慢性脑缺血及急性缺血性脑卒中患者循环内皮祖细胞及其诱导因子的表达变化

Expression changes of circulating endothelial progenitor cells and their inducible factors in patients with chronic cerebral hypoperfusion and acute ischemic stroke

目的探讨慢性脑缺血(CCH)及急性缺血性脑卒中(AIS)患者循环内皮祖细胞(EPCs)水平及血管内皮生长因子(VEGF)、基质细胞衍生因子-1(SDF-1)、低氧诱导因子-1(HIF-1)的表达情况,比较CCH与AIS患者EPCs表达水平及其诱导因子的表达差异。方法四川省人民医院神经内科门诊就诊的CCH患者34例(CCH组),同期住院诊治的AIS患者31例(AIS组),对照组为同期健康体检者25例。收集患者临床资料;采用动脉自选标记(ASL)检查证实CCH组存在脑血流低灌注区;流式细胞学技术检测血液中EPCs的表达情况;酶联免疫吸附法检测血清中VEGF、SDF-1、HIF-1的表达量。结果AIS组吸烟率高于CCH组(P<0.05),CCH组及AIS组高血压病患病率高于对照组(P<0.05)。CCH患者脑缺血部位多见于额叶及半卵圆中心,且27例CCH患者为颅内多发脑组织缺血。26例AIS患者存在不同程度头颈部动脉狭窄和(或)闭塞改变。CCH组EPCs、VEGF、HIF-1表达高于对照组(P<0.05),SDF-1表达与对照组比较差异无统计学意义(P>0.05)。AIS组EPCs、VEGF、HIF-1表达高于对照组,SDF-1表达低于对照组(P<0.05)。AIS组与CCH组比较,VEGF表达升高(P<0.05),EPCs、HIF-1、SDF-1表达差异无统计学意义(P>0.05)。结论CCH患者脑缺血部位多见于额叶及半卵圆中心,且大部分CCH患者为颅内多发脑组织缺血。CCH患者与早期AIS患者EPCs升高,可能与VEGF及HIF-1升高有关。CCH向AIS早期转化过程中,EPCs的表达变化不明显,但其诱导因子VEGF已在发生变化。

Objective To investigate the levels of circulating endothelial progenitor cells(EPCs)and the expression levels of EPCs induction factors such as vascular endothelial growth factor(VEGF),stromal cell-derived factor-1(SDF-1)and hypoxia inducible factor-1(HIF-1)in patients with chronic cerebral hypoperfusion(CCH)and acute ischemic stroke(AIS),and to compare the expressions of EPCs and inducible factors between patients with CCH and AIS.Methods Thirty-four patients with CCH(CCH group),31 patients with AIS(AIS group)and 25 healthy subjects during the same period(control group)at the department of Neurology of Sichuan Provincial People′s Hospital were selected.Clinical data of the patients were collected.Arterial self-selective marker(ASL)examination was used to confirm the presence of cerebral blood flow hypoperfusion in the CCH group.Flow cytometry was used to detect the expression of EPCs in blood.Enzyme-linked immunosorbent assay was used to detect the expression levels of serum VEGF,SDF-1 and HIF-1.Results The smoking rate in the AIS group was higher than that in the CCH group(P<0.05).The prevalence of hypertension in the CCH group and AIS group was higher than that in the control group(P<0.05).The cerebral ischemia sites in the CCH patients are mainly in the frontal lobe and semiovale center,and most CCH patients have multiple cerebral tissue ischemia.Most AIS patients had different degrees of head and neck artery stenosis and/or occlusion.The expressions of EPCs,VEGF and HIF-1 in the CCH group were higher than those in the control group(P<0.05),while the expression of SDF-1 had no significant change compared with the control group(P>0.05).The expressions of EPCs,VEGF and HIF-1 in the AIS group were higher than those in the control group(P<0.05),while the expression of SDF-1 in the AIS group was lower than that in the control group(P<0.05).Compared with the CCH group,VEGF expression was increased in the AIS group(P<0.05),while there were no significant differences in EPCs,HIF-1 and SDF-1 between the two groups(P>0.05).Conclusion The most common sites of cerebral ischemia in patients with CCH are frontal lobe and semiovale center,and most patients with CCH have multiple cerebral tissue ischemia.EPCs are elevated in CCH patients and AIS patients,which may be related to the increased expression of VEGF and HIF-1.During the early transformation from CCH to AIS,the expression of EPCs do not change significantly,but its inducer VEGF is changing.