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

      摘要
    • 摘要: 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。

       

      Abstract: 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.

       

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