症状性颅内动脉狭窄支架置入术后内皮祖细胞的数量及功能与再狭窄的相关性研究

Study on the correlation between the number and function of endothelial progenitor cells and in-stent restenosis after stent-implantation for symptomatic intracranial atherosclerotic stenosis

目的探讨症状性动脉粥样硬化性颅内动脉狭窄（ sICAS）患者颅内动脉支架置入术后内皮祖细胞（ EPCs）数量、功能及血管内皮生长因子（ VEGF）水平变化与术后颅内动脉再狭窄的关系。方法选择2008年1月—2012年10月聊城市人民医院神经内科因sICAS行颅内动脉支架置入术的87例患者进行前瞻性研究。87例患者中,男48例,女39例；年龄48~81岁。均采用颅内动脉支架置入术治疗,术后1年行头颈CTA检查,根据患者颅内动脉狭窄情况分为再狭窄组和无狭窄组,分别对两组患者术后1年外周血EPCs的数量、黏附能力、迁移能力,以及VEGF水平进行测定,并对结果进行对比分析。结果87例sICAS患者均成功行经皮血管内支架置入术。术后1年行头颈CTA检查显示,无狭窄组64例,再狭窄组23例,其中14例患者再狭窄〉50%。再狭窄组与无狭窄组比较,术后1年外周血中 EPCs 数量分别为（36.5依4.8）个/mL、（65.6依6.7）个/mL,细胞黏附数量分别为（27.4依7.3）个/mL、（58.5依9.4）个/mL,迁移数量分别为（13.6依3.7）个/mL、（24.7依6.8）个/mL, VEGF的水平（57.79依13.53） pg/mL、（94.36依17.57） pg/mL,差异均有统计学意义（t值分别为19.110、14.376、7.425、9.051, P值均〈0.05）。结论 sICAS患者采用颅内动脉支架置入术治疗后,EPCs数量、黏附能力、迁移能力及VEGF水平明显下降的患者,发生血管再狭窄的风险增加；术后检测EPCs、VEGF水平对预测发生血管再狭窄的可能性和判断患者的远期预后可能有一定的临床价值。

Objective To explore the relationship of endothelium progenitor cells（ EPCs） number and function, the level of vascular endothelial growth factor （ VEGF ） with in-stent restenosis after stent implantation for symptomatic intracranial atherosclerotic stenosis. Methods From Jan 2008 to October 2012, a total of 87 patients stent-implantation with symptomatic intracranial atherosclerotic stenosis （sICAS） were prospectively studied in Liaocheng People’s Hospital. In 87 patients, there were 48 males and 39 females, the age was 48-81 years. All the patients were divided into restenosis group and non-restenosis group according to the examining results of Cranial CTA 1 year after percutaneous stent implantation. The EPCs number, adhesion and migration activities and the level of VEGF in the peripheral blood were tested and aralyzed in two groups. Results The 87 patients with symptomatic intracranial atherosclerotic stenosis were successfully performed percutaneous intravascular stent implantation, 23 patients showed varying degrees of in-stent restenosis 1 year after post-operatively, the restenosis rate of 14 patients was more than 50%. The number of endothelial progenitor cells [（36. 5 ±4. 8） /mL vs （65. 6 ± 6. 7） /mL], adhesion activities[（27. 4 ± 7. 3） /mL vs （58. 5 ± 9. 4） /mL], migration activities[（13. 6 ±3. 7） /mL vs （24. 7±6. 8） /mL] and level of VEGF[（57. 79 ±13. 53） pg/ mL vs （94. 36 ±17. 57） pg /mL] were significantly lower in restenosis group than non-restenosis group （t=19. 110, 14. 376, 7. 425, and 9. 051,＆nbsp;respectively, all P values〈0. 05）. Conclusions The risk of in-stent restenosis is increased in the patients which the migration ability of EPC, and the level of EPC and VEGF will decrease significantly 1 year after postoperatively. It is helpful to judge the possibility of in-stent restenosis and certain clinical values for long-term prognosis of patients to detect the level of EPCs and VEGF. It may offer a new way for prevention of in-stent restenosis after stenting by changing the levels of EPCs and VEGF.