与血液透析患者血管血栓形成相关的循环祖细胞缺乏。

Deficiency of circulating progenitor cells associated with vascular thrombosis of hemodialysis patients.

机构信息

Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.

College of Medicine, National Taiwan University, Taipei, Taiwan.

出版信息

Nephrol Dial Transplant. 2017 Mar 1;32(3):556-564. doi: 10.1093/ndt/gfw401.

DOI:10.1093/ndt/gfw401

PMID:28339557

Abstract

BACKGROUND

Hemodialysis (HD) patients have an increased risk of thrombosis. Endothelial progenitor cells (EPCs), which function in vascular repair, are deficient in HD patients. Nonetheless, the relationship between EPC deficiency and thrombosis in HD patients is unknown.

METHODS

From January 2010 to December 2012, circulating levels of EPCs that were positive for CD34 and kinase insert domain receptor (KDR) were measured in 269 HD patients. Patients received prospective follow-ups at 6-month intervals until May 2015. The primary outcome was the composite of HD access thrombosis and systemic vascular thrombosis.

RESULTS

There were 141 thrombotic events, 50 systemic vascular thrombotic events and 116 HD access thrombotic events. We found significantly negative associations between CD34 + KDR + tertile and overall thrombotic events (low: 61%; middle: 56%; high: 40%; P = 0.02), systemic vascular thrombotic events (low: 27%; middle: 18%; high: 10%; P = 0.03) and HD access thrombotic events (low: 52%; middle: 46%; high: 36%; P = 0.02). Univariate analysis indicated that systemic vascular thrombotic events were positively associated with age, diabetes, dyslipidemia, vascular disease history, urea clearance, albumin and C-reactive protein (CRP), and negatively associated with CD34 + KDR + cell count. HD access thrombosis was positively associated with vascular disease history and CRP, and negatively associated with CD34 + KDR + cell count. Multivariate analysis indicated that a low CD34 + KDR + cell count was an independent risk factor for both types of thrombosis.

CONCLUSIONS

Our study of a population of HD patients showed that a low level of circulating EPCs is associated with thrombosis.

摘要

背景

血液透析（HD）患者发生血栓的风险增加。血管修复中起作用的内皮祖细胞（EPC）在 HD 患者中存在缺陷。然而，HD 患者中 EPC 缺陷与血栓之间的关系尚不清楚。

方法

从 2010 年 1 月至 2012 年 12 月，测量了 269 例 HD 患者循环中 CD34 和激酶插入结构域受体（KDR）阳性的 EPC 水平。患者在 2015 年 5 月前每隔 6 个月接受一次前瞻性随访。主要结局是 HD 通路血栓形成和全身血管血栓形成的复合事件。

结果

共发生 141 例血栓事件，50 例全身血管血栓形成事件和 116 例 HD 通路血栓形成事件。我们发现 CD34 + KDR + 三分位与总血栓形成事件（低：61%；中：56%；高：40%；P=0.02）、全身血管血栓形成事件（低：27%；中：18%；高：10%；P=0.03）和 HD 通路血栓形成事件（低：52%；中：46%；高：36%；P=0.02）呈显著负相关。单因素分析表明，全身血管血栓形成事件与年龄、糖尿病、血脂异常、血管病史、尿素清除率、白蛋白和 C 反应蛋白（CRP）呈正相关，与 CD34 + KDR + 细胞计数呈负相关。HD 通路血栓形成与血管病史和 CRP 呈正相关，与 CD34 + KDR + 细胞计数呈负相关。多因素分析表明，低 CD34 + KDR + 细胞计数是两种类型血栓形成的独立危险因素。