-HD组ICAM-1、VCAM-1和PECAM-1高于MHD组,差异均有统计学意义(均P<0.05)。结论ICAM-1、VCAM-1和PECAM-1在MHD的ESRD患者血清表达低于N-HD患者,提示维持性血液透析对ESRD患者血管内皮损伤具有一定的保护作用。

Objective To compare the serum levels of ICAM-1,VCAM-1 and PECAM-1 between maintenance dialysis and non-dialysis end-stage renal disease(ESRD)patients and explore the effect of dialysis versusnon-dialysis on vascular endothelial damage.Methods A total of 71 ESRD patients were selected and divided into two groups of MHD(n=35)and N-HD(n=36).At the same time,20 cases of normal control group(group C)were selected.And 5 mL of venous blood was harvested from normal control and non-dialysis groups in the morning under a fasting state.Also 5 mL of venous blood was collected from dialysis group on the day of dialysis from the side of internal fistula under a fasting state.The samples were submitted to the biochemical room for blood routine,parathyroid hormone(PTH),hepato-renal function,blood glucose,blood lipid and electrolytes.Another 4 mL of venous blood was tested for the values of ICAM-1,VCAM-1 and PECAM-1 by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).Results Among three groups,no significant difference existed in gender,age or etiology(all P>0.05).And significant differences existed in hemoglobin(Hb),PTH,blood phosphorus,albumin(Alb),triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL),blood urea nitrogen(BUN),creatinine(Cr)and uric acid(UA)(all P<0.05).Also significant differences existed between MHD and control groups(all P<0.05);And significant differences existed in the above parameters between N-HD and control groups(all P<0.05).PTH,BUN,Cr and UA in N-HD group were significantly higher than those in MHD group(all P<0.05).No significant differences existed in Hb,serum calcium,phosphorus,ALB,TG,LDL and high-density lipoprotein(HDL)between MHD and N-HD groups(both P>0.05).ICAM-1,VCAM-1 and PECAM-1 were higher in MHD group than those in control group(all P<0.05).ICAM-1,VCAM-1 and PECAM-1 were higher in N-HD group than those in control group(all P<0.05).ICAM-1,VCAM-1 and PECAM-1 were significantly higher in N-HD group than those in MHD group(all P<0.05).Conclusion The serum expressions of ICAM-1,VCAM-1 and PECAM-1 in ESRD patients with MHD are lower than those in N-HD patients.It indicates that maintenance hemodialysis has a protective effect on vascular endothelial injury in ESRD patients.