Chen Tsung-Yan, Lin Lin, Hsieh Mu-Yang, Kuo Jui-Cheng, Wang Chia-Ling, Wang Ren-Huei, Lai Chao-Lun, Huang Po-Hsun, Wu Chih-Cheng
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu.
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu; ; College of Medicine, National Taiwan University.
Acta Cardiol Sin. 2017 Jan;33(1):81-91. doi: 10.6515/acs20160225c.
The deficiency of endothelial progenitor cells has been demonstrated to be associated with cardiovascular events in patients undergoing dialysis. However, their correlation with dialysis graft outcomes remains unknown. The objective of this study was to investigate the relationship between circulating endothelial progenitor cells and dialysis graft outcomes.
After excluding 14 patients with acute coronary syndrome, decompensated heart failure or graft thrombosis in the prior three months, a total of 120 patients undergoing dialysis who underwent endovascular therapy of dysfunctional dialysis grafts were prospectively enrolled. Blood was sampled from study subjects in the morning of a mid-week non-dialysis day. Surface makers of CD34, KDR, and CD133 were used in combination to determine the number of circulating endothelial progenitor cells. All participants were prospectively followed until June 2013.
The median follow-up duration was 13 months, within which 62 patients experienced at least one episode of graft thrombosis. Patients with graft thrombosis had lower CD34KDR cell counts compared with patients without graft thrombosis (median 4.5 vs. 8 per 10 mononuclear cells, p = 0.02). Kaplan-Meier analysis demonstrated thrombosis-free survival was lower in the low CD34KDR cell count group (30%) than in the high CD34KDR cell count group (61%; p = 0.007). Univariate analysis showed diabetes, high sensitive C-reactive protein, lesion length and CD34KDR cell counts associated with graft thrombosis. Multivariate analyses confirmed an independent association between low CD34KDR cell counts and graft thrombosis (hazard ratio, 2.52; confidence interval, 1.43-4.44; p = 0.001).
Our study demonstrated an independent association between low circulating endothelial progenitor cell counts and dialysis graft thrombosis.
内皮祖细胞缺乏已被证明与接受透析的患者发生心血管事件有关。然而，它们与透析移植物结局的相关性仍不清楚。本研究的目的是探讨循环内皮祖细胞与透析移植物结局之间的关系。
排除14例在过去三个月内患有急性冠状动脉综合征、失代偿性心力衰竭或移植物血栓形成的患者后，前瞻性纳入了120例接受功能失调透析移植物血管内治疗的透析患者。在一周中间的非透析日上午采集研究对象的血液。联合使用CD34、KDR和CD133的表面标志物来确定循环内皮祖细胞的数量。所有参与者均进行前瞻性随访直至2013年6月。
中位随访时间为13个月，在此期间62例患者至少经历了一次移植物血栓形成。与未发生移植物血栓形成的患者相比，发生移植物血栓形成的患者CD34KDR细胞计数较低（中位数为每10个单核细胞4.5个对8个，p = 0.02）。Kaplan-Meier分析表明，低CD34KDR细胞计数组的无血栓生存期（30%）低于高CD34KDR细胞计数组（61%；p = 0.007）。单因素分析显示糖尿病、高敏C反应蛋白、病变长度和CD34KDR细胞计数与移植物血栓形成有关。多因素分析证实低CD34KDR细胞计数与移植物血栓形成之间存在独立关联（风险比为2.52；置信区间为1.43 - 4.44；p = 0.001）。
我们的研究表明循环内皮祖细胞计数低与透析移植物血栓形成之间存在独立关联。
