急性脑梗死患者外周血内皮祖细胞水平变化及其临床意义

Changes of circulating endothelial progenitor cells and their clinical significance in patients with acute cerebral infarction

目的 探讨急性脑梗死和慢性脑缺血患者周围血中内皮祖细胞（endothelial progenitor cell,EPC）水平变化及其临床意义. 方法 EPC表面标记CD34、CD133和激酶插入嵌合受体（kinase insert domain receptor,KDR）用于鉴定循环EPC数.分别从急性脑梗死患者（梗死组,30例）发病24h内和慢性脑缺血患者（缺血组,20例）和无脑缺血症状患者（对照组,10例）采集外周静脉血4 ml.采用流式细胞计数法测定各组循环EPC数,以及各组患者收缩压、糖化血红蛋白（glycosylated hemoglobin,HbAlc）、总胆固醇（total cholesterol,TC）、甘油三酯（triglyceride,TG）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol,LDL-C）、高密度脂蛋白胆固醇（high density lipoprotein-cholesterol,HDL-C）等指标. 结果 梗死组CD34细胞数、CD34/CD133细胞数、CD34/KDR细胞数分别为（14.2±8.1）‰、（7.1±4.1）‰、（5.0±3.7）‰,缺血组分别为（28.5±9.9）‰、（15.2±3.7）‰、（6.8±2.0）‰,对照组分别为（44.8±9.5）‰、（22.1±6.6）‰、（16.7±6.9）‰;结果显示,与对照组比较,梗死组、缺血组循环EPC水平明显下降（P＜0.05）;梗死组循环EPC较缺血组更少（P＜0.05）.梗死组循环EPC水平与收缩压、TC、TG和LDL-C呈中度负相关（P＜0.05）,与HDL-C无明显相关性. 结论 急性脑梗死循环EPC数量降低可能是脑缺血发生的危险因素之一,EPC对于急性脑梗死的预测、预防和治疗具有重要临床价值.

Objective To investigate the changes of circulating endothelial progenitor cells （EPCs） in patients with acute cerebral infarction or chronic cerebral ischemia and discuss the related clinical significance.Methods Circulating EPCs were isolated using staining markers of CD34,CD133,and kinase insert domain receptor （KDR）.Peripheral venous blood was collected from patients with acute cerebral infarction within 24 hours of onset （infarction group,n =30）,with chronic cerebral ischemia （ischemia group,n =20）,and without cerebral ischemia （control group,n =10） to quantify circulating level of EPCs using flow cytometry and measure parameters of systolic pressure,glycosylated hemoglobin （HbAlc）,total cholesterol （TC）,and triglyceride （TG）,and low density lipoprotein-cholesterol （LDL-C）,and high density lipoprotein-cholesterol （HDL-C）.Results CD34-,CD34/CD133-,and CD34/KDR-positive cells counted （14.2 ± 8.1）‰,（7.1 ± 4.1）‰ and （5.0 ± 3.7）‰ in infarction group,（28.5 ± 9.9）‰,（15.2 ± 3.7）‰ and （6.8 ± 2.0）‰ in ischemia group,and （44.8 ± 9.5） ‰,（22.1 ± 6.6） ‰ and （16.7 ± 6.9） ‰ in control group.Taken together,circulating level of EPCs lowered substantially in infarction and ischemia groups compared to control group （P ＜ 0.05） and a far lower level was observed in infarction group （P ＜ 0.05）.Circulating level of EPCs in infarction group was in a moderate negative correlation with systolic pressure,TC,TG,and LDL-C （P ＜ 0.05）.Conclusions Decreased circulating level of EPCs may be a risk factor to the development of cerebral ischemia in acute cerebral infarction patients.Therefore,level of EPCs is vital for prediction,prevention and treatment of acute cerebral infarction.