慢性稳定型心绞痛患者PCI术后循环内皮祖细胞计数变化及其影响因素
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(天津市胸科医院心内科,天津市 300222)

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张楠,硕士,主治医师,研究方向为心血管病内科治疗,E-mail为fish7910@hotmail.com。

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天津市卫生局科技基金项目(2013KZ077)


The dynamic change of circulating endothelial progenitor cells counts after percutaneous coronary intervention in patients with chronic stable angina pectoris and its influence factors
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Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China)

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    摘要:

    目的 研究慢性稳定型心绞痛患者经皮冠状动脉介入治疗(PCI)前后循环内皮祖细胞(EPC)的数量变化,并探讨PCI术后CD34+/KDR+最大动员幅度与患者内皮损伤定量参数等临床资料的相关性。方法 选取93例诊断为慢性稳定型心绞痛的患者,将其中成功行PCI术治疗的72例患者作为PCI组,21例仅行冠状动脉造影术(CAG)保守治疗的患者作为对照组。采集患者股动脉鞘管或肘正中静脉血样,通过流式细胞仪对PCI组和对照组患者CAG术后即刻(基线水平)及PCI术后或CAG后1 h、3 h、5 h、7 h、24 h的EPC数量进行测定。结果 不同类型的EPC在不同时间点及在PCI组和对照组两组间的总体均数存在统计学差异(P<0.05)。PCI组中,与基线水平相比,CD34+/KDR+在24 h,CD133-/CD34+/KDR+在3 h、5 h、24 h,CD133+/CD34+/KDR+在5 h、7 h,CD133+/KDR+在3 h、5 h,CD133+/CD34+在24 h差异有统计学意义(P<0.05)。对照组中,各类型EPC在不同时间点计数与基线水平相比,无统计学差异(P>0.05)。CD34+/KDR+最大动员幅度与C反应蛋白呈现负相关,与体质指数、服用血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂类药物的情况、血管内皮损伤定量参数呈现正相关(P<0.01)。结论 PCI导致的血管内皮损伤可以引发EPC时间依赖性的动态变化,同时可以促进CD34+/KDR+的大幅动员、迁移、归巢,有利于受损血管内皮修复愈合,减少并发症,改善患者预后。

    Abstract:

    Aim To investigate the dynamic changes of circulating endothelial progenitor cells(EPC) counts after percutaneous coronary intervention(PCI) in patients with chronic stable angina pectoris and related factors of CD34+/KDR+ maximum motivation. Methods 93 patients were divided into PCI group (n=72) and control group (n=21).Blood samples were collected by femoral artery sheath or median cubital vein. EPC counts were measured following CAG(baseline) and 1 h, 3 h, 5 h, 7 h, 24 h after PCI or CAG by flow cytometry. Results Population means of different type EPC counts has significantly statistic difference at different time points and EPC counts between PCI group and control group(P<0.05). In PCI group, CD34+/KDR+ at 24 h, CD133-/CD34+/KDR+ at 3 h, 5 h, 24 h, CD133+/CD34+/KDR+ at 5 h, 7 h, CD133+/KDR+ at 3 h, 5 h, CD133+/CD34+ at 24 h has significantly statisitc difference compared with baseline(P<0.05). However, there has no significantly statisitc difference in the counts of each type of EPC at different time points compared with baseline in the control group(P>0.05). The maximum motivation of CD34+/KDR+ has negative relationship with basal C-reactive protein, and has positive correlations with body mass index (BMI), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor antagonists (ARB) drug treatment and the quantitative parameters of endothelial injury. Conclusion PCI can initiate time-dependment mobilization of EPC and promote motivation, migration and recruitment of CD34+/KDR+ which can accelerate endothelial damage reparation and reduce complication of patients with chronic stable angina pectoris after PCI to improve prognosis.

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张楠,刘寅,高明东.慢性稳定型心绞痛患者PCI术后循环内皮祖细胞计数变化及其影响因素[J].中国动脉硬化杂志,2017,25(2):165~170.

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  • 收稿日期:2016-04-11
  • 最后修改日期:2016-08-09
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  • 在线发布日期: 2017-02-08