中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2009年
20期
1421-1425
,共5页
张海涛%杨跃进%吴以岭%程宇彤%康晟%赵京林%孟亮%田毅%张燕婉%叶珏%孟宪敏
張海濤%楊躍進%吳以嶺%程宇彤%康晟%趙京林%孟亮%田毅%張燕婉%葉玨%孟憲敏
장해도%양약진%오이령%정우동%강성%조경림%맹량%전의%장연완%협각%맹헌민
心肌梗死%内皮,血管%基质制金属蛋白酶%通心络
心肌梗死%內皮,血管%基質製金屬蛋白酶%通心絡
심기경사%내피,혈관%기질제금속단백매%통심락
Acute myocardial infarction%Endothelium,vascular%Matrix metalloproteinases%Tongxinluo急性心肌梗死%内皮,血管%基质金属蛋白酶%通心络
目的 评价冠脉再通前2 h给予不同剂量通心络对猪急性心肌梗死(AMI)缺血再灌注后心肌微血管结构完整和无再流变化的疗效.方法 中华小型猪40只,分成假手术组、AMI对照组、通心络治疗组:小剂量(0.1 g/kg)、中剂量(0.2 g/kg)和大剂量(0.4 g/kg),每组8只.冠状动脉前降支阻断1.5 h,再灌注3 h建立AMI缺血再灌注动物模型.各通心络治疗组于AMI缺血再灌注前2 h行灌胃给药.测定并比较各组再灌注后3 h正常区、再灌注区、无再流区心肌组织中血管内皮钙黏连蛋白、β连环蛋白、基质金属蛋白酶(MMP)-2和9水平变化.于AMI 1.5 h和再灌注3 h行心肌声学造影(MCE),测定并比较心肌无再流面积变化.结果 (1)与正常区相比,对照组再灌注区和无再流区心肌组织中血管内皮钙黏连蛋白和β连环蛋白水平均显著降低,而MMP -2、9水平均显著升高(P均<0.05),且无再流区变化更显著(P均<0.05);(2)大剂量通心络能够显著升高再灌注区和无再流区血管内皮钙黏连蛋白,分别为(22.2±3.2)%比(32.0±3.9)%和(14.5±2.8)%比(28.3±2.2)%,β连环蛋白,分别为(20.5±3.5)%比(27.3±2.9)%和(13.3±2.1)%比(20.6±2.4)%,同时显著降低以上区域MMP -2,分别为(48.3±4.1)%比(29.4±3.5)%和(57.3±4.3)%比(38.2±4.0)%,MMP -9,分别为(55.6±4.0)%比(34.3±3.5)%和(62.4±4.8)%比(44.4±4.1)%,以上P均<0.05;(3)大剂量通心络能够显著缩小再灌注后3 h心肌无再流区面积,(6.6±1.7)cm2比(4.8±1.5)cm2,P<0.05;和心肌无再流范围,(90.8±3.8)%比(71.4±4.1)%,P<0.05.结论 AMI缺血再灌注前2 h预给予大剂量通心络对心肌微血管内皮结构完整和心肌无再流有明确保护作用,为通心络的临床应用提供了实验依据.
目的 評價冠脈再通前2 h給予不同劑量通心絡對豬急性心肌梗死(AMI)缺血再灌註後心肌微血管結構完整和無再流變化的療效.方法 中華小型豬40隻,分成假手術組、AMI對照組、通心絡治療組:小劑量(0.1 g/kg)、中劑量(0.2 g/kg)和大劑量(0.4 g/kg),每組8隻.冠狀動脈前降支阻斷1.5 h,再灌註3 h建立AMI缺血再灌註動物模型.各通心絡治療組于AMI缺血再灌註前2 h行灌胃給藥.測定併比較各組再灌註後3 h正常區、再灌註區、無再流區心肌組織中血管內皮鈣黏連蛋白、β連環蛋白、基質金屬蛋白酶(MMP)-2和9水平變化.于AMI 1.5 h和再灌註3 h行心肌聲學造影(MCE),測定併比較心肌無再流麵積變化.結果 (1)與正常區相比,對照組再灌註區和無再流區心肌組織中血管內皮鈣黏連蛋白和β連環蛋白水平均顯著降低,而MMP -2、9水平均顯著升高(P均<0.05),且無再流區變化更顯著(P均<0.05);(2)大劑量通心絡能夠顯著升高再灌註區和無再流區血管內皮鈣黏連蛋白,分彆為(22.2±3.2)%比(32.0±3.9)%和(14.5±2.8)%比(28.3±2.2)%,β連環蛋白,分彆為(20.5±3.5)%比(27.3±2.9)%和(13.3±2.1)%比(20.6±2.4)%,同時顯著降低以上區域MMP -2,分彆為(48.3±4.1)%比(29.4±3.5)%和(57.3±4.3)%比(38.2±4.0)%,MMP -9,分彆為(55.6±4.0)%比(34.3±3.5)%和(62.4±4.8)%比(44.4±4.1)%,以上P均<0.05;(3)大劑量通心絡能夠顯著縮小再灌註後3 h心肌無再流區麵積,(6.6±1.7)cm2比(4.8±1.5)cm2,P<0.05;和心肌無再流範圍,(90.8±3.8)%比(71.4±4.1)%,P<0.05.結論 AMI缺血再灌註前2 h預給予大劑量通心絡對心肌微血管內皮結構完整和心肌無再流有明確保護作用,為通心絡的臨床應用提供瞭實驗依據.
목적 평개관맥재통전2 h급여불동제량통심락대저급성심기경사(AMI)결혈재관주후심기미혈관결구완정화무재류변화적료효.방법 중화소형저40지,분성가수술조、AMI대조조、통심락치료조:소제량(0.1 g/kg)、중제량(0.2 g/kg)화대제량(0.4 g/kg),매조8지.관상동맥전강지조단1.5 h,재관주3 h건립AMI결혈재관주동물모형.각통심락치료조우AMI결혈재관주전2 h행관위급약.측정병비교각조재관주후3 h정상구、재관주구、무재류구심기조직중혈관내피개점련단백、β련배단백、기질금속단백매(MMP)-2화9수평변화.우AMI 1.5 h화재관주3 h행심기성학조영(MCE),측정병비교심기무재류면적변화.결과 (1)여정상구상비,대조조재관주구화무재류구심기조직중혈관내피개점련단백화β련배단백수평균현저강저,이MMP -2、9수평균현저승고(P균<0.05),차무재류구변화경현저(P균<0.05);(2)대제량통심락능구현저승고재관주구화무재류구혈관내피개점련단백,분별위(22.2±3.2)%비(32.0±3.9)%화(14.5±2.8)%비(28.3±2.2)%,β련배단백,분별위(20.5±3.5)%비(27.3±2.9)%화(13.3±2.1)%비(20.6±2.4)%,동시현저강저이상구역MMP -2,분별위(48.3±4.1)%비(29.4±3.5)%화(57.3±4.3)%비(38.2±4.0)%,MMP -9,분별위(55.6±4.0)%비(34.3±3.5)%화(62.4±4.8)%비(44.4±4.1)%,이상P균<0.05;(3)대제량통심락능구현저축소재관주후3 h심기무재류구면적,(6.6±1.7)cm2비(4.8±1.5)cm2,P<0.05;화심기무재류범위,(90.8±3.8)%비(71.4±4.1)%,P<0.05.결론 AMI결혈재관주전2 h예급여대제량통심락대심기미혈관내피결구완정화심기무재류유명학보호작용,위통심락적림상응용제공료실험의거.
Objective To assess the effects of tongxinluo on vascular endothelial integrity and myocardial no-reflow in early reperfusion of acute myocardial infarction.Methods Forty mini-swines were divided into five groups randomly, sham group, control group, low dose (0.1 g*kg-1), medium dose (0.2 g*kg-1) and high dose (0.4 g*kg-1) groups of Tongxinluo. It was administered at 2 hours pre-reperfusion. Animals except in sham group were subjected to 1.5 hour of coronary occlusion followed by 3 hours of reperfusion. Content of VE-cadherin, β-catenin, matrix metalloproteinase (MMP)-2 and 9 in myocardium were evaluated; no-reflow area was examined with myocardial contrast echocardiography (MCE) at 1.5 hour of AMI and 3 hours of reperfusion.Results (1) Compared with that of normal myocardium, content of VE-cadherin and β-catenin decreased in reperfusion and no-reflow myocardium while MMP-2 and 9 increased significantly (all P<0.05); (2) Compared with that of control group, a high dose of Tongxinluo could increase significantly the content of VE-cadherin in both reperfusion and no-reflow myocardium, (22.2±3.2)% vs (32.0±3.9)% and (14.5±2.8)% vs (28.3±2.2)% respectively, β-catenin, (20.5±3.5)% vs (27.3±2.9)% and (13.3±2.1)% vs (20.6±2.4)%,while reduce MMP-2, (48.3±4.1)% vs (29.4±3.5)% and (57.3±4.3)% vs (38.2±4.0)% respectively, MMP-9, (55.6±4.0)% vs (34.3±3.5)% and (62.4±4.8)% vs (44.4±4.1)%,all P<0.05; (3) Compared with that of control group, a high dose of Tongxinluo could reduce significantly both no-reflow area, (6.6±1.7)cm2 vs (4.7±1.5)cm2, P<0.05, and percentage(90.8±3.8)% vs (71.4±4.1)%, P<0.05, at 3 hours of reperfusion.Conclusion A high dose of tongxinluo could effectively maintain the integrity of vascular endothelium and attenuate no-reflow area in early reperfusion of acute myocardial infarction.
