急性心肌梗死伴2型糖尿病患者内皮祖细胞动员障碍
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国家自然科学基金(30170370);江苏省自然科学基金(BK2004083)


Impaired Mobilization of Bone-Derived Endothelial Progenitor Cells in Patients of Acute Myocardial Infarction with Type 2 Diabetics
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    摘要:

    目的观察急性心肌梗死伴2型糖尿病患者血浆缺血相关因子血管内皮生长因子和基质细胞衍生因子水平,骨髓内皮祖细胞动员是否存在障碍,以及基质细胞衍生因子、血管内皮生长因子-内皮祖细胞动员通路是否存在异常。方法采用密度梯度离心法分离外周血单个核细胞,用流式细胞仪检测急性心肌梗死后不同时间点(1、3、5、7、14和28天)外周血CD45-/low+/CD34+/CD133+/KDR+早期内皮祖细胞数量。酶联免疫吸附法检测血浆中血管内皮生长因子、基质细胞衍生因子以及高敏C反应蛋白的浓度。结果急性心肌梗死伴2型糖尿病患者外周血内皮祖细胞动员高峰(第7天)较急性心肌梗死非糖尿病患者(第5天)延迟且显著减少[(140±48)/106比(246±100)/106,P<0.05]。糖尿病组血浆血管内皮生长因子(第5天:277±95ng/L比168±35ng/L,P<0.05)、基质细胞衍生因子(第5天:3835±402ng/L比3287±384ng/L,P<0.05)以及高敏C反应蛋白(第3天:55.55±14.88mg/L比36.92±14.83mg/L,P<0.05)在高峰点的水平显著高于非糖尿病组。结论糖尿病患者心肌梗死后组织缺血程度较重,但组织缺血后基质细胞衍生因子、血管内皮生长因子-内皮祖细胞动员通路存在障碍,这可能是糖尿病患者缺血后血管新生功能障碍,发生急性心肌梗死后预后较差的原因之一。

    Abstract:

    Aim To observe the level of plasma vascular endothelial growth factor (VEGF),stromal cell-derived factor-1α (SDF-1α),whether mobilization of endothelial progenitor cells (EPC) is impaired in patients of acute myocardial infarction (AMI) with type 2 diabetics,and the pathway of SDF-1α,VEGF-EPC is abnormal. Methods Circulating CD45-/low+/ CD34+/ CD133+/ KDR+ early EPC count in peripheral blood mononuclear cells(PBMC) were quantified by flow cytometric analysis on day 1,3,5,7,14,28 after AMI. Plasma VEGF,SDF-1α and high sensitivity C-reactive protein (hs-CRP) level were mearsured at the above time points as those at EPC number counts with a standardized ELISA-kit. Results In non-diabetic patients,circulating EPC count increased after AMI,with the highest peak at day 5,following which EPC count gradually returned to baseline. In patients with type 2 diabetes,the highest peak was delayed (day 7 vs day 5),and the magnitude of EPC mobilization was decreased as compared with non-diabetic subjects [highest EPC count:(140±48)/106 vs (246±100)/106,P<0.05]. Plasma VEGF [day 5:277±95 ng/L vs 168±35 ng/L,P<0.05],SDF-1α [day 5:3 835±402 ng/L vs 3 287±384 ng/L,P<0.05]and hs-CRP[day 3:55.55±14.88 mg/L vs 36.92±14.83 mg/L,P<0.05] were significantly higher in AMI patients with diabetics than those without diabetics. Conclusion Tissue ischemia is more serious and ischemia-induced bone marrow-derived EPC mobilization is impaired in AMI patients with type 2 diabetics,and such impairment is likely due to impaired SDF-1α,VEGF -EPC mobilization pathway. This abnormal SDF-1α,VEGF-EPC mobilization pathway possibly contributes to the poor collateralization observed in diabetic patients in response to vascular occlusive disease.

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王昆,康丽娜,王涟,宋杰,张静梅,徐标.急性心肌梗死伴2型糖尿病患者内皮祖细胞动员障碍[J].中国动脉硬化杂志,2008,16(10):829~833.

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  • 收稿日期:2008-09-01
  • 最后修改日期:2008-10-09
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