Werner Nikos, Kosiol Sonja, Schiegl Tobias, Ahlers Patrick, Walenta Katrin, Link Andreas, Böhm Michael, Nickenig Georg
Division of Cardiology, Angiology, and Intensive Care Medicine, Department of Internal Medicine, University of Saarland, Homburg-Saar, Germany.
N Engl J Med. 2005 Sep 8;353(10):999-1007. doi: 10.1056/NEJMoa043814.
Endothelial progenitor cells derived from bone marrow are believed to support the integrity of the vascular endothelium. The number and function of endothelial progenitor cells correlate inversely with cardiovascular risk factors, but the prognostic value associated with circulating endothelial progenitor cells has not been defined.
The number of endothelial progenitor cells positive for CD34 and kinase insert domain receptor (KDR) was determined with the use of flow cytometry in 519 patients with coronary artery disease as confirmed on angiography. After 12 months, we evaluated the association between baseline levels of endothelial progenitor cells and death from cardiovascular causes, the occurrence of a first major cardiovascular event (myocardial infarction, hospitalization, revascularization, or death from cardiovascular causes), revascularization, hospitalization, and death from all causes.
A total of 43 participants died, 23 from cardiovascular causes. A first major cardiovascular event occurred in 214 patients. The cumulative event-free survival rate increased stepwise across three increasing baseline levels of endothelial progenitor cells in an analysis of death from cardiovascular causes, a first major cardiovascular event, revascularization, and hospitalization. After adjustment for age, sex, vascular risk factors, and other relevant variables, increased levels of endothelial progenitor cells were associated with a reduced risk of death from cardiovascular causes (hazard ratio, 0.31; 95 percent confidence interval, 0.16 to 0.63; P=0.001), a first major cardiovascular event (hazard ratio, 0.74; 95 percent confidence interval, 0.62 to 0.89; P=0.002), revascularization (hazard ratio, 0.77; 95 percent confidence interval, 0.62 to 0.95; P=0.02), and hospitalization (hazard ratio, 0.76; 95 percent confidence interval, 0.63 to 0.94; P=0.01). Endothelial progenitor-cell levels were not predictive of myocardial infarction or of death from all causes.
The level of circulating CD34+KDR+ endothelial progenitor cells predicts the occurrence of cardiovascular events and death from cardiovascular causes and may help to identify patients at increased cardiovascular risk.
源自骨髓的内皮祖细胞被认为有助于维持血管内皮的完整性。内皮祖细胞的数量和功能与心血管危险因素呈负相关，但循环内皮祖细胞的预后价值尚未明确。
采用流式细胞术测定519例经血管造影证实患有冠状动脉疾病患者中CD34和激酶插入结构域受体（KDR）阳性的内皮祖细胞数量。12个月后，我们评估了内皮祖细胞基线水平与心血管原因导致的死亡、首次重大心血管事件（心肌梗死、住院、血运重建或心血管原因导致的死亡）、血运重建、住院以及全因死亡之间的关联。
共有43名参与者死亡，其中23例死于心血管原因。214例患者发生了首次重大心血管事件。在对心血管原因导致的死亡、首次重大心血管事件、血运重建和住院进行分析时，随着内皮祖细胞基线水平的三个递增水平，累积无事件生存率逐步提高。在对年龄、性别、血管危险因素和其他相关变量进行校正后，内皮祖细胞水平升高与心血管原因导致的死亡风险降低（风险比，0.31；95%置信区间，0.16至0.63；P = 0.001）、首次重大心血管事件（风险比，0.74；95%置信区间，0.62至0.89；P = 0.002）、血运重建（风险比，0.77；95%置信区间，0.62至0.95；P = 0.02）和住院（风险比，0.76；95%置信区间，0.63至0.94；P = 0.01）相关。内皮祖细胞水平不能预测心肌梗死或全因死亡。
循环CD34+KDR+内皮祖细胞水平可预测心血管事件的发生和心血管原因导致的死亡，并可能有助于识别心血管风险增加的患者。
