迷走神经电刺激后处理对大鼠心肌缺血再灌注损伤的影响

目的 评价迷走神经电刺激后处理对大鼠心肌缺血再灌注损伤的影响.方法 雄性SD大鼠60只,体重250～350 g,采用随机数字表法,将其随机分为3组(n＝20):假手术组(S组)、缺血再灌注组(I/R组)和迷走神经电刺激后处理组(POES组).I/R组和POES组采用结扎左冠状动脉前降支30 min和再灌注120 min的方法制备心肌缺血再灌注损伤模型,S组仅穿线.POES组在心肌缺血15 min时对右侧迷走神经干实施电刺激30 min,电刺激参数:波宽2ms,频率10 Hz,电流强度随大鼠HR进行调整,以保持HR较刺激前降低10％.于缺血前(基础状态)、缺血1、10 min和再灌注30、60、120 min时记录HR和MAP,计算HR和MAP的乘积(RPP).各组随机取10只大鼠,于再灌注120 min时,采集颈动脉血样,采用ELISA法检测血清cTnI、CK-MB、TNF-α、高迁移率族蛋白1(HMGB1)、细胞间粘附分子1(ICAM-1)、IL-1、IL-6和IL-10的浓度；颈动脉采血后,采用伊文蓝和TTC双重染色法测定心肌梗死体积.再灌注120 min时,各组随机处死10只大鼠,取缺血区和非缺血区心肌组织,采用ELISA法检测TNF-α、HMGB1、ICAM-1、IL-1、IL-6和IL-10的含量.结果 与S组比较,I/R组缺血10 min和再灌注30 min时HR增快,缺血1min时MAP和RPP降低,心肌梗死体积、血清cTnI、CK-MB、TNF-α、HMGB1、ICAM-1、IL-1和IL-6的浓度、缺血区和非缺血区心肌组织TNF-α、HMGB1、ICAM-1、IL-1、IL-6和IL-10的含量升高；POES组缺血10 min时HR增快,血清TNF-α浓度降低,心肌梗死体积、血清cTnI、CK-MB、ICAM-1和IL-10的浓度、缺血区心肌组织ICAM-1、IL-1、IL-6和IL- 10的含量、非缺血区心肌组织HMGB1、ICAM-1、IL-1、IL-6和IL-10的含量升高(P<0.05)；与I/R组比较,POES组HR、MAP和RPP差异无统计学意义(P＞0.05),心肌梗死体积、血清cTnI、CK-MB、TNF-α、HMGB1、ICAM-1、IL-1和IL-6的浓度、缺血区和非缺血区心肌组织TNF-α、HMGB1、ICAM-1、IL-1和IL-6的含量降低,IL- 10含量升高(P<0.05).结论 迷走神经电刺激后处理可减轻大鼠心肌缺血再灌注损伤,其机制与抑制局部和全身炎性反应有关.

Effects of postconditioning with electric vagal stimulation on myocardial ischemia-reperfusion injury in rats

Objective To investigate the effects of postconditioning with electric vagal stimulation on myocardial ischemia-reperfusion (I/R) injury in rats.Methods Sixty male SD rats weighing 250-350 g were randomly divided into 3 groups (n ＝ 20 each):group sham operation (group S); group myocardial I/R (group I/R) and group electric vagal stimulation postconditioning (group POES).Myocardial I/R was induced by occlusion of left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion in groups I/R and POES.In group POES right cervical vagus nerve trunk was stimulated for 30 min with continuous electric rectangular pulses (2 ms,10 Hz) starting from 15 min of myocardial ischemia.The voltage of the pulses was adjusted to decrease HR by 10％ of the baseline HR before stimulation.MAP,HR and RPP (MAP× HR) were recorded before (baseline) and at 1 and 10 min of ischemia and 30,60 and 120 min of reperfusion.Arterial blood samples were collected from 10 rats in each group at 120 min of reperfusion for determination of serum concentrations of cTnI,CK-MB,TNF-a,high mobility group box 1 protein (HMGB1),ICAM-1,IL-1,IL-6 and IL-10 (by ELISA).The animals were then sacrificed and myocardial infarct size was measured by Evans blue and TTC staining.Another 10 rats were sacrificed at 120 min of reperfusion for determination of myocardial contents of TNF-α,HMGB1,ICAM-1,IL-1,IL-6 and IL-10 (by ELISA).Results I/R induced myocardial infarct,significantly increased serum concentrations of cTnI,CK-MB,TNF-α,HMGB1,ICAM-1,IL-1 and IL-6 and significantly increased myocardial contents of TNF-α,HMGB1,ICAM-1,IL-1,IL-6 and IL-10 in both ischemic and non-ischemic regions in group I/R as compared with group S.Electric vagal stimulation significantly decreased myocardial infarct size and serum concentrations of cTnI,CK-MB,TNF-α,HMGB1,1CAM-1,IL-1 and IL-6 in group POES compared with group I/R.Myocardial contents of TNF-α,HMGB1,ICAM-1,IL-1 and IL-6 were significantly decreased while myocardial IL-10 content was increased in both ischemic and non-isehemic regions in groups POES compared with group I/R.Conclusion Postconditioning with electric vagal stimulation can attenuate myocardial I/R injury by inhibiting inflammatory response in rats.