부산대학교 도서관

Endothelial progenitor cells (EPC) are bone marrow-derived cells involved in adult neovascularization and endothelial homeostasis. Previous studies have shown that low EPC in peripheral blood may predict macrovascular disease (MVD) and mortality in patients at high risk for MVD. By contrast, an excess of EPC may be involved in pathologic neoangiogenesis of cancer and proliferative diabetic retinopathy (PDR). Data concerning MVD and different stages of diabetic retinopathy are not available. Thus, we performed a study of EPC in type 2 diabetic patients with retinopathy and with (n=70)and without MVD (n=70), carefully staged for both diabetic eye disease as well as for presence of MVD. EPC were enumerated by flow cytometry (CD34+/CD133+/CD309+). Diabetic Patients were classified as having no retinopathy (CO; n=60), mild non-proliferative diabetic retinopathy (mNPDR; n=20), moderate-severe NPDR (msNPDR; n=20), mild PDR (mPDR; n=20), and severe PDR (sPDR; n=20). Half of the patients in each retinopathy group had MVD, the other had not. Baseline characteristics were as followed (mean±STD): age: 63±11 years; diabetes years: 13±9; HbA1c 8.0±1.6 rel.%, BMI: 30±5 kg/m2; Systolic Blood Pressure 146±22 mm Hg, Diastolic Blood Pressure 83±13 mm Hg, Cholesterol: 186±44 mg/dl; LDL-cholesterol: 97±38 mg/dl, HDL-cholesterol 47±13 mg/dl, Triglycerides: 219±149 mg/dl. No significant changes in baseline characteristics were found between different stages of retinopathy. In patients without retinopathy (CO), the known diminuation of EPC by MVD in type 2 diabetic patients was observed: 153±86 vs 97±70, p=0.007 (without MVD vs with MVD). In patients with MVD EPC showed a continous decline from mild to severe diabetic retinopathy. In patients without MVD and advancing retinopathy EPC where unchanged in mNPDR, msNPDR and mPDR versus CO. However, in patients with sPDR but without MVD a significant increase of EPC (234±102) was observed vs sPDR patients with MVD (21±16, p<0.001), but also versus CO with MVD (p=0.002) and CO without MVD (p=0.019). In summary, EPC show a different regulation in diabetic patients presenting with PDR or MVD or a combination of both. Since patients presenting with both MVD and sPDR demonstrate a much lower number of EPC than patients with isolated sPDR, future prospective follow-up studies are needed to document whether the divergent findings for EPC have an influence on neo-vascularisation and outcome of the severe eye disease. [ABSTRACT FROM AUTHOR]