长期血液透析患者内皮祖细胞的变化及其影响因素分析

目的 检测长期面液透析患者外周血内皮祖细胞数量(EPCs)和功能的改变,并探讨其与微炎症、贫血、高同型半胱氨酸血症各影响因素的关系.方法 采用Ficoll密度梯度离心法分离培养慢性肾功能衰竭长期血液透析患者组和健康组的外周血单个核细胞,将其接种在人纤维连接蛋白包被培养板,7天后取贴壁细胞进行Eli-LDL和FITC-UEA-I双染色,并通过流式细胞仪检测其表面标志CD34、CD133、KDR,以鉴定EPCs.采用改良Boyden小室、黏附功能检测评价其迁移和黏附能力,并与患者血红蛋白(Hb)、血清半胱氨酸(Hey)、C反应蛋白(CRP)含量进行多元线性逐步回归分析.结果 长期血液透析患者EPCs 的数量和迁移、黏附功能都低于正常健康者,差异有统计学意义(P<0.05);患者血清CRP、Hcy含量高于正常对照组(P<0.05),与患者EPcs的数量和迁移、黏附功能分别呈负相关(P<0.05);患者Hb含量低于正常对照组(P<0.05),与患者EPCs的数量和黏附功能分别呈正相关;多元线性逐步回归分析发现血清CRP和Hcy是患者EPCs的数量和功能的独立影响因素.结论 长期血液透析患者的EPCs数量和功能降低,存在血管新生和内皮修复的缺陷,增加了患冠心病的风险,其中血清CRP和Hey是患者EPCs的数量和功能的独立影响因素.

Changes of endothelial progenitor cells in long-term hemodialysis patients and its impact factors

Objectives Detect the number and function changes of endothelial progenitor cells ( EPCs)from peripheral blood in long-term hemodialysis patients, and explore their correlation with microinflammation, anaemia, hyperhomocysteinemia. Methods Mononuclear cells ( MNCs) were isolated from peripheral blood of a long-term hemodialysis group and a normal control group by Ficoll density-gradient centrifugation and then were planted on human fibronectin-coated dishes. After 7 days of culture, adherent EPCs were double stained with FITC-UEA-I and Di-LDL, and were further identified by the expression of CD34 ,CD133 and KDR with flow cytometry. EPCs migration were detected by modified Boyden chamber assay. EPCs adhesion were performed by replanting EPCs on human fibronectin-coated plates and then counting the adherent cells. Analysising correlation of the EPCs 'number and function changes with hemoglobin ( Hb) ,homocysteine( Hey) and C-reactiveprotein(CRP) by the multiple linear stepwise regression. Results Number and function activities including migration and adhesion of EPCs in long-time hemodialysis group were significantly lower than the control group( p <0.05); significant increase were observed in serum CRP and Hey level in patients compared with control group( p <0.05) and these had negative correlation with the number and function activities including migration and adhesion ; A significant decrease was observed in serum Hb level in patients compared with control group ( p < 0.05) and these had positive correlation with EPCs'number and adhesion capacities; By multiple linear stepwise regression analysis, CRP and Hey were the independent factors affecting EPCs'number and function activities in patients . Conclusions The number and function activities of EPCs,independent affected by CRP and Hey,were decreased in patients with long-term hemodialysis ,neovascularization and repainnent of damaged endothelium were impaired in these patients, all those increased risk of coronary heart disease.