Chen Lu-Lu, Liao Yun-Fei, Zeng Tian-Shu, Li Yu-Ming, Yu Fan, Li Hui-Qing
Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Yi Xue Za Zhi. 2009 May 12;89(18):1234-9.
To investigate the number and function of circulating endothelial progenitor cell (EPC) in different vascular complications of type 2 diabetes (T2DM) and its associations with vascular endothelial function.
A total of 415 T2DM patients were recruited from the outpatients and inpatients of the Endocrinology Department at Union Hospital. Assessments of cardiovascular disease and cerebrovascular disease were based on each patient's medical records. Peripheral vascular disease was diagnosed by bilateral ultrasonography bilaterally. Non-mydriatic fundus camera screening was used as a tool to identify diabetic retinopathy. Urinary albumin exceeding 30 mg/24 h occurring twice over a period of six months was diagnosed as diabetic nephropathy. Circulating EPC was quantified by flow cytometry. Colony forming count (CFU) and migration assay were used for evaluating the function of circulating EPC. Vascular endothelial function was assessed by flow-mediated brachial artery dilatation (FMD).
There were four groups in the study: T2DM without vascular disease (TC, n = 97), T2DM with macrovascular disease (TA, n = 106), T2DM with microvascular disease (TI, n = 100), T2DM with macro- and micro-vascular diseases (TAI, n = 112). The sequence of circulating EPC number and CFU in four groups was TA < TAI < TI < TC (532 +/- 90, 616 +/- 93, 768 +/- 97 and 1045 +/- 106 cell/ml; 21 +/- 4, 28 +/- 5, 43 +/- 7 and 70 +/- 9 unit/chamber) and there was a significant difference between any two groups (P < 0.05). The results of migration were consistent with circulating EPC number (125 +/- 12; 90 +/- 9 cell/HP field) except there were no significant differences in TA and TAI groups (24 +/- 6; 28 +/- 7 cell/HP field). Age, HbA1c, SBP, BMI and duration of T2DM were the independent risk factors of circulating EPC number in T2DM patients with macrovascular disease (P < 0.05). Age, HbA1c and duration of T2DM were the independent risk factors of circulating EPC number in T2DM patients with microvascular disease (P < 0.05). After the adjustment of traditional risk factors, the number of circulating EPC had a close correlation with FMD (standardized coefficient, t = 0.61, P = 0.01).
The number and function of circulating EPC decreased with different degrees in T2DM patients of different vascular diseases. Circulating EPC number was associated with endothelial function and can be considered as a surrogate biological marker of vascular endothelial function for T2DM.
探讨2型糖尿病（T2DM）不同血管并发症中循环内皮祖细胞（EPC）的数量和功能及其与血管内皮功能的关系。
从协和医院内分泌科门诊及住院患者中招募415例T2DM患者。根据每位患者的病历评估心血管疾病和脑血管疾病。通过双侧超声检查诊断外周血管疾病。使用免散瞳眼底照相机筛查作为识别糖尿病视网膜病变的工具。6个月内两次尿白蛋白超过30mg/24h被诊断为糖尿病肾病。通过流式细胞术对循环EPC进行定量。采用集落形成计数（CFU）和迁移试验评估循环EPC的功能。通过血流介导的肱动脉扩张（FMD）评估血管内皮功能。
研究分为四组：无血管疾病的T2DM（TC，n = 97）、伴有大血管疾病的T2DM（TA，n = 106）、伴有微血管疾病的T2DM（TI，n = 100）、伴有大血管和微血管疾病的T2DM（TAI，n = 112）。四组循环EPC数量和CFU的顺序为TA < TAI < TI < TC（532±90、616±93、768±97和1045±106个细胞/ml；21±4、28±5、43±7和70±9个单位/腔），任意两组之间均有显著差异（P < 0.05）。迁移结果与循环EPC数量一致（125±12；90±9个细胞/高倍视野），但TA组和TAI组无显著差异（24±6；28±7个细胞/高倍视野）。年龄、糖化血红蛋白、收缩压、体重指数和T2DM病程是伴有大血管疾病的T2DM患者循环EPC数量的独立危险因素（P < 0.05）。年龄、糖化血红蛋白和T2DM病程是伴有微血管疾病的T2DM患者循环EPC数量的独立危险因素（P < 0.05）。调整传统危险因素后，循环EPC数量与FMD密切相关（标准化系数，t = 0.61，P = 0.01）。
不同血管疾病的T2DM患者循环EPC的数量和功能均有不同程度下降。循环EPC数量与内皮功能相关，可作为T2DM血管内皮功能的替代生物标志物。
