Sobrino Tomás, Hurtado Olivia, Moro María Angeles, Rodríguez-Yáñez Manuel, Castellanos Mar, Brea David, Moldes Octavio, Blanco Miguel, Arenillas Juan F, Leira Rogelio, Dávalos Antonio, Lizasoain Ignacio, Castillo José
Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
Stroke. 2007 Oct;38(10):2759-64. doi: 10.1161/STROKEAHA.107.484386. Epub 2007 Aug 30.
Increased circulating endothelial progenitor cells (EPC) have been associated with a low cardiovascular risk and may be involved in endothelial cell regeneration. The present study was designed to evaluate the prognostic value of EPC in acute ischemic stroke.
Forty-eight patients with a first-ever nonlacunar ischemic stroke were prospectively included in the study within 12 hours of symptoms onset. Stroke severity was evaluated by the National Institutes of Health Stroke Scale, and functional outcome was assessed at 3 months by the modified Rankin Scale (mRS). Infarct volume growth between admission and days 4 to 7 was measured on multiparametric MRI. EPC colonies were defined as early outgrowth colony-forming unit-endothelial cell (CFU-EC). The increment of CFU-EC was quantified during the first week and defined as the absolute difference between the number of CFU-EC at day 7 and admission. The influence of CFU-EC increase on good functional outcome (mRS <or=2) and infarct growth was analyzed by logistic regression and linear models.
Patients with good outcome (n=25) showed a higher CFU-EC increment during the first week (median [quartiles], 23 [11, 36] versus -3 [-7, 1], P<0.0001) compared with patients with poor outcome. CFU-EC increment >or=4 during the first week was associated with good functional outcome at 3 months (odds ratio, 30.7; 95% CI, 2.4 to 375.7; P=0.004) after adjustment for baseline stroke severity, ischemic volume and thrombolytic treatment. For each unit increase in the CFU-EC the mean reduction in the growth of infarct volume was 0.39 (0.03 to 0.76) mL (P=0.033).
The increase of circulating EPC after acute ischemic stroke is associated with good functional outcome and reduced infarct growth. These findings suggest that EPC might participate in neurorepair after ischemic stroke.
循环内皮祖细胞（EPC）数量增加与较低的心血管风险相关，且可能参与内皮细胞再生。本研究旨在评估EPC在急性缺血性卒中中的预后价值。
48例首次发生的非腔隙性缺血性卒中患者在症状发作后12小时内被前瞻性纳入研究。采用美国国立卫生研究院卒中量表评估卒中严重程度，在3个月时用改良Rankin量表（mRS）评估功能结局。在多参数磁共振成像上测量入院时与第4至7天之间梗死体积的增长。EPC集落被定义为早期生长的集落形成单位内皮细胞（CFU-EC）。在第一周内对CFU-EC的增量进行量化，定义为第7天与入院时CFU-EC数量的绝对差值。通过逻辑回归和线性模型分析CFU-EC增加对良好功能结局（mRS≤2）和梗死生长的影响。
与预后不良的患者相比，预后良好的患者（n=25）在第一周内CFU-EC的增量更高（中位数[四分位数]，23[11,36]对-3[-7,1]，P<0.0001）。在调整基线卒中严重程度、缺血体积和溶栓治疗后，第一周内CFU-EC增量≥4与3个月时良好的功能结局相关（优势比，30.7；95%可信区间，2.4至375.7；P=0.004）。CFU-EC每增加一个单位，梗死体积增长的平均减少量为0.39（0.03至0.76）mL（P=0.033）。
急性缺血性卒中后循环EPC的增加与良好的功能结局和梗死生长减少相关。这些发现提示EPC可能参与缺血性卒中后的神经修复。
