循环内皮祖细胞在伴冠状动脉钙化的类风湿关节炎患者中的作用。
Role of circulating endothelial progenitor cells in patients with rheumatoid arthritis with coronary calcification.
机构信息
Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong.
出版信息
J Rheumatol. 2010 Mar;37(3):529-35. doi: 10.3899/jrheum.090782. Epub 2010 Jan 15.
OBJECTIVE
Patients with rheumatoid arthritis (RA) are prone to premature atherosclerosis. We hypothesize that depletion of circulating endothelial progenitor cells (EPC) related to RA can contribute to the development of atherosclerosis.
METHODS
We studied coronary calcifications by multidetector computed tomography and their relationship with different subtypes of circulating EPC in 70 patients with RA and 35 age- and sex-matched controls (mean age 54.1 +/- 10.2 yrs, 87% were women). The presence of coronary atherosclerosis was defined as an Agatston score > or = 10. Four subpopulations of EPC were determined by flow cytometry on the basis of surface expression of CD34, CD133, and KDR antigen: CD34+, CD34/KDR+, CD133+, and CD133/KDR+ EPC, respectively.
RESULTS
Among those with RA, 15 patients (21%) had coronary atherosclerosis. The mean Agatston score was higher (61.8 +/- 201.7 vs 0.14 +/- 0.69; p = 0.01) and coronary atherosclerosis was more prevalent (21.4% vs 0%; p < 0.01) in patients with RA compared to controls. RA patients with coronary atherosclerosis were older (66.2 +/- 6.9 vs 51.5 +/- 16.2 yrs; p < 0.01), had higher prevalence of hypertension (46.7% vs 14.5%; p = 0.01), and had lower CD133/KDR+ (0.45% +/- 0.28% vs 0.89% +/- 0.81%; p < 0.01) and CD133+ EPC levels (0.74% +/- 0.39% vs 1.22% +/- 0.83%; p < 0.01), but similar CD34/KDR+ and CD34+ EPC levels (all p > 0.05) compared to those without. Multiple logistic regression revealed that older age (OR 1.25, 95% CI 1.10-1.41, p < 0.01) and lower CD133/KDR+ EPC (OR 0.07, 95% CI 0.00-0.97, p < 0.01) were independent predictors for coronary atherosclerosis in patients with RA.
CONCLUSION
Our results demonstrated that RA patients with coronary atherosclerosis have significantly lower levels of CD133/KDR+ and CD133+ EPC than those without. In addition to older age, lower levels of circulating CD133/KDR+ EPC also predicted occurrence of coronary atherosclerosis in RA patients.
目的
类风湿关节炎（RA）患者易发生动脉粥样硬化。我们假设与 RA 相关的循环内皮祖细胞（EPC）耗竭可能导致动脉粥样硬化的发展。
方法
我们通过多排 CT 研究了 70 例 RA 患者和 35 名年龄和性别匹配的对照者（平均年龄 54.1 +/- 10.2 岁，87%为女性）的冠状动脉钙化情况及其与不同类型循环 EPC 的关系。冠状动脉粥样硬化的存在定义为 Agatston 评分> = 10。通过流式细胞术根据 CD34、CD133 和 KDR 抗原的表面表达，确定了 4 种 EPC 亚群：CD34+、CD34/KDR+、CD133+和 CD133/KDR+EPC。
结果
在 RA 患者中，15 例（21%）存在冠状动脉粥样硬化。RA 患者的平均 Agatston 评分更高（61.8 +/- 201.7 vs 0.14 +/- 0.69；p = 0.01），且冠状动脉粥样硬化更为常见（21.4% vs 0%；p < 0.01）。与对照组相比，患有冠状动脉粥样硬化的 RA 患者年龄更大（66.2 +/- 6.9 vs 51.5 +/- 16.2 岁；p < 0.01），高血压患病率更高（46.7% vs 14.5%；p = 0.01），CD133/KDR+（0.45% +/- 0.28% vs 0.89% +/- 0.81%；p < 0.01）和 CD133+EPC 水平更低（0.74% +/- 0.39% vs 1.22% +/- 0.83%；p < 0.01），但 CD34/KDR+和 CD34+EPC 水平相似（均 p > 0.05）。多变量逻辑回归显示，年龄较大（OR 1.25，95%CI 1.10-1.41，p < 0.01）和 CD133/KDR+EPC 水平较低（OR 0.07，95%CI 0.00-0.97，p < 0.01）是 RA 患者发生冠状动脉粥样硬化的独立预测因素。
结论
我们的结果表明，患有冠状动脉粥样硬化的 RA 患者的 CD133/KDR+和 CD133+EPC 水平明显低于无冠状动脉粥样硬化者。除了年龄较大外，循环 CD133/KDR+EPC 水平较低也可预测 RA 患者发生冠状动脉粥样硬化。
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