Levels of Circulating Progenitor Cells, Cardiovascular Outcomes and Death A Meta-Analysis of Prospective Observational Studies
Levels of Circulating Progenitor Cells, Cardiovascular Outcomes and Death A Meta-Analysis of Prospective Observational Studies
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DOI：
10.1161/circresaha.116.308366
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发表时间：
2016-06-10
影响因子：
20.1
通讯作者：
Fadini, Gian Paolo
中科院分区：
文献类型：
--
作者：
Rigato, Mauro;Avogaro, Angelo;Fadini, Gian Paolo
原理：循环祖细胞（CPCs），包括内皮祖细胞（EPCs）与心血管疾病的许多方面具有生物学相关性，因为它们促进血管生成和血管修复。目的：本文旨在荟萃分析报告CPC/EPC测量对心血管结局和死亡的预后作用的研究。方法和结果：我们筛选了报告基线CPC/EPC水平、未来心血管事件和死亡之间关系的纵向研究的英文文献。我们检索了28项研究，其中21项包含可合并数据并进入荟萃分析，共纳入4155名患者，其中大多数具有高基线心血管风险。60%的研究至少达到了16项质量评估中的11项。总体而言，CPC/EPC水平降低与未来心血管事件和心血管死亡风险增加约2倍相关。最具预测性的表型是CD34（+）和CD133(+)：低水平和高水平预测心血管事件、血管内干预后再狭窄、心血管死亡和全因死亡率。研究之间以及CPC/EPC表型的异质性普遍较高。排除风险估计必须外推的研究或将分析限制在高质量的研究中仍然表明，在祖细胞计数低与高的患者中，未来心血管事件和死亡的风险显著。结论：本荟萃分析显示，具有血管再生特性的循环细胞水平的降低是心血管不良结局和死亡的一个危险因素。
Rationale: Circulating progenitor cells (CPCs), including endothelial progenitor cells (EPCs) are biologically related to many aspects of cardiovascular disease, as they promote angiogenesis and vascular repair.Objective: We herein aimed to meta-analyze studies reporting the prognostic role of the CPC/EPC measure on cardiovascular outcomes and death.Methods and Results: We screened the English-language literature for longitudinal studies reporting the association between baseline CPC/EPC levels, future cardiovascular events, and death. We retrieved 28 studies, 21 of which contained poolable data and entered the meta-analysis, for a total of 4155 patients, mostly with a high baseline cardiovascular risk. Sixty percent of the studies met at least 11 of 16 items of quality assessment. Overall, reduced CPC/EPC levels were associated with a approximate to 2-fold increased risk of future cardiovascular events and cardiovascular death. The most predictive phenotype was CD34(+)CD133(+): low versus high levels predicted cardiovascular events, restenosis after endovascular intervention, cardiovascular death, and all-cause mortality. Heterogeneity among studies and according to the CPC/EPC phenotype was generally high. Excluding studies for which the risk estimate had to be extrapolated or limiting the analyses to higher quality studies still indicated a significant risk for future cardiovascular events and death in patients with low versus high progenitor cell counts.Conclusions: This meta-analysis shows that a reduction in the levels of circulating cells putatively provided with vasculoregenerative properties represents a risk factor for adverse cardiovascular outcomes and death.