Endothelial progenitor cells and surgical outcomes

描述（由申请人提供）：随着人口的持续老龄化，需要手术的老年患者数量将急剧增加。他们中的许多人将从手术中获得质量和寿命的好处。其他人会出现并发症，使他们有更高的风险出院到养老院，这一结果与死亡风险增加有关。更好地了解影响手术结果的因素有两个重要原因。首先，它可以通过识别手术风险可能超过收益的患者来帮助指导选择性手术的候选资格。其次，改进后的风险预测可以识别出可能需要采取旨在改善预后的干预措施的患者。内皮祖细胞（EPCs）是成体干细胞的一种亚型，通过其产生内皮和使缺血组织新生血管的能力，似乎可以预防心脑血管动脉硬化疾病。这两种作用可能对手术患者有重要意义，因为手术引起的心脏缺血是心肌梗死的诱因。我们的研究将通过确定EPC是否与术后心肌梗死风险相关来扩展先前关于EPC在心血管疾病中的作用的观察。我们提出了一项为期2年的前瞻性试验，纳入125例在UCSF医学中心接受血管手术的患者，我们将收集有关EPC计数和功能的术前和术后数据，使用临床客观测量（如心电图和肌钙蛋白- 1）确定心脏事件的发生率，并通过1个月和6个月的电话随访检测其他出院后事件。我们的研究结果将使我们对重大非心脏手术后恢复的病理生理学有更深入的了解，对EPC如何与传统风险指数一起使用来帮助风险分层，以及指导未来使用EPCs作为治疗方式的预防策略的观察和临床试验的发展。

DESCRIPTION (provided by applicant): As the population continues to age, the number of elderly patients who are candidates for surgery will rise dramatically. Many of them will derive quality and length of life benefits from their surgery. Others will experience complications, placing them at higher risk for discharge to a nursing home, an outcome associated with an increased risk for death. Better understanding of factors influencing outcomes following surgery is important for two reasons. First, it can help guide candidacy for elective surgery by identifying patients in whom the risks of surgery likely exceeds the benefits. Second, improved risk predictions can identify patients in whom interventions designed to improve outcomes may be indicated. Endothelial progenitor cells (EPCs) are a subtype of adult stem cell that appear to protect against cardiac and cerebrovascular arteriosclerotic disease through their ability to generate endothelium and neovascularize ischemic tissues. These two actions are likely to have importance in patients undergoing surgery in that cardiac ischemia induced by surgery is a precipitant of myocardial infarction. Our study will extend previous observations regarding EPC's role in cardiovascular disease by determining whether EPC's are associated with risk for postoperative myocardial infarction. We propose a 2 year prospective trial of 125 patients undergoing vascular surgery at UCSF Medical Center, in whom we will collect pre-and postoperative data regarding EPC count and function, determine the incidence of cardiac events using clinically objective measures (e.g. ECG and Troponin-l), as well as detecting additional post-discharge events through phone follow-up at 1 and 6 months. Our study's results will give a greater knowledge of the pathophysiology of recovery following major noncardiac surgery, yield understanding of how EPC's may be used - along with traditional risk indices - to aid risk stratification, as well as guide the development of future observational and clinical trials of preventative strategies using EPCs as a therapeutic modality.