阿托伐他汀对急性ST段抬高型心肌梗死患者外周血内皮祖细胞表面标志物表达的影响  

Effect of atorvastatin on expression of peripheral blood EPC surface markers in patients with acute ST-segment elevation myocardial infarction

作　　者：刘洁[1] 陈祖平[1] 陈见红[1] 银剑斌[1] 储成顶[2] 

机构地区：[1]柳州市人民医院心血管内科,广西柳州545006 [2]安徽医科大学公共卫生学院,安徽合肥230032

出　　处：《中国病理生理杂志》2017年第5期851-856,共6页Chinese Journal of Pathophysiology

基　　金：广西壮族自治区卫计委科研基金资助项目(No.Z2014546)

摘　　要：目的:比较不同剂量的阿托伐他汀对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者中内皮祖细胞(endothelial progenitor cells,EPCs)功能变化的影响。方法:选择确诊为STEMI的患者共40例,根据服用阿托伐他汀钙片的剂量不同,随机分为20 mg组及40 mg组。采用流式细胞术,在不同时点(服药前及服药后第5、10、15、20、30、60、90、120天)对STEMI患者的循环EPCs进行识别及量化分析,检测EPCs表面标志物CXC趋化因子受体(CXCR)4、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、沉默信息调节因子1(SIRT1)的表达。结果:第5天40 mg组细胞增殖力及CXCR4、VEGF、bFGF的表达高于20 mg组(P<0.05);第10~120天20 mg组细胞增殖力及CXCR4、VEGF、bFGF的表达高于40 mg组(P<0.05)。SIRT1在第30天前2组的表达差异无统计学显著性;在第30天后出现明显变化,第60天达高峰,随后呈下降趋势,各时点均可见20 mg组大于40 mg组(P<0.05)。结论:在STEMI急性期,40 mg阿托伐他汀提升机体修复功能优于20mg。然而,长期低浓度的他汀治疗在改善血管内膜功能和促进血管新生作用方面优于高剂量。AIM： To compare the effects of atorvastatin at different doses on the function of endothelial proge-nitor cells （EPCs） in the patients with ST-segment elevation myocardial infarction （STEMI）.METHODS： The patients of STEMI （n=40） were chosen. According to treatment with different doses of atorvastatin calcium tablet, they were randomly divided into a group of 20 mg and a group of 40 mg （20 cases in each group）. The EPCs isolated from the patients were identified and quantitatively analyzed at different time points （before the treatment and on days 5, 10, 15, 20, 30, 60, 90 and 120 after the treatment） by flow cytometry. The surface markers of the EPCs, CXC chemokine receptor 4 （CXCR4）, vascular endothelial growth factor （VEGF）, basic fibroblast growth factor （bFGF） and silent information regulator 1 （SIRT1）, were also detected.RESULTS： On the 5th day, the group of 40 mg demonstrated stronger cell proliferation capability and higher expression levels of CXCR4, VEGF and bFGF than the group of 20 mg （P〈0.05）. From the 10th day to 120th day, the group of 20 mg revealed stronger cell proliferation capability and higher expression levels of CXCR4, VEGF and bFGF than the group of 40 mg （P〈0.05）. Within 30 d, the expression of SIRT1 showed no significant diffe-rence between the 2 groups, yet it witnessed a marked change after that and peaked on the 60th day with a drop afterwards. At each time point, the SIRT1 expression level in the group 20 mg was observed higher than that in the group of 40 mg （P〈0.05）.CONCLUSION： In the acute phase, the repair function of the body treated with atorvastatin at dose of 40 mg is better than that with 20 mg. However, in a long term the low concentration of statin therapy works better in improving the vascular intima and promoting the angiogenesis than high concentration.

关 键 词：ST段抬高型心肌梗死 内皮祖细胞 阿托伐他汀 CXC趋化因子受体4 血管内皮生长因子 碱性成纤维细胞生长因子 沉默信息调节因子1 

分 类 号：R542.22[医药卫生—心血管疾病] R363[医药卫生—内科学]