循环内皮祖细胞与脑梗死急性期神经功能缺损症状的关系研究

Relationships study of endothelial progenitor cells and the neurologic impairment symptoms of acute cerebral infarction

目的观察脑梗死患者急性期外周血内皮祖细胞(endothelial progenitor cells,EPCs)的水平变化情况,探讨EPCs对脑梗死急性期神经功能缺损症状严重程度的预测价值。方法连续纳入首次发病24 h内住院的急性脑梗死患者72例为脑梗死组,同期选择宿州市立医院脑卒中筛查门诊脑卒中高危患者50例作为对照组。以发病1周内最高美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分作为脑梗死患者急性期神经功能缺损程度的评估标准,NIHSS评分<7分为轻症组,≥7分为重症组;以CD133^+KDR^+细胞作为EPCs的标记,采用流式细胞分析,分别检测急性脑梗死患者发病后第1、5、10天的外周血EPCs数量。结果急性脑梗死患者EPCs数量存在动态变化趋势,呈第1天降低、第5天升高、第10天下降趋势,且均显著低于对照组(均P<0.05);重症组第1、5、10天EPCs数量均低于轻症组,差异有统计学意义(均P<0.05),脑梗死急性期NIHSS评分与第1、5、10天外周血EPCs数量呈负相关(相关系数分别为r_1=-0.762、r_5=-0.622、r_(10)=-0.414,均P<0.05)。结论脑梗死患者急性期外周血基线EPCs水平明显降低;外周血EPCs水平降低可能是脑梗死的危险因素;脑梗死急性期EPCs数量越低提示患者神经功能缺损症状越重,EPCs对脑梗死患者急性期神经功能缺损症状评估具有指导意义。

Objective To observe the changes of peripheral blood endothelial progenitor cells （EPCs）in patients with acute cerebral infarction （ACI）. To investigate the predictive value of EPCs in the neurologic impairment symptoms of acute cerebral infarction. Methods Consecutive 72 patients with acute ischemic stroke within 24 hours were enrolled in the study, and all patients were diagnosed acute ischemic stroke for the first time. At the same time to choose our stroke screening outpatient 50 cases as control group. To within 1 week of the highest of the National Institute of Health stroke scale（NIHSS） scores as the evaluation criteria for the severity of the neurologic impairment symptoms of acute cerebral infarction. As CD133^ ＋ KDR^＋ cells as a sign of EPCs,using flow cytometry in patients with acute cerebral infarction inci- dence 1,5,10 clays the number of peripheral blood EPCs. Results In patients with acute cerebral infarction 1 d ,5 d, 10 d number of EPCs in 1 d reduce 5 d increased 10 d downward trend, and were significantly lower than the control group （ all P 〈 0.05 ）. Severe group 1 d ,5 d, 10 d number of EPCs were lower than that of mild group, and a statistically significant differences（ all P 〈 0.05 ）. Cerebral infarction in patients with acute phase NIHSS score and the onset of EPCs negatively correlated with the number 1 d,5 d, 10 d （ r1 = - 0. 762, r5 = - 0. 622, r10 = - 0.414, all P 〈 0.05 ）. Conclusion Baseline level of EPCs was significantly lower in patients with ACI than control group, EPCs may be an risk factor for acute cerebral infarction. Cerebral infarction in patients with acute phase, the lower the number of EPCs and the heavier of the neurologic impairment symptoms. EPCs in patients with cerebral infarction in acute stage of the neurologic impairment symptoms assessment has a guiding significance.