Department of Medical and Surgical Critical Care, Thrombosis Center, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Transplantation. 2012 Apr 27;93(8):835-41. doi: 10.1097/TP.0b013e318247a75d.
Endothelial dysfunction may contribute to modulate cardiovascular complications in renal transplant recipients (RTRs), and a relationship between endothelial dysfunction and parathyroid hormone (PTH) levels in RTRs has been demonstrated. We evaluated the relationship between endothelial response to hyperemia and circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) PTH, and genetic parameters in RTRs.
In 120 RTRs and in healthy subjects without (n=107, group A) and with cardiovascular risk factors (n=109, group B), we evaluated endothelial response to hyperemia through digital tonometry (peripheral arterial tonometry) detected by reactive hyperemia index (RHI) and EPCs and CPCs by flow cytometry.
In RTRs, RHI median value was lower than in group A (P=0.05). EPC number was significantly lower in RTRs than in groups A and B (P<0.0001), whereas PTH median value was significantly higher (P<0.0001). In RTRs, RHI values were significantly lower according to the presence of three or more risk factors (P=0.04) and positively correlated with EPCs (P=0.04) but not with PTH (P=0.2). In patients who underwent dialysis for more than 5 years, lower RHI values (P=0.08), EPC number (P=0.5), and higher PTH concentrations (P=0.09) than in patients with less than 1 year dialysis time were observed. No relationship between eNOS gene -786T>C, 894G>T, and 4a/4b polymorphisms and RHI, EPC, and CPC number was found.
This study shows an altered endothelial response, associated with reduced EPCs, and increased PTH in RTRs; the evaluation of endothelial status in RTRs may contribute to better assess the risk profile of these patients.
内皮功能障碍可能导致肾移植受者（RTR）心血管并发症的发生，并且已经证明 RTR 中内皮功能障碍与甲状旁腺激素（PTH）水平之间存在关系。我们评估了 RTR 中内皮对充血的反应与循环祖细胞（CPC）和内皮祖细胞（EPC）PTH 以及遗传参数之间的关系。
在 120 名 RTR 以及无心血管危险因素的健康受试者（n=107，组 A）和有心血管危险因素的健康受试者（n=109，组 B）中，我们通过反应性充血指数（RHI）通过数字张力测定法（外周动脉张力测定法）评估内皮对充血的反应，通过流式细胞术评估 EPC 和 CPC。
在 RTR 中，RHI 中位数低于组 A（P=0.05）。RTR 中 EPC 数量明显低于组 A 和组 B（P<0.0001），而 PTH 中位数明显升高（P<0.0001）。在 RTR 中，根据是否存在 3 个或更多危险因素，RHI 值显著降低（P=0.04），并且与 EPC 呈正相关（P=0.04），但与 PTH 无关（P=0.2）。在透析时间超过 5 年的患者中，RHI 值（P=0.08）、EPC 数量（P=0.5）和 PTH 浓度（P=0.09）均低于透析时间少于 1 年的患者。未发现 eNOS 基因 -786T>C、894G>T 和 4a/4b 多态性与 RHI、EPC 和 CPC 数量之间存在关系。
本研究表明，RTR 中存在改变的内皮反应，与 EPC 减少和 PTH 增加有关；评估 RTR 中的内皮状态可能有助于更好地评估这些患者的风险状况。
