Elevated Serum Level of Soluble VCAM-1 in Patients with Type 2 Diabetes Mellitus with Overt Nephropathy / 대한신장학회잡지

ABSTRACT

BACKGROUND: Soluble adhesion molecules including soluble vascular cell adhesion molecule-1 (sVCAM-1) are released during an infalmmatory process such as artherosclerosis. Elevated sVCAM-1 also has been reported in diabetic nephropathy. But, the clinical significance of elevated of sVCAM-1 is not certain. We measured serum sVCAM-1 for the purpose to validate the clinical usefulness in diabetic nephropathy. METHODS: In this study, we measured serum sVCAM-1 in 12 normal subjects and 64 type 2 diabetic patients with proteinuria over 300 mg/day [median 24-h urine protein (range): 2.2 (0.3-18.7) g/day]. We evaluated the relationship of serum sVCAM-1 with lipoproteins including total cholesterol, LDL, oxidized LDL (oxLDL), HDL, and lipoprotein(a) (Lp(a)), with markers of inflammation including high-sensitivity CRP (hs-CRP), serum albumin and fibrinogen, and with renal parameters including 24-h urine protein, serum creatinine and homocysteine. RESULTS: In patients with diabetic nephropathy, median sVCAM-1 was 561 ng/mL (range 183-1304), which was significantly higher than that of normal subjects (324 ng/mL; 213-760, p< 0.05). In the diabetic nephropathy patients, sVCAM-1 was positively correlated with serum creatinine (r=0.34, p< 0.01), serum Lp(a) (r=0.27, p< 0.05) and 24-h urine protein (r=0.26, p< 0.05). In a multiple linear regression analysis, 24-h urine protein and serum Lp(a) were associated with an increased level of sVCAM-1 (r2=0.22, p=0.003). CONCLUSION: In summary, a positive correlation of sVCAM-1 with 24-h urine protein suggests that high sVCAM-1 may reflect increased production of sVCAM-1 due to more advanced renal injury. A positive association of sVCAM-1 and serum Lp(a) also suggests increased release of sVCAM-1 from associated atherosclerotic lesions in these patients. These results suggest that sVCAM-1 may be closely related with the renal function in patients with overt diabetic nephropathy.