维持性血液透析患者循环内皮细胞与动脉粥样硬化的关系

目的 探讨维持性血液透析（MHD）患者循环内皮细胞（CEC）与动脉粥样硬化（AS）的关系。 方法 选取MHD患者65例、慢性肾脏病4~5期非透析患者（CKD-non-HD）25例和健康对照者24例为研究对象。抽取外周血，多参数流式细胞仪计数CEC数目。用CD3-PerCP和CD146-PE进行标记，确定CD3-CD146+ 的细胞为CEC。检测颈总动脉内中膜厚度（CCA-IMT）及有关临床参数。对CEC与IMT及有关参数进行相关和回归分析。 结果 MHD组透前和CKD-non-HD组CEC数目[（151.52±98.24）和（183.00±81.38）个/ml] 均显著高于健康对照组[（106.50±24.14）个/ml]（分别为P < 0.05和P < 0.01），但MHD组和CKD-non-HD组间差异无统计学意义。MHD组和CKD-non-HD组CCA-IMT [（0.94±0.36）和（1.02±0.37）mm]均显著高于健康对照组[（0.75±0.15） mm]（分别为P < 0.05和P < 0.01）。MHD组透前血CEC数目和CCA-IMT呈正相关（r = 0.328，P < 0.01）。多元回归分析显示，MHD组CEC是颈动脉IMT的独立危险因素。 结论 CEC是MHD患者AS的独立危险因素，可作为评价MHD患者血管内皮损伤程度的新指标。

Association between circulating endothelial cells and atherosclerosis in maintenance hemodialysis patients

Objective To explore the association between circulating endothelial cells (CECs)and atherosclerosis in maintenance hemodialysis(MHD)patients. Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 65 MHD patients,25 non-hemodialysis patients with chronic kidney disease(CKD)of stage 4 or 5(CKD-non-HD)and 24 age-and Sex-matched healthy controls. CECs in peripheral blood were determined by multiparametrie flow cytometry(FCM).CECs were labeled with CD3-PerCP and CD146-PE before FCM and identified as CD3dim,CD146bright.Atherosclerosis in both groups Was assessed by the measurement of common carotid arery intimamedia thickness (CCA-IMT)and plaque of the common carotid arteries with ultrasound scanner. Results CECs were significantly higher in pre-dialysis patients[(151.52±98.24) cell/ml]and CKD-non-HD patients[(183.00±81.38)cell/ml ] compared with control group[(106.50± 24.14)cell/ml](P<0.05 and P<0.01,respectively).But the number of CECs was not significantly different between MHD and CKD-non-HD patients.CCA-IMT was also significantly higher in MHD patients[(0.94±0.36)mm]and CKD-non-HD patients [(1.02±0.37)mml compared with control group[(0.75±0.15)mm](P<0.05 and P<0.01,respectively).The number of pre-dialysis CECs was positively correlated with CCA-IMT in MHD patients(r=0.328,P<0.01).Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT. Conclusion InMHD patients, CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.