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目的观察2型糖尿病老年患者外周血中内皮细胞(CECs)、内皮祖细胞(EPCs)和循环祖细胞(CPCs)改变,探讨内皮功能紊乱在糖尿病视网膜微血管病变发生发展中的作用。方法选择糖尿病老年患者30例和老年正常对照10例,流式细胞仪测定外周血中CECs、EPCs和CPCs含量。根据有无视网膜微血管病变分为糖尿病组(DM)、背景型糖尿病视网膜微血管病变组(NPDR)和增生型糖尿病视网膜微血管病变组(PDR),并进行糖尿病视网膜微血管病变与内皮功能紊乱相关性分析。结果(1)DM患者外周血中CECs、EPCs和CPCs的含量分别为0.145%±0.006%、0.059%±0.004%、0.12%±0.03%。DM+DR患者外周血中CECs、EPCs和CPCs的含量分别为0.185%±0.013%、0.043%±0.004%、0.05%±0.02%。15例正常人外周血中CECs、EPCs和CPCs的含量分别为0.067%±0.013%、0.062%±0.004%、0.156%±0.02%,DM患者外周血中的ECs含量均高于正常对照组(P<0.05),EPCs和CPCs的含量低于正常对照组(P<0.05)。(2)PDR与NPDR组rBDR与DM组=0.221,P<0.05;rPDR与NPDR组=0.354,P<0.05;EPCs与微血管病变程度相关系数rBDR与DM组=-0.121,P<0.05;rPDR与NPDR组=-0.175,P<0.05。CPCs与微血管病变程度相关系数rBDR与DM组=-0.373,P<0.05;rPDR与NPDR组=-0.361,P>0.05。(3)相关性分析显示在2型糖尿病组中,EPCs数值与BMI、腰臀比、腹围、FPG,TG,UAER,肌酐,尿酸有负相关性(r值分别为-0.218,-0.223,-0.208,-0.145,-0.126,-0.271,-0.224,-0.198,P<0.05)。结论糖尿病患者外周血CECs、EPCs、CPCs)与微血管病变有一定的相关性,三者作为糖尿病患者血管病变发生发展的早期变化预测指标可能有一定意义。
Objective To investigate the changes of endothelial cells (CECs), endothelial progenitor cells (EPCs) and circulating progenitor cells (CPCs) in peripheral blood of type 2 diabetic elderly patients and explore the role of endothelial dysfunction in the development of diabetic retinopathy. Methods 30 elderly patients with diabetes mellitus and 10 elderly normal controls were selected. The contents of CECs, EPCs and CPCs in peripheral blood were measured by flow cytometry. According to the presence or absence of retinal microangiopathy, the patients were divided into diabetic group (DM), diabetic retinopathy group (NPDR) and proliferative diabetic retinopathy group (PDR). The correlation between diabetic retinopathy and endothelial dysfunction was analyzed. Results (1) The contents of CECs, EPCs and CPCs in DM patients were 0.145% ± 0.006%, 0.059% ± 0.004% and 0.12% ± 0.03% respectively. The levels of CECs, EPCs and CPCs in DM + DR patients were 0.185% ± 0.013%, 0.043% ± 0.004%, 0.05% ± 0.02% respectively. The contents of CECs, EPCs and CPCs in peripheral blood of 15 normal persons were 0.067% ± 0.013%, 0.062% ± 0.004% and 0.156% ± 0.02%, respectively. The contents of ECs in peripheral blood of DM patients were higher than those of normal controls <0.05). The contents of EPCs and CPCs were lower than those in normal control group (P <0.05). (2) The rBDR and DM group in PDR and NPDR group was 0.221, P <0.05; rPDR and NPDR group was 0.354, P <0.05; rBDR and DM group was -0.121, P <0.05; NPDR group = -0.175, P <0.05. The correlation coefficient between CPCs and microvessel density was rBDR and DM group = -0.373, P <0.05; rPDR and NPDR group was -0.361, P> 0.05. (3) The correlation analysis showed that there was a negative correlation between EPCs and BMI, waist-hip ratio, abdominal circumference, FPG, TG, UAER, creatinine and uric acid in type 2 diabetes patients (r = -0.218, -0.223, -0.208, -0.145, -0.126, -0.271, -0.224, -0.198, P <0.05). Conclusion CECs, EPCs and CPCs in peripheral blood of patients with diabetes mellitus have some correlation with microangiopathy. It may be of some significance to predict the early changes of vascular lesions in diabetic patients.