原发性高血压儿童降压治疗前后外周血循环内皮细胞和内皮祖细胞水平的变化  

The dynamic changes of the levels of circulating endothelial cells and endothelial progenitor cells in peripheral blood of children with essential hypertension before and after antihypertensive therapy

作　　者：崔雅茜 石琳 崔小岱[3] 孙丽萍[3] CUI Ya-xi;SHI Lin;CUI Xiao-dai;SUN Li-ping(Capital Institute of Pediatrics-Peking University Teaching Hospital,Beijing,100020,China;Department of Cardiology,Children’s Hospital Affiliated to Capital Institute of Pediatrics;Central Laboratory,Capital Institute of Pediatrics)

机构地区：[1]北京大学首都儿科研究所教学医院,北京100020 [2]首都儿科研究所附属儿童医院心血管内科 [3]首都儿科研究所中心实验室

出　　处：《中华高血压杂志》2022年第3期253-259,共7页Chinese Journal of Hypertension

基　　金：北京市医院管理中心儿科学协同发展中心儿科专项项目(XTYB201801);首都儿科研究所方向性引导基金项目(FX-15-02)。

摘　　要：目的探讨原发性高血压儿童外周血循环内皮细胞(CEC)和内皮祖细胞(EPC)在血压控制前后的动态变化,以揭示血压动态变化对血管内皮损伤和修复的影响。方法采用前瞻性研究,以2019年6月至2020年2月在首都儿科研究所附属儿童医院诊断为原发性高血压且未经治疗的患儿57例(男44例、女13例)为高血压组,年龄(13.3±1.2)岁;同时纳入在门诊体检的健康儿童30名(男19名,女11名)作为对照组,年龄(13.0±1.1)岁。应用流式细胞仪测定外周血CEC和EPC的数量,经过3个月系统化治疗后,再次测定外周血CEC和EPC的数量。结果治疗前,高血压组儿童外周血CEC数量高于对照组[55.0(32.5~104.0)/μL比21.0(14.0~25.3)/μL,Z=-6.199,P<0.001];外周血EPC数量低于对照组[3.0(1.5~4.5)/μL比17.5(13.8~30.0)/μL,Z=-6.859,P<0.001]。与高血压组治疗前相比,高血压组治疗后收缩压水平下降[(123.2±5.2)比(137.7±8.9)mm Hg,t=17.666,P<0.001];舒张压水平下降[(70.5±4.4)比(80.0±6.4)mm Hg,t=14.740,P<0.001];外周血CEC数量减少[29.0(13.0~46.5)/μL比55.0(32.5~104.0)/μL,Z=-6.567,P<0.001];外周血EPC数量增高[9.0(5.0~18.0)/μL比3.0(1.5~4.5)/μL,Z=-6.515,P<0.001]。Spearman相关性分析显示,治疗前,收缩压与外周血CEC呈正相关(r;=0.583,P<0.001),与外周血EPC呈负相关(r;=-0.384,P=0.030)。多元线性回归分析显示,收缩压是外周血CEC和EPC的主要影响因素。结论原发性高血压患儿存在CEC升高和EPC降低的情况。治疗前外周血CEC和EPC水平与收缩压水平相关,收缩压是外周血CEC和EPC的危险因素。在有效抗高血压治疗后,外周血CEC和EPC有明显改变。Objective To investigate the dynamic changes of circulating endothelial cells(CEC)and endothelial progenitor cells(EPC)in children with essential hypertension before and after antihypertensive therapy,and reveal the effect of blood pressure dynamic changes on vascular endothelium.Methods A prospective study was conducted.A total of 57 untreated essential hypertension children(44 males and 13 females)with the average age of(13.3±1.2)years were enrolled in Children’s Hospital,Capital Institute of Pediatrics from June 2019 to February 2020.Thirty healthy children were included as the control group(19 males and 11 females),and the average age was(13.0±1.1)years.The number of CEC and EPC in peripheral blood were measured by flow cytometry.After 3 months of treatment,the number of CEC and EPC in peripheral blood were measured again.Results Before treatment,compared with children in control group,children with essential hypertension had higher peripheral blood CEC[55.0(32.5-104.0)/μL vs 21.0(14.0-25.3)/μL,Z=-6.199,P<0.001]and lower peripheral blood EPC[3.0(1.5-4.5)/μL vs 17.5(13.8-30.0)/μL,Z=-6.859,P<0.001].There were significant differences in systolic/diastolic blood pressure before and after treatment[(137.7±8.9)vs(123.2±5.2)mm Hg,t=17.666;(80.0±6.4)vs(70.5±4.4)mm Hg,t=14.740,both P<0.001].After treatment,the number of peripheral blood CEC in hypertensive group reduced[29.0(13.0-46.5)/μL vs 55.0(32.5-104.0)/μL,Z=-6.567,P<0.001],and the number of peripheral blood EPC increased[9.0(5.0-18.0)/μL vs 3.0(1.5-4.5)/μL,Z=-6.515,P<0.001].Spearman correlation coefficient analysis showed that systolic blood pressure in children with essential hypertension had a positive correlation with the peripheral blood CEC(r;=0.583,P<0.001),and a negative correlation with the peripheral blood EPC(r;=-0.384,P=0.030)before treatment.Multiple linear regression analysis showed that systolic blood pressure was the main influencing factor of the CEC and EPC.Conclusions Peripheral blood CEC and EPC levels in children with essentia

关 键 词：儿童 原发性高血压 循环内皮细胞 内皮祖细胞 降压治疗 

分 类 号：R725.4[医药卫生—儿科]