原发性高血压黏附分子及胶原代谢变化的初步探讨

A Study of Adhesion Molecule and the Changes of Collagen Metabolism in Essential Hypertension

目的 :探讨血清中可溶性细胞间黏附分子 1(sICAM 1)及Ⅲ型前胶原、Ⅳ型胶原在原发性高血压早期肾损害患者血中的变化及卡托普利对其影响。 方法 :43例原发性高血压早期肾损害患者 [血肌酐正常 ,尿蛋白阴性 ,尿微量白蛋白和 (或 )尿视黄醇结合蛋白异常 ] ,按血压高低分为 3组 (原发性高血压 1组、原发性高血压 2组、原发性高血压 3组 ) ,给卡托普利治疗 8周 ,治疗前后测定血清中sICAM 1、Ⅲ型前胶原、Ⅳ型胶原。另选 18例健康体检者为正常对照组。 结果 :原发性高血压组治疗前血清中sICAM 1、Ⅲ型前胶原及Ⅳ型胶原显著升高 ,与正常对照组及组间比较差异显著 (P <0 0 5～ 0 0 1)。卡托普利治疗后 ,无论降压明显与否 ,上述指标均显著下降 ,与治疗前比较有显著差异 (P <0 0 5～ 0 0 1)。血清中sICAM 1分别与Ⅲ型前胶原 ,与Ⅳ型胶原间呈显著正相关 (γ分别为 0 6914、0 70 99,P <0 0 1)。治疗后下降值之间也呈正相关 (γ =0 65 3 1、γ =0 6742 ,P <0 0 1)。 结论 :①原发性高血压早期肾损害血清中sICAM 1升高 ,细胞间黏附分子 1(ICAM 1)可能参与了肾纤维化的发生 ;②原发性高血压早期已有胶原代谢紊乱 ;③卡托普利降低血清sICAM 1、Ⅲ型前胶原、Ⅳ型胶原 ,可减轻肾纤维化。

Objective:To study the changes of soluble intercellular adhesion molecule 1(sICAM 1),pro collagen Ⅲ(pc Ⅲ) and collagen Ⅳ(IVC) in the serum of essential hypertensive(EH) patients with early stage of renal damage, and to investigate the effects of captopril. Methods:Forty three EH patients with early stage of renal damage, who had normal serum creatinine, negative urinary protein, and abnormal urinary retinol binding protein and/or urinary albumin were devided into three groups according to the levels of their blood pressure and given captopril for 8 weeks. Serum sICAM 1,pc Ⅲ,IVC were measured before and after treatment. Results:The above values were significantly elevated in EH groups as compared with those of the controls. The values was obviously decreased after treatment(p<0 05).There was a positive correlation between sICAM 1 and pc Ⅲ(γ=0 6914,p<0 01) or between sICAM 1 and IVC(γ=0 7099,p<0 01).The decreased sICAM 1 levels were also positively correlated with the decreased pc Ⅲ and IVC values(γ=0 6531,γ=0 6742,p<0 01,respectivly). Conclusions:①Serum sICAM 1 is elevated in EH patients with early renal damage.ICAM 1 may be involved in the process of kidney fibrosis.② There is a collagen disorder in the early stage of EH. Pc Ⅲ and IVC may forecast the kidney fibrosis.③Captopril decreases serum sICAM 1,pc Ⅲ and IVC,thus reducing the kidney fibrosis.