循环内皮祖细胞水平降低与经皮冠状动脉和外周血管介入治疗患者的对比剂诱导肾病相关。
Reduction of circulating endothelial progenitor cell level is associated with contrast-induced nephropathy in patients undergoing percutaneous coronary and peripheral interventions.
机构信息
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan; Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
出版信息
PLoS One. 2014 Mar 19;9(3):e89942. doi: 10.1371/journal.pone.0089942. eCollection 2014.
OBJECTIVES
Reduced number and impaired function of circulating endothelial progenitor cells (EPCs) in patients with chronic kidney disease have been reported. However, there is little data about the association between circulating EPC levels and risk of contrast-induced nephropathy (CIN). The aim of this study was to investigate the relationship between circulating EPCs and CIN in patients after angiography.
METHODS AND RESULTS
A total of 77 consecutive patients undergoing elective percutaneous coronary intervention (PCI) and percutaneous transluminal angioplasty (PTA) were enrolled. Flow cytometry with quantification of EPC markers (defined as CD34+, CD34+KDR+, and CD34+KDR+CD133+) in peripheral blood samples was used to assess EPC number before the procedure. CIN was defined as an absolute increase ≧0.5 mg/dl or a relative increase ≧25% in the serum creatinine level at 48 hours after the procedure. Eighteen (24%) of the study subjects developed CIN. Circulating EPC levels were significantly lower in patients who developed CIN than in those without CIN (CD34+KDR+, 4.11±2.59 vs. 9.25±6.30 cells/105 events, P<0.001). The incidence of CIN was significantly greater in patients in the lowest EPC tertile (CD34+KDR+; from lowest to highest, 52%, 15%, and 4%, P<0.001). Using univariate logistic regression, circulating EPC number (CD34+KDR+) was a significant negative predictor for development of CIN (odds ratio 0.69, 95% CI 0.54-0.87, P = 0.002). Over a two-year follow-up, patients with CIN had a higher incidence of major adverse cardiovascular events including myocardial infarction, stroke, revascularization of treated vessels, and death (66.7% vs. 25.4%, P = 0.004) than did patients without CIN.
CONCLUSIONS
Decreased EPC level is associated with a greater risk of CIN, which may explain part of the pathophysiology of CIN and the poor prognosis in CIN patients.
目的
有报道称，慢性肾脏病患者循环内皮祖细胞（EPC）的数量减少且功能受损。然而，关于循环 EPC 水平与对比剂诱导肾病（CIN）风险之间的关系的数据较少。本研究旨在探讨血管造影后患者循环 EPC 与 CIN 的关系。
方法和结果
共纳入 77 例连续行选择性经皮冠状动脉介入治疗（PCI）和经皮腔内血管成形术（PTA）的患者。采用流式细胞术检测外周血样本中 EPC 标志物（定义为 CD34+、CD34+KDR+和 CD34+KDR+CD133+）的数量，以评估术前 EPC 数量。CIN 定义为术后 48 小时血清肌酐水平绝对升高≥0.5mg/dl 或相对升高≥25%。研究中有 18 例（24%）患者发生 CIN。与未发生 CIN 的患者相比，发生 CIN 的患者循环 EPC 水平显著降低（CD34+KDR+，4.11±2.59 与 9.25±6.30 个/105 事件，P<0.001）。EPC 最低三分位组（CD34+KDR+；从低到高，52%、15%和 4%，P<0.001）的 CIN 发生率显著更高。使用单变量逻辑回归，循环 EPC 数量（CD34+KDR+）是 CIN 发生的显著负预测因子（比值比 0.69，95%置信区间 0.54-0.87，P=0.002）。在两年的随访期间，发生 CIN 的患者发生包括心肌梗死、卒中和靶血管血运重建在内的主要不良心血管事件的发生率更高（66.7%与 25.4%，P=0.004），预后更差。
结论
EPC 水平降低与 CIN 风险增加相关，这可能部分解释了 CIN 的病理生理学机制以及 CIN 患者预后不良的原因。
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