短暂脑缺血发作后继脑梗死患者循环内皮祖细胞的变化及意义  

The changes and value of circulating endothelial progenitor cells levels in cerebral infarct patients with prior transient ischemic attack

作　　者：李龙宣[1] 赵斌[1] 唐荣华[2] 柯俊龙[1] 

机构地区：[1]广东医学院附属医院神经科,广东湛江524001 [2]华中科技大学同济医学院附属同济医院神经科,湖北武汉430030

出　　处：《中风与神经疾病杂志》2010年第12期1072-1075,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨短暂脑缺血发作(TIA)后继脑梗死患者早期外周血循环内皮祖细胞(EPCs)的变化及意义。方法序贯收集首次脑梗死患者58例,根据病前有无同侧TIA史分为TIA组(26例)和非TIA组(32例),另选取16例健康志愿者为正常对照。以NIHSS评分评价神经功能缺损程度;根据头部CT测定脑梗死灶体积;以CD34和KDR双阳性细胞作为EPCs标记,用流式细胞仪测定早期外周血循环EPCs数量,以ELISA检测血管内皮生长因子(VEGF)含量。分析循环EPCs数量与神经功能缺损程度、脑梗死体积及血清VEGF含量间的相关性。结果 TIA组患者NIHSS评分及梗死体积明显小于非TIA组(均P<0.01)。非TIA组患者外周血循环EPCs数量与正常对照组有上升趋势,但无统计学差异;TIA组患者外周血循环EPCs数量和血清VEGF含量均显著高于非TIA组和正常对照组(均P<0.001)。相关分析显示:有或无TIA史的脑梗死患者循环EPCs数量与神经功能缺损严重程度或脑梗死体积均成负相关,而且在TIA组内EPCs数量与血清VEGF含量呈正相关。结论早期外周血循环EPCs数量关系到急性缺血性卒中的严重程度。TIA增加了对循环EPCs的动员,提高了外周血循环EPCs数量,EPCs增加很可能受VEGF调节,这可能是TIA发挥对后继脑梗死保护作用的机制之一。Objective To investigate the changes and value of circulating endothelial progenitor cells（EPCs） from peripheral blood in cerebral infarct patients with prior transient ischemic attack（TIA）.Methods A total of 58 cases of first ever cerebral infarct patients were consecutively allocated to two groups,that is,TIA group（n=26） and non-TIA group（n=32） based on the presence or absence of prior ipsilateral TIA.16 healthy individuals were included as normal controls.Stroke severity was assessed by certified neurologists using the National Institutes of Health Stroke Scale（NIHSS） at admission.Cerebral infarct volumes were calculated according to CT scan.Early peripheral blood circulating EPCs were characterized by double staining using antibodies against CD34 and vascular endothelial growth factor receptor-2（or KDR）.Serum concentrations of vascular endothelial growth factor（VEGF） were determined by enzyme-linked immunosorbent assay.Spearman correlation analyses were used to determine the correlation between circulating EPCs and stroke severity,cerebral infarct volumes and serum levels of VEGF.Results The NIHSS scores and cerebral infarct volumes of patients in TIA group were significantly lower than those of non-TIA group（P〈0.01）.The peripheral blood circulating EPCs counts in non-TIA group were a little higher than normal controls,but it made no significant difference between two groups.The circulating EPCs counts and serum levels of VEGF in TIA group were both significantly higher than those of non-TIA group and normal controls（both P〈0.001）.The circulating EPCs counts negatively correlated with stroke severity and cerebral infarct volumes in TIA and non-TIA groups.Also,a positive correlation between circulating EPCs counts and VEGF expression was found within TIA group.Conclusions The early level of circulating EPCs is associated with acute ischemic stroke severity.TIA increases the mobilization of EPCs and elevates the levels of EPCs in peripheral blood.And the increase of EPCs

关 键 词：短暂脑缺血发作 内皮祖细胞 脑梗死 缺血耐受现象 血管内皮生长因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]