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1.
目的探讨循环内皮祖细胞(EPCs)与冠心病危险因素及冠状动脉病变程度的关系及临床意义。方法42例冠心病患者均经选择性冠状动脉造影证实有明显的冠状动脉狭窄(>50%的狭窄);36例对照组经临床检查和选择性冠状动脉造影排除冠心病。采集研究对象外周血进行EPCs的分离培养,14天后在倒置相差显微镜下计数细胞克隆形成单位以评估循环EPCs水平,并将EPCs数量与年龄、性别、血脂水平、高血压、糖尿病、吸烟、冠心病家族史及冠状动脉病变程度进行统计学分析。结果冠心病危险因素分数与循环EPCs水平呈明显负相关(r=-0.436,P=0.014),吸烟患者循环EPCs水平明显低于不吸烟者(P<0.05),低密度脂蛋白胆固醇(LDLC)、尿酸与循环EPCs水平呈明显负相关(P<0.05);而性别、高血压、冠心病家族史对循环EPCs水平有一定影响,但差异无统计学意义,年龄、高密度脂蛋白胆固醇(HDLC)及载脂蛋白A(apoA)与循环EPCs水平也有相关性,但不具有统计学意义。冠心病组患者循环EPCs水平明显低于非冠心病组[(12.8±6.3)对(37.0±5.5)个,P<0.001],冠状动脉病变程度(单支、双支、三支)与EPCs水平降低明显相关(P<0.01)。结论循环EPCs水平与冠心病危险因素分数及冠状动脉病变程度呈负相关。提示冠状动脉内皮损伤而又缺乏足够的循环内皮祖细胞时可能影响冠心病的病情程度及临床表现。  相似文献   

2.
目的探讨非阻塞性冠状动脉粥样硬化患者内皮功能不全的影响因素。方法选取2013年6月至2015年6月首都医科大学宣武医院心脏内科收治的因胸痛疑诊冠心病、经冠状动脉造影检查证实为非阻塞性冠状动脉粥样硬化症(冠状动脉狭窄<50%)的患者110例。行肱动脉血流介导内皮依赖性血管舒张功能(FMD)检测,用流式细胞仪检测外周血CD133+/KDR+、CD34+/KDR+以及CD34+/CD133+/KDR+内皮祖细胞(EPCs)。根据FMD分为对照组(FMD>10%)和内皮功能不全组(FMD≤10%)。采用SPSS 19.0软件进行统计分析。应用logistic回归模型分析影响内皮功能不全的因素。结果2组患者CD133+/CDR+、CD34+/KDR+或CD34+/CD133+/KDR+循环EPCs数量比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄是影响内皮功能不全的独立危险因素(95%CI 1.004~1.104,P=0.033)。结论非阻塞性冠状动脉粥样硬化患者内皮功能不全的独立影响因素是年龄,而非循环EPCs数量。  相似文献   

3.
目的 探讨冠心病患者不同胰岛素水平与循环内皮祖细胞(EPC)数量、功能及冠状动脉病变程度的关系并探讨相关临床意义.方法 69例经选择性冠状动脉造影证实的冠心病患者,按胰岛素水平高低分为胰岛素抵抗(IR)组和胰岛素敏感(IS)组,另设25例健康对照者.采集研究对象外周血以激酶插入区域受体(KDR)和CD133双阳性为循环EPC标记行流式细胞分析,同时采血进行EPC的分离培养,7 d后鉴定并检测增殖及迁移能力,将各组的一般临床资料,循环EPC数量、迁移、增殖能力指标、稳态模型胰岛素抵抗指数(HOMA-IR)及冠状动脉病变Gensini评分进行统计学分析.结果 IR组循环EPC数量明显少于IS组[(0.34±0.08)‰比(0.47±0.09)‰,P<0.01],HOMA-IR自然对数与循环EPC数量呈负相关(r=-0.291,P=0.01),循环EPC数量与Gensini评分呈负相关(r=-0.3984,P=0.006).IR组的增殖能力和迁移能力均低于IS组减弱(P<0.05).结论 冠心病患者血清胰岛素水平与循环EPC数量呈负相关.循环EPC数量及功能与冠状动脉病变程度呈负相关;IR或高胰岛素血症可能部分通过损害循环EPC的数量及功能,从而影响冠状动脉病变程度.  相似文献   

4.
目的:证据显示内皮祖细胞(EPCs)含两亚群即CD34+-EPCs和CD14+-EPCs.之前评估EPCs与冠心病关系的研究并没有区分CD34+-EPCs和CD14+-EPC8这两类细胞或只纳入了CD34+-EPCs.因此本研究探索了CD14+-EPCs数量与冠心病及心血管危险因素的关系.方法:100例患者入选(对照组34例,稳定性冠心病组41例,急性冠脉综合征组25例),CD14+-EPCs定义为表面标记CD14阳性和血管内皮生长因子受体-2(KDR)阳性细胞,用流式细胞仪检测其数量.结果:3组间CD14+-EPCs水平差异无统计学意义;CD14+-EPCs数量与冠状动脉严重程度或危险因素也无关.结论:CD14+-EPCs水平与冠心病严重程度或心血管危险因素无关.  相似文献   

5.
目的 分析中年女性冠心病临床危险因素、冠状动脉造影及介入治疗特点,评价冠心病发病、危险因素构成、冠状动脉造影及介入治疗方面年龄和性别的差异.方法 入选1998年1月1日至2006年12月30日9年间在我院临床疑诊冠心病、年龄40~79岁、行冠状动脉造影的住院患者5685例.根据年龄分为中年组(40~59岁)和老年组(60~79岁),根据性别分为女性组和男性组.以同龄男性及老年女性为对照,回顾性分析冠心病危险因素在中年女性的分布情况、冠心病的检出率、冠状动脉病变及介入治疗特点、肾动脉造影及介入治疗特点.结果 ①中年女性与同龄男性比较:血脂异常患病率女性(75.68%)显著低于男性(88.80%)(P<0.01);高血压患病率女性(59.42%)显著高于男性(50.66%)(P<0.01);糖尿病患病率女性(30.47%)与男性(33.42%)差异无统计学意义(P=0.98);陈旧心肌梗死患病率女性(11.48%)显著低于男性(42.50%)(P<0.01);脑卒中患病率女性(5.01%)与男性(4.77%)差异无统计学意义(P=0.82);肾功能下降患病率女性(1.71%)低于男性(2.87%)(P=0.07).冠状动脉造影冠心病检出率女性(36.64%)显著低于男性(69.10%)(P<0.001);在冠心病患者中,冠状动脉受累血管数量及严重程度中年女性组比男性轻(P<0.01);介入治疗比例(58.87%)低于男性(67.08%)(P<0.01).肾动脉狭窄检出率女性(8.62%)高于男性(4.97%)(P<0.05).②中年女性与老年女性比较:血脂异常、高血压、糖尿病、陈旧心梗、脑卒中、肾功能不全患病率,冠状动脉造影阳性率,冠状动脉病变受累血管数量及严重程度,冠状动脉介入治疗比例,肾动脉狭窄检出率均显著低于老年女性组(P<0.01).结论 在临床疑诊冠心病而行冠状动脉造影的患者中,中年女性血脂异常、陈旧心梗患病率、冠心病检出率、冠状动脉病变受累血管数量及严重程度、介入治疗比例显著低于同龄男性及老年女性.  相似文献   

6.
目的探讨高海拔地区冠状动脉粥样硬化性心脏病(冠心病)的危险因素,并分析影响冠心病患者冠状动脉病变程度的相关因素。方法选取2018年2月至2019年8月因胸痛在青海省心脑血管病专科医院住院治疗并行冠状动脉造影检查的患者516例为研究对象,根据冠状动脉造影检查结果分为冠心病组(n=304)和非冠心病组(n=212)。采用Gensini评分对冠心病患者冠状动脉病变程度进行分级,将冠心病组患者分为低分组(n=156)、中分组(n=86)和高分组(n=62)。比较冠心病组和非冠心病组患者、不同冠状动脉病变程度组患者的一般临床资料,并分析影响冠心病和冠状动脉病变程度的危险因素。结果冠心病组患者在男性患者比例、吸烟史、合并原发性高血压(高血压)、空腹血糖浓度、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)浓度明显高于非冠心病组患者,高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)和载脂蛋白A浓度明显低于非冠心病组患者,差异有统计学意义(P0.01)。Logistic回归分析结果显示合并高血压、空腹血糖浓度增高、LDL-C浓度增高属于冠心病的独立危险因素,HDL-C、载脂蛋白A属于冠心病的保护因素。不同冠状动脉病变程度组患者年龄、空腹血糖浓度、LDL-C和HDL-C浓度比较,差异有统计学意义(P0.01)。Logistic回归分析结果显示年龄、空腹血糖浓度、LDL-C浓度增高属于冠状动脉病变的独立危险因素,HDL-C属于冠状动脉病变的保护因素。结论在高原地区,伴随年龄的增大、空腹血糖浓度增高和LDL-C浓度增高是冠心病患者冠状动脉病变程度加重的危险因素,而HDL-C是高海拔地区冠心病患者冠状动脉病变程度的保护因素。  相似文献   

7.
冠心病合并2型糖尿病患者冠状动脉造影分析   总被引:2,自引:6,他引:2  
目的:探讨冠心病合并2型糖尿病患者的临床特征和冠状动脉造影特点。方法:对110例冠心病合并糖尿病患者和40例冠心病不合并糖尿病患者进行临床和冠状脉造影资料的对比分析。结果:在冠心病合并糖尿病组中女性比例高(P<0.05),合并高血压(P<0.05)、高血脂者(P<0.01)比例高,冠状动脉造影发现多支病变的比例高(P<0.01)。结论:2型糖尿病患者常有多种心血管危险因素聚集,冠心病合并2型糖尿病者多支病变常见。  相似文献   

8.
目的:研究急性心肌梗塞(AMI)患者外周血中内皮祖细胞(EPCs)的水平与冠状动脉病变程度之间的关系。方法:选取55例AMI患者,以定量冠状动脉造影评估冠状动脉的血管狭窄程度,同时选取30名冠状动脉造影阴性的患者为对照组。所有患者均在入院后即刻[AMI发病平均时间(2.5±1.5)h],第24h、48h、72h、7d、14d及一个月时采血,以CD133作为EPCs标记物,用流式细胞仪检测患者外周血中CD133标记细胞数量。结果:AMI组患者及对照组均有EPCs(CD133)的表达,AMI患者EPCs数目明显低于非冠心病患者(P〈0.05)。多支病变者较单支病变者有降低趋势,但无显著性差异(P〉0.05)。EPCs数目和Gensini评分呈明显负相关(n=55,r=-0.619,P〈0.05)。结论:急性心肌梗塞患者EPCs数目和冠状动脉病变程度有关。  相似文献   

9.
目的探讨老年冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素. 方法根据1997年WHO糖尿病诊断标准,对133例冠心病(CHD)患者行口服75 g葡萄糖耐量试验,其中冠心病合并糖尿病(CHD+DM)组65例,单纯CHD组68例,133例患者均行冠状动脉造影(CAG),检测血糖、胰岛素、血脂、血压、血尿素氮(BUN)、血肌酐(Cr).冠状动脉病变程度应用CAG分析,冠状动脉狭窄程度根据美国心脏协会(AHA)1975年分类标准评价,冠状动脉病变的危险因素应用多元逐步直线回归分析. 结果 CHD+DM组多支冠状动脉病变的发生率高于CHD组(75.4%与38.2%,P<0.05);冠状动脉狭窄(8.6±3.8与6.5±3.9,P<0.05)及钙化程度(6.6±6.1与3.9±4.1,P<0.05)高于CHD组;冠状动脉远端病变发生率高于CHD组(41.2%与13.1%,P<0.05);血脂、胰岛素、血压与冠状动脉粥样硬化程度明显正相关(P<0.001). 结论老年CHD+DM患者多支冠状动脉病变的发生率增高,病变多呈弥漫性狭窄,远端血管病变发生率高.提示糖尿病、高脂血症、高血压是发生冠状动脉粥样硬化的独立危险因素.  相似文献   

10.
目的探讨冠心病多种危险因素与冠状动脉病变程度的相关性。方法 157例患者依据冠状动脉造影结果分为冠心病组(102例)、对照组(55例)。研究同型半胱氨酸(HCY)、纤维蛋白原(FIB)、空腹血糖(GLU)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)与冠状动脉病变程度的相关性。结果冠心病组与对照组比较,HCY、FIB、GLU、TC、LDL-C均有统计学差异(P0.05),UA无统计学差异(P0.05)。冠心病患者的HCY、FIB、GLU、TCH、LDL-C与冠状动脉病变程度之间呈显著相关性(P0.05),血尿酸与冠状动脉病变程度无相关性(P0.05)。结论对患者HCY、FIB、GLU、TCH、LDL-C水平进行监测及控制具有重要的临床意义,对于预防冠心病有积极的作用。  相似文献   

11.
We sought to investigate whether numbers and activity of circulating endothelial progenitor cells (EPCs) correlate with severity of coronary stenosis as well as cardiovascular risk factors in patients with stable coronary artery disease (CAD). Number of circulating EPCs was analyzed in 104 consecutive patients with proven or clinically suspected CAD. Adhesive and migratory activity was also determined. The number of EPCs was lower in patients with a single diseased coronary artery (Group II, n=35, p<0.05 vs. Group I) or multiple diseased arteries (Group III, n=25, p<0.01 vs. Group I, p<0.05 vs. Group II) compared to those with normal coronary arteries (Group I, n=44). The number of EPCs was also related with angiographic Gensini score (r=-0.355, p=0.006). In addition, concentrations of C-reactive protein (CRP) were elevated in patients with CAD, and positively correlated with Gensini score (r=0.476, p=0.001). As for the risk factors, the number of EPCs was also inversely correlated with age (p=0.001), high sensitivity-CRP (p=0.012), hypertension (p=0.042) and family history of CAD (p=0.043). Most importantly, the migratory capacity of EPCs was compromised in patients with CAD, and inversely correlated with the angiographic Gensini score (r=-0.315, p=0.021). EPCs isolated from patients with CAD also showed an impaired adhesive activity (p<0.05). In conclusion, in patients with stable CAD, reduction in the number and impairment in the function of circulating EPCs were correlated with the severity of coronary stenosis. CRP may play an important role in reducing the number of EPCs and accelerating atherosclerosis. Given the important role of EPCs in neovascularization of ischemic tissue, a decrease in the number and activity of EPCs may contribute to the impaired vascularization in patients with CAD.  相似文献   

12.
AIMS: We sought to assess (1) whether C-reactive protein (CRP) is an independent predictor of future cardiovascular events after adjustment for coronary artery disease (CAD) severity and (2) whether CRP levels correlate with number of angiographically complex coronary artery stenosis. METHODS AND RESULTS: We studied 825 consecutive angina patients (mean age 63+/-10 years, 74% men), 700 with chronic stable angina (CSA) and 125 with acute coronary syndromes without ST-segment elevation (ACS). The composite endpoint of non-fatal acute myocardial infarction, hospital admission with class IIIb unstable angina and cardiac death was assessed at one year follow-up. Hs-CRP level was higher in CSA patients with the combined end-point (P=0.03) after adjustment for number of diseased coronary arteries. Hs-CRP was also significantly higher in patients with ACS compared to CSA ( P=0.004) and correlated with number of complex angiographic stenoses (r=0.36, P=0.01). Hs-CRP was also increased in patients with NYHA functional class III or IV compared to those in class I or II (p<0.0001). CONCLUSIONS: CRP levels predict future cardiovascular events independently of CAD severity and correlate with number of angiographically complex coronary artery stenosis in patients with ACS. Thus, CRP levels are a marker of atheromatous plaque vulnerability and CAD activity.  相似文献   

13.
OBJECTIVES: The objective of this study was to determine whether the number of endothelial progenitor cells (EPCs) and circulating angiogenic cells (CACs) in peripheral blood was associated with the presence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography. BACKGROUND: Previous studies have suggested an inverse relationship between levels of circulating EPCs/CACs and the presence of CAD or cardiovascular risk factors, whereas other studies have observed increased numbers of EPCs in the setting of acute ischemia. However, the criteria used to identify specific angiogenic cell subpopulations and methods of evaluating CAD varied in these studies. In the present study, we used rigorous criteria to identify EPCs and CACs in the blood of patients undergoing coronary angiography. METHODS: The number of EPCs and CACs were measured in the blood of 48 patients undergoing coronary angiography. Patients with acute coronary syndromes were excluded. RESULTS: Compared with patients without angiographically significant CAD, the number of EPCs was increased (1.11 +/- 2.50 vs. 4.01 +/- 3.70 colonies/well, p = 0.004) and the number of CACs trended higher (175 +/- 137 vs. 250 +/- 160 cells per mm(2), p = 0.09) among patients with significant CAD. The highest levels of EPCs were isolated from patients subsequently selected for revascularization (5.03 +/- 4.10 colonies/well). CONCLUSIONS: In patients referred for coronary angiography, higher numbers of EPCs, and a trend toward higher numbers of CACs, were associated with the presence of significant CAD, and EPC number correlated with maximum angiographic stenosis severity. Endothelial progenitor cell levels were highest in patients with CAD selected for revascularization.  相似文献   

14.
There is evidence for two subpopulations among circulating endothelial progenitor cells (EPCs), i.e., CD34+-EPCs and CD14+-EPCs. Prior studies on the relationship between the level of EPCs and coronary artery disease (CAD), either did not distinguish between the two types of EPCs or studied only CD34+-EPCs. We therefore investigated whether the number of circulating CD14+-EPCs correlates with either CAD and/or cardiovascular risk factors. Circulating CD14+-EPCs—as defined by the surface markers CD14+KDR+—were analyzed by flow cytometry in 100 individuals [34 control subjects, 41 patients with stable CAD and 25 patients with acute coronary syndromes (ACS)]. The level of circulating CD14+-EPCs was not significantly different in patients with normal coronary arteries compared to those with stable CAD or ACS. Neither was there any association between the severity of CAD or risk factors and the number of circulating CD14+-EPCs. Thus, the number of circulating CD14+-EPCs was not significantly correlated either with the severity of coronary disease or with cardiovascular risk factors.  相似文献   

15.
OBJECTIVE: As regular physical exercise improves endothelial dysfunction and promotes cardiovascular health, we investigated the effect of training on angiogenesis by measuring the number of circulating endothelial progenitor cells (EPC), the level of EPC-mobilizing growth factors and tested vascular function by flow-mediated dilation (FMD) in patients with coronary artery disease (CAD) and cardiovascular risk factors (CVRF). In addition, degradation products of the NO pathway (NOx) were determined. METHODS AND RESULTS: Twenty patients with documented CAD and/or CVRF joined a 12-week supervised running training. Circulating EPCs--defined by the surface markers CD34, KDR and CD133--were measured at baseline and after exercise training by flow cytometry. We found a significant increase in circulating EPCs (2.9+/-0.4-fold increase; P < .0001), which was positively correlated with both, the change of FMD (r = .81, P < .001) and the increase of NOx synthesis (r = .83, P < .001). Plasma VEGF and erythropoietin did not change in response to exercise. However, we observed a positive correlation between the number of EPCs and erythropoietin at baseline (r = .70, P < .01) and after training (r = .73, P < .01). CONCLUSIONS: Regular exercise training augments the number of circulating EPCs in patients with CVRF and CAD and is associated with improved vascular function and NO synthesis.  相似文献   

16.
While statin treatment may transiently mobilize endothelial progenitor cells (EPCs), the dose-dependent effects of a continuous statin therapy on EPCs in patients with chronic coronary artery disease (CAD) have not been analyzed. In 209 patients with angiographically documented CAD, 144 of which received 10-40 mg/day of statins for >8 weeks, the EPC number was determined by flow cytometry directly (CD34(+)/KDR(+), n=58) and after in vitro-culture (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine-labeled Ac-LDL (DiI-Ac-LDL(+))/lectin(+), n=209). EPC function was assessed by the formation of colony forming units (CFUs). Univariate analysis revealed that the dose of continuous statin therapy inversely correlated with the EPC number. Treatment with 40 mg/day significantly reduced EPC counts. Multivariate analysis unveiled the statin dose and extent of CAD as independent predictors of reduced EPC numbers. Conversely, obesity predicted increased counts, while CFU development was not detectable in all patients and augmented in females and smokers but not in statin-treated patients. Compared with matched controls, statin-treated patients showed significantly reduced absolute and relative EPC counts. In a prospective analysis, initiation of statin therapy significantly diminished the number of circulating and isolated EPCs after 3 but not after 1 month(s). Thus, the statin dose during chronic and continuous treatment independently predicts reduced numbers of circulating as well as isolated EPCs in patients with CAD.  相似文献   

17.
目的: 评估稳定型冠状动脉疾病(stable coronary artery disease, CAD)患者血清白细胞介素-6(IL-6)、可溶性IL-6受体(sIL-6R)和可溶性糖蛋白130(sgp130)浓度及与冠状动脉粥样硬化严重程度间的关系。方法:纳入2017年1月到2019年1月间于惠州市第六人民医院心内科具有动脉造影适应症疑似冠心病患者89例,根据冠状动脉造影结果将患者分成两组:存在冠状动脉粥样斑块CAD组,即粥样斑块组,共64例;不存在冠状动脉粥样斑块CAD组,即非粥样斑块组,共25例。采用ELISA法检测两组患者血清IL-6、sIL-6R和sgp130浓度,Spearman相关分析sgp130浓度与受累冠脉数目及Gensini评分的相关性,多因素logistic回归分析冠状动脉粥样硬化斑块病变的预测因子。结果: 粥样斑块组与非粥样斑块组在年龄、BMI、高血压、糖尿病、血脂参数上无统计学差异(P>0.05), 粥样斑块组患者男性吸烟者居多(P<0.05)。粥样斑块组血清sgp130浓度显著低于非粥样斑块组(314.97±84.39 VS 399.08±79.99 ng/ml, P<0.001),粥样斑块组血清IL-6浓度显著高于非粥样斑块组(P<0.05), 粥样斑块组血清sIL-6R浓度和C-反应蛋白浓度(CRP)与非粥样斑块组比较差异无统计学意义。多因素logistic回归分析示血清sgp130浓度是冠状动脉粥样硬化斑块病变存在的预测因子(P=0.018)。血清sgp130浓度与受累冠状动脉数目间呈负相关(r=-0.310,P=0.007),Gensini评分指数与血清sgp130浓度呈负相关(r=-0.410, P=0.001),稳定型CAD患者sgp130浓度是Gensini评分指数独立危险因素。结论:稳定型CAD患者血清sgp130浓度与冠状动脉损伤严重程度呈负相关,血清sgp130水平是冠状动脉粥样硬化严重程度血清标志物。  相似文献   

18.
OBJECTIVE: To investigate the association of plasma adiponectin levels with coronary artery disease (CAD), arterial hypertension (HT), and insulin resistance (IR) in nondiabetic Caucasian patients. DESIGN: We measured plasma adiponectin levels, IR (HOMA index), and the CAD atherosclerotic burden (angiography-based modified Duke Index score) in 400 nondiabetic patients undergoing coronary angiography. HT was diagnosed by the European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines or if patients were on antihypertensive treatment. RESULTS: Coronary artery disease was found in 62% of the patients and ruled out in the rest (non-CAD group). Plasma adiponectin levels were inversely related to the CAD score (beta = -0.12, P = 0.029) and predicted the coronary atherosclerotic burden independent of other cardiovascular risk factors. However, they were similar in NT and HT and showed no correlation with blood pressure values. In non-CAD, but not in CAD patients, they were lower in patients with than without IR (8.3 +/- 1.2 vs. 11.3 +/- 1.3, respectively; P = 0.007). CONCLUSIONS: In nondiabetic high-risk Caucasian patients plasma adiponectin levels are inversely related to CAD severity and IR; however, they are not strongly related to blood pressure values.  相似文献   

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