循环内皮祖细胞与大动脉粥样硬化性卒中患者动脉粥样硬化负荷的相关性

Correlation of circulating endothelial progenitor cells and cerebral atherosclerotic burden in patients with large artery atherosclerotic stroke

目的探讨大动脉粥样硬化性卒中（large artery atherosclerotic stroke, LAAS）患者循环内皮祖细胞（endothelial progenitor cells, EPCs）水平与脑动脉粥样硬化负荷（cerebral atherosclerosis burden, CAB）的相关性及其对LAAS的预测作用。 方法连续纳入LAAS患者和健康对照者。采用流式细胞术检测外周血EPCs水平。根据CT血管造影或磁共振血管造影结果评价CAB。采用单变量分析比较2组间人口统计学和临床资料，多变量logistic回归分析确定循环EPCs水平与LAAS的相关性。 结果共纳入LAAS患者141例和对照者100名。病例组高血压（65.9%对51.0%；χ2＝5.443，P＝0.020）、糖尿病（27.0%对16.0%；χ2＝4.035，P＝0.045）的患者构成比及收缩压[（139.1±11.1）mmHg对（131.6±15.7）mmHg；t＝3.549，P＝0.003；1 mmHg＝0.133 kPa]和空腹血糖[（5.8±2.1）mmol/L对（5.2±2.0）mmol/L；t＝2.344，P＝0.020]显著高于对照组，而循环EPCs水平（中位数，四分位数间距）[13（3～32）个/ml对31（7～59）个/ml；Z＝3.913，P＝0.001]显著低于对照组。多变量logistic回归分析显示，校正混杂因素后，循环EPCs水平下降（优势比2.632，95%可信区间1.412～4.907；P＝0.002）是LAAS的独立危险因素。CAB〉3分组EPCs水平显著低于1分组[5（2～19）个/ml对22（9～43）个/ml；Z＝3.338，P＝0.011]。Spearman相关分析显示，EPCs水平与CAB呈显著负相关（r＝－0.257，P＝0.002）。 结论循环EPCs水平降低是LAAS发病的独立危险因素，且EPCs水平与CAB呈显著负相关。

ObjectiveTo investigate the correlation of the level of circulating endothelial progenitor cells （EPCs） and cerebral atherosclerosis burden （CAB） in patients with large artery atherosclerotic stroke （LAAS） and its predictive effect for LAAS. MethodsConsecutive patients with LAAS and healthy controls were enrolled. Flow cytometry wad used to detect EPC level in peripheral blood. CAB was assessed according to the results of CT angiography or magnetic resonance angiography. Univariate analysis was used to compare the demographic and clinical data in both groups. Multivariate logistic regression analysis was used to identify the correlation of circulating EPC level and LAAS. ResultsA total of 141 patients with LAAS and 100 controls were enrolled. The constituent ratios of hypertension （65.9% vs. 51.0%; χ2 =5.443, P=0.020） and diabetes （27.0% vs. 16.0%; χ2 =4.035, P=0.045） of the patents, as well as systolic blood pressure （139.1±11.1 mmHg vs. 131.6±15.7 mmHg; t=3.549, P=0.003; 1 mmHg=0.133 kPa） and fasting blood glucose （5.8±2.1 mmol/L vs. 5.2±2.0 mmol/L; t=2.344, P=0.020） in the patient group were significantly higher than those in the control group, while the circulating EPC level （median, interquartile range） （13[3-32] /ml vs. 31[7-59]/ml; Z=3.913, P=0.001） was significantly lower than the control group. Multivariate logistic regression analysis showed that the decreased circulating EPC level （odd ratio 2.632, 95% confidence interval 1.412-4.907, P=0.002） was an independent risk factor for LAAS after adjusting the confounders. The EPC level in the CAB 〉3 group was significantly lower than that in the CAB 1 group （5 [2-19]/ml vs. 22 [9-43]/ml; Z=3.338, P=0.011）. Spearman rank correlation analysis showed that the EPC level was significantly negatively correlated with CAB （r=-0.257, P=0.002）. ConclusionsThe decreased circulating EPC level was an indenpendent risk factor for the onset of LAAS, and the EPC level was negatively correlated with CAB.