他汀类调脂药物对高脂血症患者黏附分子的影响

目的　探讨他汀类调脂药物对高脂血症患者血清可溶性黏附分子含量及白细胞黏附分子表达的影响。方法　38例高脂血症患者使用他汀类药物治疗8周，观察治疗前后血清可溶性内皮细胞白细胞黏附分子(sELAM)、可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)水平，白细胞黏附分子L-选择素(L-Selectin)、细胞间黏附分子-1(ICAM-1)、细胞间黏附分子-3(ICAM-3)的表达及血清白细胞介素-1β(IL-1β)、肿瘤坏死因子(TNF)浓度的变化。结果　治疗8周后，高脂血症患者血清sELAM、sICAM-1水平显著下降（P<0.01），个体sELAM、sICAM-1水平均与血清总胆固醇呈正相关（P<0.005及P<0.01），与高密度脂蛋白胆固醇呈负相关（P<0.01），sVCAM-1无明显变化；L-选择素阳性单核细胞、淋巴细胞百分率升高（P<0.05及P<0.01），ICAM-1阳性单核细胞及淋巴细胞百分率下降（P<0.05及P<0.01），白细胞ICAM-3平均荧光强度明显下降（P<0.01）；血清IL-1β含量下降，其降低值与L-选择素阳性淋巴细胞百分率上升值及ICAM-3阳性白细胞平均荧光强度下降值明显相关（P<0.01）。结论　他汀类药物降低高脂血症患者血清内皮细胞黏附分子水平，并可调节白细胞黏附分子的表达和细胞因子的生成，其作用可能主要是通过调节血脂而产生。

The effects of statins on cell adhesion molecules in dyslipidemic patients

Objective To investigate the effects of statins on soluble celladhesion molecules in serum and on the expression of adhesion molecules on leukocytes in dyslipidemia. Methods 38 patients with dyslipidemia were treated with statins for 8 weeks. Before and after the therapy, serum soluble endothelial leucocyte adhesion molecule(sELAM), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell molecule-1(sVCAM-1) and the expression of L-Selectin, intercellular adhesion molecule (ICAM)-1, ICAM-3 on leucocytes were examined. Serum interleukin-1β(IL-1β), tumour necrosis factor (TNF) were tested as well. Results After the treatment, sELAM (74.2±16.8) ng/ml vs (55.8±16.3) ng/ml, sICAM-1(441±110) ng/ml vs (321±92) ng/ml were reduced markedly (both P<0.01), but sVCAM-1 (582±67) ng/ml vs (547±72) ng/ml was not reduced significantly. Individual sELAM and sICAM-1 were positively correlated with TC(P<0.005 and P<0.01) and negatively with HDL-C （both P<0.01）. The percentages of monocytes and lymphocytes positive for L-Selectin were increased (45.5±11.4)% vs (56.7±9.1)% and (15.9±7.2)% vs (23.1±5.7)%, P<0.05, P<0.01, respectively, whereas percentages of ICAM-1-positive monocytes and lymphocytes were reduced (91.1±6.1)% vs (78.3±5.0)% and (23.4±6.2)% vs (14.6±5.3)%, P<0.05 and P<0.01, respectively; mean fluorescence intensity of ICAM-3 on leukocytes was lowered, P<0.01. Serum IL-1 β was declined, and the individual change value was well correlated with the changes of percentage of L-Selectin positive lymphocytes and mean fluorescence intensity of ICAM-3 (both P<0.01). Conclusion Statins could reduce serum soluble adhesion molecules, and regulate the expression of adhesion molecules on leucocytes and the production of cytokines, which was realized possiblely through modulating serum lipid.