糖尿病患者循环血中内皮祖细胞与冠状动脉支架内再狭窄的关系

The relationship between activities of circulating endothelial progenitor cells and in-stent restenosis in diabetes mellitus

目的观察糖尿病患者循环血中内皮祖细胞(endothelial progenitor cells,EPC)的数量、功能与冠状动脉支架术后再狭窄的关系。方法 68例行冠状动脉支架置入术的冠心病患者,其中合并糖尿病21例,分别用免疫荧光法及流式细胞仪检测其循环血中EPC的数量,采用黏附能力试验、改良Boyden小室、MTT比色法分别检测EPC的黏附、迁移、增殖功能,术后6个月行冠状动脉造影。结果共有15例出现再狭窄,糖尿病组再狭窄率为38.10%,显著高于非糖尿病组(P<0.05);糖尿病组循环血EPC数量显著低于非糖尿病组(P<0.05),EPC的各项功能也显著低于非糖尿病组(P<0.05)。结论循环血中EPC数量减少与功能受损可能是导致冠状动脉支架术后再狭窄发生的独立危险因素,并且是糖尿病患者冠状动脉支架术后高再狭窄率发生的重要原因。

Objective To study the relationship between the activities of circulating endothelial progenitor cells （EPC） and in - stent restenosis in diabetes mellitus. Methods Sixty - eight patients with coronary heart disease （ CHD）, including 21 with diabetes mellitus, underwent coronary bare metal stent implantations. The mononuclear cells isolated from human peripheral blood by density gradient eentrifugation were cultured. Circulating EPC numbers were determined by immunfluorescence analysis and flow cytometry. The abilities of cell adhesion, migration and proliferation were assessed by cell counts to extraeellular matrix, Boyden chamber and MTT, respectively. All the patients underwent coronary angiography six months after coronary stent implantations. Results Follow - up angiography found that restenosis occurred in 15 patients with a restenosis rate of 38.10% , significantly higher than in diabetes mel- litus （P 〈 0.05 ）. The number of EPC in diabetic patients was remarkably lower （ P 〈 0.05 ）, and the ability of EPC to adhere, migrate and proliferate were all reduced significantly （ P 〈 0.05 ）, compared with non - diabetic patients. Conclusions The impaired EPC may be an independent risk in - stent restenosis and contributes to the mechanism of the high restenosis rate in diabetes mellitus.