进展性脑梗死患者循环内皮细胞数量及与糖化血红蛋白、同型半胱氨酸水平的相关性

Circulating endothelial cell quantity in patients with stroke in progression and its association with HbAlc and Hcy levels

目的探讨进展性脑梗死(SIP)患者外周血循环内皮细胞(CECs)、糖化血红蛋白(Hb A1c)、同型半胱氨酸(Hcy)的含量变化及其临床意义。方法选取2014年11月至2016年4月在石家庄市第一医院神经内科确诊的SIP患者50例(SIP组)、非进展性脑梗死(NSIP)患者50例(NSIP组),并选择同一时期进行体检的正常健康成人24例作为对照组。运用流式细胞仪法测定SIP组及NSIP组发病第1天和第7天外周血中CECs的含量,用Hb A1c分析仪、氨基酸分析仪分别测定脑梗死患者Hb A1c、Hcy含量,并与24例健康对照组进行比较。结果 SIP组及NSIP组发病第1天CECs、Hb A1c明显高于正常对照组(P均<0.05),但3组Hcy水平无显著差异(P均>0.05);SIP组Hb A1c、第7天CECs水平明显高于NSIP组,SIP组和NSIP组发病第7天外周血CECs水平较发病第1天均明显升高(P均<0.05)。SIP组发病第7天外周血CECs水平与Hb A1c(r=0.714,P=0.000)、Hcy(r=0.819,P=0.000)均呈明显正相关,NSIP组发病第7天CECs水平与Hcy呈正相关(r=0.55,P=0.000),与Hb A1c无相关性(r=0.161,P=0.265)。结论血管内皮损伤在脑梗死发病机制中发挥重要作用,Hb A1c、Hcy含量的升高可能是脑梗死急性期病情进展的重要因素。

Objective To investigate the changes of circulating endothelial cells （CECs） quantity and contents of glycosylated hemoglobin （HbAle） and homocysteine （Hcy） in peripheral blood and the clinical significance in patients with stroke in progression （SIP）. Methods Fifty patients with SIP （ SIP group） and 50 patients with stroke in non- progression（ NSIP, NSIP group） diagnosed between November 2014 and April 2016 in department of neurology of First Hospital of Shijiazhuang were selected, and 24 healthy adults during the same period were selected as control group. Flow eytometer was used to detect the quantities of CECs of peripheral blood in the first day and seventh day in SIP group and NSIP group. HbAlc analyzer and amino-acid analyzer were used to respectively detect HbAle and Hcy contents. Above results were compared in three groups. Results In the first day of onset,levels of CECs and HbAlc in SIP group and NSIP group were all significantly higher than those in control group （ all P 〈 0.05 ） , but there were no significant differences in Hcy levels in three groups （ all P 〉 0.05 ）. Levels of HbAlc and CECs at the seventh day in SIP group were significantly higher than those in NSIP group （ all P 〈 0.05 ）. CECs levels in peripheral blood at the seventh day of onset in SIP group and NSIP group were significantly higher than that at the first day of onset （ all P 〈 0.05 ）. In SIP group, CECs levels in peripheral blood at the seventh day of onset was positively correlated with HbAlc （ r = 0. 714, P = 0. 000 ） and Hcy （ r = 0. 819 ,P =0. 000）. In NSIP group, CECs levels in peripheral blood at the seventh day of onset was positively correlated with Hcy（r =0. 55 ,P =0. 000） while not correlated with HbAlc（r =0. 161 ,P =0. 265）. Conclusion Vascular endothelial injury plays an important role in the pathogenesis of cerebral infarction, and the increase of HbAlc and Hcy may be the important factors in the progression of cerebral infarction at acute stage.