冠心病患者循环内皮祖细胞与相关危险因素及冠状动脉病变的关系

The relationship between circulating endothelial progenitor cells and the risk factors of CHD as well as the severity of coronary lesions, and its clinical significance

目的探讨循环内皮祖细胞(EPCs)与冠心病危险因素及冠状动脉病变程度的关系及临床意义。方法42例冠心病患者均经选择性冠状动脉造影证实有明显的冠状动脉狭窄(>50%的狭窄);36例对照组经临床检查和选择性冠状动脉造影排除冠心病。采集研究对象外周血进行EPCs的分离培养,14天后在倒置相差显微镜下计数细胞克隆形成单位以评估循环EPCs水平,并将EPCs数量与年龄、性别、血脂水平、高血压、糖尿病、吸烟、冠心病家族史及冠状动脉病变程度进行统计学分析。结果冠心病危险因素分数与循环EPCs水平呈明显负相关(r=-0.436,P=0.014),吸烟患者循环EPCs水平明显低于不吸烟者(P<0.05),低密度脂蛋白胆固醇(LDLC)、尿酸与循环EPCs水平呈明显负相关(P<0.05);而性别、高血压、冠心病家族史对循环EPCs水平有一定影响,但差异无统计学意义,年龄、高密度脂蛋白胆固醇(HDLC)及载脂蛋白A(apoA)与循环EPCs水平也有相关性,但不具有统计学意义。冠心病组患者循环EPCs水平明显低于非冠心病组[(12.8±6.3)对(37.0±5.5)个,P<0.001],冠状动脉病变程度(单支、双支、三支)与EPCs水平降低明显相关(P<0.01)。结论循环EPCs水平与冠心病危险因素分数及冠状动脉病变程度呈负相关。提示冠状动脉内皮损伤而又缺乏足够的循环内皮祖细胞时可能影响冠心病的病情程度及临床表现。

Objective To investigate the correlation between circulating endothelial progenitor cells （EPCs） and the risk factors of coronary heart disease （CHD） as well as the severity of coronary lesions, and its clinical significance. Methods 42 patients with CHD and 36 patients excluding CHD （control） were studied. Total mononuclear cells were isolated from peripheral blood by Ficoll density gradient centrifugation, and were cultured in M199 medium supplemented with 20% fetal bovine serum , 50 ng/ml vascular endothelial growth factor （VEGF）. After 14 days cultured, the numbers of colony-forming units of EPCs were counted by phase-contrast microscope. The relationship between the number of colony-forming units of EPCs and the risk factors of CHD （ such as age, gender, hypertension, hypercholesterolemia, diabetes, smoking, positive family history of CHD ） as well as the severity of coronary lesions were assessed. Results The number of risk factors of CHD was significantly correlated with a reduction of EPCs levels（r = -0. 436, P = 0. 014）. Smoking was associated with significantly lower EPCs levels, whereas a minor but nonsignificant reduction of EPCs levels was detected in the presence of gender, hypertension, and a positive family history of CHD. It was observed that low density lipoprotein （LDL） and uric acid were negatively correlated with the number of colony-forming units of circulating EPCs （ P 〈 0. 05 ）. A correlation existed between age, high density lipoprotein, apoprotein A and levels of circulating EPCs, however, this relation was not statistically significant. The number of colony-forming units of circulating EPCs in CHD groups was significantly lower than those in control group （ 12. 8±6. 34 versus 37. 0 ± 5.5, P 〈 0. 001 ） ; and the circulating EPCs level of coronary artery lesion group （including single, double, triple vessels disease） was significantly lower than that of control group （ P 〈 0. 01 ）. Conclusions The level of circulating EPCswas inversely associated with the risk factor scores of CHD and the severity of coronary artery lesion. These finding imply that endothelial injury in the absence of sufficient circulating EPCs may affect the degree of the heart disorder and the clinical situation.