The Study In Relationship Between The Level Of Endothelial Progenitor Cells CD34+ And Impaired Glucose Regulation And The Value Of Epcs As A Early Predictor Of Coronary Heart Disease Complications In Patients With Hypertension

BackgroundNowadays,Hypertension is a major risk factor for cardiovascular diseases (CVD) which are still the leading causes of death in China. There would be 3-5% patients complicated with coronary heart disease in patients with hypertension. Hypertension may almost be the most important risk factor, estimates of the relative risk of independent disease was 3.4 and population attributable risk is 45%。Compared to other risks,the morbidity of cardiovascular disease impacted by hypertension is much lager。An elderly population survey research in China showed that the risk of complicating with cardiovascular disease in elderly people with abnormal glucose regulation and diabetes is 2.185 times and 2.179 times more than the normal glucose regulation ones。It's a consensus that Diabetes itself is a risk factor for cardiovascular disease,however, the risk of cardiovascular disease is no longer limited to diabetes, but extends to pre-diabetes,which included impaired fasting glucose(IFG) and impaired glucose tolerance(IGT).This is a intermediate stage that normal blood glucose develop into diabetes,and it's showed that patients with IGT are more likely to develop into diabetes and cardiovascular disease.High blood pressure and abnormal glucose regulation are the trigger for atherosclerosis,which is the key point in cardiovascular disease development.Several studies indicated, in the earlier stages of hypertension and abnormal glucose regulation,the damage of endothelial function was already exist, although without clinical symptoms . Endothelial dysfunction can be considered as the beginning of atherosclerosis dynamic link.Increasing number of studies show that, endothelial progenitor cells (EPCs) are peripheral pluripotent vascular cells which capable of enhancing re-endothelialization and diminishing neointima formation following arterial injury.When EPCs cycle pool decreased or dried up,the function of endothelial injury repair would be weakened,and accelerate the pathological process of atherosclerosis.Hypertension is an independent risk factor for coronary heart disease. An increase in blood pressure increases the incidence of coronary heart disease. Hypertension-induced pathological cardiac hypertrophy may affect the number of coronary artery disease branches.Besides,hypertension could affect the cardiac structure,leading to severe coronary artery stenosis.Obviously,hypertension and other factors markedly increased the incidence of coronary heart disease. Peripheral EPCs are the key to repairing the damage of vascular endothelium, the decrease in number of EPCs indicates that the risk of atherosclerotic disease increased.Coronary heart disease is the most common complication of hypertensive disease,which was a great burden on this society. Early identification and treatment of coronary heart disease in patients with hypertension has a great positive implication.In this study,we detected several levels of EPCs and carotid artery IMT in patients with different levels of glucose metabolism,in order to investigate the effects of abnormal glucose regulation and diabetes on EPCs and atherosclerotic plaques in patients with hypertension.However,by contrasting the difference of EPCs in hypertension with coronary heart disease or not,discusse the correlation between the peripheral level of CD34+ cells and the severity of coronary stenosis and investigate the value and implication that EPCs served as one of the risk indicators for complication of coronary heart disease in patients with hypertension.ObjectTo investigate the effects of impaired glucose regulation(IGR)on the peripheral blood endothelial progenitor cells and carotid artery intima-media thickness(IMT)in patients with essential hypertension(EH)。To investigate the level of endothelial progenitor cells in the peripheral blood in patients with hypertension complicated with coronary heart disease(CHD),and to discusse the correlation between the level of CD34+ cells and the severity of coronary artery stenosis.Methods and ResultsPart 1 Impaired glucose regulation inversely correlate with the number of peripheral blood endothelial progenitor cells CD34+ in patients with essential hypertensionMethods 84 consecutive patients with EH were enrolled and were divided into four groups, EH + IFG group (11 cases), EH + IGT group (22 cases), EH + DM group (19 cases), EH + NBG group (32 cases) according to the results of standard OGTT test. And select the ventilation healthy subjects(17 cases) as control.The peripheral blood endothelial progenitor cells as measured by the number of CD34 positive cells were detected by Flow Cytometry(FCM).Carotid artery IMT had been respectively measured by Doppler ultrasonic diagnostic apparatus.Results Compared with the control group,the levels of endothelial progenitor cells CD34+ decreased significantly(P<0.01),and it decreased more significantly in the EH + IFG, EH + IGT, EH + DM group (P <0.01). Correlation analysis showed that there were significantly negatively correlated (r = -0.257, -0.296 and -0.344, P <0 .01) between fasting plasma glucose (FPG),postprandial 2 hours blood glucose,glycated hemoglobin (GHB) and the levels of peripheral endothelial progenitor cells. Multiple linear regression analysis study showed that Carotid artery IMT is related with the levels of EPCsCD34+ in peripheral,high-density lipoprotein cholesterol(HDL) and age (P <0.05 or P <0.01).Part 2 An analysis about peripheral endothelial progenitor cells in hypertension with coronary artery disease and inversely correlate with the severity of coronary artery diseaseMethods 104 consecutive patients who underwent coronary angiography were enrolled.The results of coronary angiography were analyzed by Gensini scoring system.All patients were divided into four groups according to Coronary angiography and Hypertension, CHD(+)/HTN(+) of 39 cases,CHD(+)/HTN(-)of 22 cases,CHD(-)/HTN(+) of 21 cases,CHD(-)/HTN(-)of 22 cases. The peripheral blood endothelial progenitor cells as measured by the number of CD34 positive cells were detected by Flow Cytometry(FCM).Results The peripheral levels of EPCsCD34+ was decreased and carotid artery IMT was thicker in patients of Hypertension with coronary disease (P <0.01).There was significant negative correlation between peripheral levels of EPCsCD34+ and carotid artery IMT (r =- 0.845, P <0.01).Conclusions1.Abnormal glucose regulation in patients with hypertension can reduce the level of peripheral blood endothelial progenitor cells , promoting the development of atherosclerosis.It's speculated that early detection of abnormal glucose regulation in patients with hypertension, and active control of blood glucose, may be possible to reduce the incidence of cardiovascular complications of hypertension.2. The number of peripheral EPCsCD34+ was significantly reduced in patients with hypertension,which resulted in endothelial dysfunction.It increased the risk of atherosclerosis formation,and raise the probability of complicating coronary heart disease in these patients.Peripheral EPCsCD34+ can be assessed as one of the risk indicators in hypertention with coronary heart disease.