循环内皮祖细胞对缺血性卒中的预后具有预测价值

hy2007

Level and Value of Circulating Endothelial Progenitor Cells in Patients After Acute Ischemic Stroke

Background and Purpose— Endothelial progenitor cells (EPCs) migrate from bone marrow to systemic circulation in response to tissue ischemia where they differentiate into mature endothelial cells for angiogenesis in situ. This study tested the hypothesis that the level of circulating EPCs is substantially increased and predictive of prognostic outcomes after acute ischemic stroke (IS).

Methods— The level of circulating EPCs (staining markers: CD31/CD34 [E1], CD62E/CD34 [E2], and KDR/CD34 [E3]) were examined using flow cytometry at 48 hours after acute IS in 138 consecutive patients. The EPC level was also evaluated once in 20 healthy volunteers and in 40 at-risk control subjects.

Results— Level of circulating EPCs (E1–3) was significantly higher in patients with IS than in at-risk control subjects (P<0.05). Additionally, EPC (E1–3) level was significantly lower in patients with severe neurological impairment (defined as a score 12 on the National Institutes of Health Stroke Scale) than in patients with less severe impairment (National Institutes of Health Stroke Scale < score 12) at 48 hours after IS (P<0.0001). Moreover, the EPC (E3) level was strongly correlated with improved National Institutes of Health Stroke Scale 4 on day 21 after IS (P=0.0004). Furthermore, low circulating EPC level was independently predictive of severe neurological impairment (National Institutes of Health Stroke Scale 12) at 48 hours (E1–3) and combined major adverse clinical outcomes (defined as recurrent IS, any cause of death, or National Institutes of Health Stroke Scale of 12) on day 90 (E1) after IS (P<0.001).

Conclusions— Level of circulating EPCs is independently predictive of prognosis after IS.
Stroke. 2008;39:69-74
背景和目的：在组织发生缺血性损伤后，内皮祖细胞(EPCs)自骨髓移行至体循环，并在损伤部位分化为成熟内皮细胞进而进行血管生发过程。本研究验证了在急性缺血性发作后循环中EPCs水平大量增加并可作为预后指标这一假说。
方法：观察138位急性缺血性脑卒中患者，在急性缺血性脑卒中后48小时流式细胞术测定循环中EPCs水平（利用CD31/CD34 [E1], CD62E/CD34 [E2], and KDR/CD34 [[E3]染色]），同时以20位健康志愿者和40位高危人群的EPC水平作为对照。
结果：循环中EPCs水平在急性缺血性脑卒中患者显著高于高危对照组(P<0.05)。另外，在急性脑卒中发生后24小时，EPC水平在发生严重神经损伤患者（定义为12分，依据美国国家卫生研究院脑中风评估量表评分标准，以下简称NIHSS）显著低于发生较轻神经损伤者（NIHSS评分低于12分） (P<0.0001)。并且，EPC水平在脑卒中发作后21天与改良的美国国家卫生研究院脑中风评评分表4显示了强烈相关性(P=0.0004)。此外，在急性脑卒中发作后，循环中低EPCs水平可作为48小时内发生严重神经损伤（NIHSS评分12分）和90天内合并主要不良事件（包括急性脑卒中复发，任何原因导致的死亡，或者NIHSS评分12分）的独立性预后因素(P<0.001)。
结论：循环EPCs水平可作为缺血性脑卒中独立预后因素。