Endothelial Progenitor Cells and Function /Cardiac Rehab

目的-CAD患者内皮祖细胞（EPCs）减少，这可能导致内皮功能障碍和心血管风险。我们假设，重复运动可能会增加内皮祖细胞的内皮功能的改善。 方法：28例CAD患者参加了为期3个月的心脏康复计划，每周3次，每次1小时的运动;所有患者均接受包括他汀类药物（既往报告可增加循环EPCs）在内的药物治疗。从血液中分离单核细胞，并在纤连蛋白包被的威尔斯孔中培养，在48小时时以1百万个非粘附细胞/孔重新铺板，以从循环中的成熟内皮细胞中除去。EPC集落形成单位（CFU）被鉴定为在7天时具有内皮生长的细胞簇。通过肱动脉对缺血后充血反应的流量介导的扩张（FMD）（相对于静息直径的变化%）测定内皮功能。 结果-在3个月时，每次训练的平均能量消耗（MET）从14.7+/-1.2增加到19.5+/-1.3（与基线相比P <0.001），跑步机运动持续时间（改良布鲁斯方案）从14.0+/-0.6增加到15.3+/-0.5分钟（与基线相比P <0.001）。EPC-CFU（计数8个威尔斯孔）从基线时的9.6+/-1.7增至3个月时的26.0+/-4.9（P <0.01）。16例患者表现出FMD改善，从5.1%到7.7%;他们的基线EPC-CFU值，每次会议的MET，运动时间的改善，以及3个月内体重和脂质，葡萄糖和C反应蛋白水平的变化与FMD没有改善的患者没有差异。然而，与无应答者相比，FMD改善的患者在3个月时的EPC-CFU显著更高（35.8+/-7.4 vs. 13.1+/-3.3，P等于0.002），EPC-CFU较基线增加更大（27.3+/-7.5 vs. 3.1+/-4.1，P小于0.01）。对于整个组来说，FMD的改善与EPC-CFU的增加显着相关（P小于0.05）。 结论：心脏康复有益于冠心病患者的运动表现.然而，内皮功能的改善--以及心血管风险的改善--可能依赖于具有内皮分化潜能的祖细胞的动员或活化。

Objective- Patients with CAD have reduced endothelial progenitor cells (EPCs) which may contribute to endothelial dysfunction and cardiovascular risk. We hypothesized that repetitive exercise might increase EPCs with improvement in endothelial function. Methods- Twenty-eight CAD patients participated in a 3 month cardiac rehabilitation program, with 1 hour exercise sessions 3 times weekly; all were on medical management that included statins (previously reported to increase circulating EPCs). Mononuclear cells were isolated from blood and cultured in fibronectin-coated wells, with replating of 1 million nonadherent cells/well at 48 hours to remove from mature endothelial cells in the circulation. EPC colony-forming units (CFU) were identified as cell clusters with endothelial outgrowth at 7 days. Endothelial function was determined by flow-mediated dilation (FMD) of the brachial artery in response to post-ischemic hyperemia (% change from resting diameter). Results- At 3 months, average energy expenditure (METs) per session increased from 14.7+/-1.2 to 19.5+/-1.3 (P less than 0.001 vs. baseline) and treadmill exercise duration (modified Bruce protocol) increased from 14.0+/-0.6 to 15.3+/-0.5 minutes (P less than 0.001 vs. baseline). EPC-CFUs (8 wells counted) increased from 9.6+/-1.7 at baseline to 26.0+/-4.9 at 3 months (P less than 0.01). Sixteen patients showed improved FMD, from 5.1% to 7.7%; their baseline EPC-CFU values, METs per session, improvement in exercise time, and changes in weight and in lipid, glucose and C-reactive protein levels over 3 months were no different than patients without improved FMD. However, patients with improved FMD had substantially greater EPC-CFU at 3 months (35.8+/-7.4 vs. 13.1+/-3.3, P equals 0.002) and greater increases in EPC-CFU from baseline (27.3+/-7.5 vs. 3.1+/-4.1, P less than 0.01) compared with non-responders. For the entire group, improvement in FMD correlated significantly with increase in EPC-CFU (P less than 0.05). Conclusions- Cardiac rehabilitation benefits exercise performance in CAD participants. However, improvement in endothelial function - and by extension, cardiovascular risk - may be dependent on mobilization or activation of progenitor cells with endothelial differentiation potential.