急性心肌梗死患者血浆VEGF、SDF-1和外周血CD34+细胞的动态改变及其意义

目的研究急性心肌梗死时血管内皮细胞生长因子(VEGF)、基质细胞衍生因子(SDF-1)以及外周血CD34 细胞的动态改变,探讨其在心肌梗死(心梗)中的作用。方法采集急性心梗患者发病第1、3、7、10、14天外周静脉血,应用酶联免疫方法检测心梗患者以及对照组患者血VEGF和SDF-1的水平。应用流式细胞仪检测心梗患者第1、7、14天外周血CD34 细胞的水平。同时对心梗患者进行心肌酶、肌钙蛋白、心电图及心脏超声等常规检查。结果(1)心梗后第7天外周血CD34 细胞(个/μl)明显增高(2.35±0.72vs1.48±0.49,P<0.05);(2)心梗后血VEGF(pg/ml)明显升高,于第14天达到高峰(197.56±39.87vs53.79±18.12,P<0.01);(3)心梗第1天血SDF-1(pg/ml)明显降低(1683.12±224.79vs2178.67±265.34,P<0.01),以后渐恢复至与对照组相同水平;(4)心梗第7天VEGF水平与外周血CD34 细胞高峰值之间有明显相关性;(5)VEGF高峰值与CK-MB高峰值和肌钙蛋白I之间均有明显相关性。结论心肌梗死本身即可动员干细胞至外周血;心梗后VEGF明显升高至少可持续2周以上,SDF-1短暂降低;两者的动态变化可能与干细胞动员及促使更多干细胞归巢至损伤心肌有关。

Dynamic changes of plasma VEGF, SDF-1 and peripheral CD34+ cells in patients with acute myocardial infarction

OBJECTIVE: To investigate the changes in plasma levels of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1) and in peripheral CD34(+) cells in patients with acute myocardial infarction (AMI), and explore their role in AMI. METHODS: Enzyme-linked immunoassay (ELISA) was employed for measuring the levels of VEGF and SDF-1 in AMI patients on days 1, 3, 7, 10, and 14 of onset and in normal control subjects. The absolute counts of CD34(+) in the peripheral blood were measured on days 1, 7, and 14 by flow cytometry in AMI patients, with their myocardial enzyme and troponin I detected and electrocardiography (ECG) and echocardiography (UCG) recorded. RESULTS: Peripheral CD34(+) cells obviously increased on day 7 after AMI onset (2.35-/+0.72/microl vs 1.48-/+0.49/micro, P<0.05). VEGF levels were significantly higher in AMI patients than in the control subjects, reaching the peak level and on day 14 (197.56-/+39.87 vs 53.79-/+18.12 pg/ml, P<0.01). SDF-1 level obviously decreased on day 1 after AMI onset (1683.12-/+224.79 vs 2178.67-/+265.34 pg/ml, P<0.01), followed by gradually increased to the control level. Obvious correlation was noted between the level of VEGF on day 7 and the peak level of peripheral CD34(+) cells, and the peak plasma VEGF level was obviously associated with the peak serum CK-MB and troponin I levels. CONCLUSION: The stem cells are mobilized into the peripheral blood in the event of AMI. Obviously increased VEGF level following AMI may persist for at least 2 weeks, whereas SDF-1 level undergoes temporary decrement after AMI. The dynamic changes of VEGF and SDF-1 can be related to the mobilization and homing of the stem cells to the injured myocardium.