CAJ | 학술논문

目的探讨冠心病患者不同胰岛素水平与循环内皮祖细胞(EPC)数量、功能及冠状动脉病变程度的关系并探讨相关临床意义.方法 69例经选择性冠状动脉造影证实的冠心病患者,按胰岛素水平高低分为胰岛素抵抗(IR)组和胰岛素敏感(IS)组,另设25例健康对照者.采集研究对象外周血以激酶插入区域受体(KDR)和CD133双阳性为循环EPC标记行流式细胞分析,同时采血进行EPC的分离培养,7 d后鉴定并检测增殖及迁移能力,将各组的一般临床资料,循环EPC数量、迁移、增殖能力指标、稳态模型胰岛素抵抗指数(HOMA-IR)及冠状动脉病变Gensini评分进行统计学分析.结果 IR组循环EPC数量明显少于IS组[(0.34±0.08)‰比(0.47±0.09)‰,P<0.01],HOMA-IR自然对数与循环EPC数量呈负相关(r=-0.291,P=0.01),循环EPC数量与Gensini评分呈负相关(r=-0.3984,P=0.006).IR组的增殖能力和迁移能力均低于IS组减弱(P<0.05).结论冠心病患者血清胰岛素水平与循环EPC数量呈负相关.循环EPC数量及功能与冠状动脉病变程度呈负相关;IR或高胰岛素血症可能部分通过损害循环EPC的数量及功能,从而影响冠状动脉病变程度.
목적 탐토관심병환자불동이도소수평여순배내피조세포(EPC)수량、공능급관상동맥병변정도적관계병탐토상관림상의의.방법 69례경선택성관상동맥조영증실적관심병환자,안이도소수평고저분위이도소저항(IR)조화이도소민감(IS)조,령설25례건강대조자.채집연구대상외주혈이격매삽입구역수체(KDR)화CD133쌍양성위순배EPC표기행류식세포분석,동시채혈진행EPC적분리배양,7 d후감정병검측증식급천이능력,장각조적일반림상자료,순배EPC수량、천이、증식능력지표、은태모형이도소저항지수(HOMA-IR)급관상동맥병변Gensini평분진행통계학분석.결과 IR조순배EPC수량명현소우IS조[(0.34±0.08)‰비(0.47±0.09)‰,P<0.01],HOMA-IR자연대수여순배EPC수량정부상관(r=-0.291,P=0.01),순배EPC수량여Gensini평분정부상관(r=-0.3984,P=0.006).IR조적증식능력화천이능력균저우IS조감약(P<0.05).결론 관심병환자혈청이도소수평여순배EPC수량정부상관.순배EPC수량급공능여관상동맥병변정도정부상관;IR혹고이도소혈증가능부분통과손해순배EPC적수량급공능,종이영향관상동맥병변정도.
Objective To investigate the correlation between the number and activity of circulating endothelial progenitor cells (EPCs), insulin resistance and severity of coronary lesions in patients with coronary artery disease (CAD). Methods Patients with coronary angiography evidenced CAD were divided in insulin resistance group ( IR, n = 25 ) and insulin sensitive group ( IS, n = 44) according to insulin level, 25 health volunteers served as control. Circulating EPCs were marked as KDR/CD133<'+ cells via fluorescence- activated cell sorter analysis. EPCs were also isolated from peripheral blood and cultured in vitro for 7 days, identified by DiI-acLDL uptake and lectin staining methods. EPCs migration activities were determined by modified Boyden chamber assay, EPCs proliferation activities were determined by MTT assay. Result Circulating EPCs number was significantly lower in IR group compared with IS group [ (0. 34±0. 08 ) ‰ vs. (0. 47±0. 09 )‰, P < 0. 01 ] and control group ( P < 0. 05 ). Both insulin resistence index (r = - 0. 291, P = 0. 01) and Gensini score ( r = - 0. 3984, P = 0. 006) were negatively correlated with number of circulating EPCs. Proliferation and migration capacities of EPCs were also significantly lower in IR group compared to those in IS group ( all P < 0. 05 ) and control group ( all P < 0. 05). Conclusions Insulin resistence/hyperinsulinemia could aggravate severity of coronary artery lesions via reducing the number and activities of circulating EPCs in patients with CAD.