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目的观察脑梗死患者急性期外周血内皮祖细胞(endothelial progenitor cells,EPCs)的水平变化情况,探讨EPCs对脑梗死急性期神经功能缺损症状严重程度的预测价值。方法连续纳入首次发病24 h内住院的急性脑梗死患者72例为脑梗死组,同期选择宿州市立医院脑卒中筛查门诊脑卒中高危患者50例作为对照组。以发病1周内最高美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分作为脑梗死患者急性期神经功能缺损程度的评估标准,NIHSS评分<7分为轻症组,≥7分为重症组;以CD133~+KDR~+细胞作为EPCs的标记,采用流式细胞分析,分别检测急性脑梗死患者发病后第1、5、10天的外周血EPCs数量。结果急性脑梗死患者EPCs数量存在动态变化趋势,呈第1天降低、第5天升高、第10天下降趋势,且均显著低于对照组(均P<0.05);重症组第1、5、10天EPCs数量均低于轻症组,差异有统计学意义(均P<0.05),脑梗死急性期NIHSS评分与第1、5、10天外周血EPCs数量呈负相关(相关系数分别为r_1=-0.762、r_5=-0.622、r_(10)=-0.414,均P<0.05)。结论脑梗死患者急性期外周血基线EPCs水平明显降低;外周血EPCs水平降低可能是脑梗死的危险因素;脑梗死急性期EPCs数量越低提示患者神经功能缺损症状越重,EPCs对脑梗死患者急性期神经功能缺损症状评估具有指导意义。
Objective To observe the changes of peripheral blood levels of endothelial progenitor cells (EPCs) in patients with acute cerebral infarction and to investigate the predictive value of EPCs for the severity of neurological deficits in acute cerebral infarction. Methods 72 consecutive acute cerebral infarction patients admitted to hospital within 24 hours after first onset were selected as cerebral infarction group and 50 high-risk stroke patients were selected as the control group in stroke clinic of Suzhou Municipal Hospital during the same period. The highest NIHSS score within 1 week of onset was used as the evaluation criteria for the acute neurological deficit in patients with cerebral infarction. The NIHSS score <7 was classified as mild, ≥ 7 were divided into severe group. The numbers of EPCs on the 1st, 5th and 10th days after onset of acute cerebral infarction were detected by flow cytometry analysis with CD133 ~ + KDR ~ + cells as markers of EPCs. Results The number of EPCs in patients with acute cerebral infarction had a trend of dynamic change, which decreased on the first day, increased on the fifth day and decreased on the tenth day, and were significantly lower than those in the control group (all P <0.05) (All P <0.05). The NIHSS score in acute stage of cerebral infarction was negatively correlated with the number of EPCs on the 1st, 5th and 10th day (the correlation coefficients were r_1 = -0.762, r_5 = -0.622, r_ (10) = -0.414, all P <0.05). Conclusions The levels of EPCs in peripheral blood of acute cerebral infarction patients with acute cerebral infarction were significantly lower than those of normal controls. Decreased EPCs in peripheral blood may be the risk factors of cerebral infarction. The lower the number of EPCs in acute stage of cerebral infarction, the more severity of neurological deficits. Evaluation of symptomatic neurological deficits is instructive.