辅酶Q10联合阿托伐他汀对心力衰竭大鼠的氧化作用及心肌重构的影响

目的 研究辅酶Q10联合阿托伐他汀对心衰大鼠氧化作用、心肌重构的影响及其机制.方法 左冠状动脉前降支被结扎并饲养6w的24只大鼠随机分为假手术组、模型组、阿托伐他汀组、辅酶Q10+阿托伐他汀组,每组6只,灌胃给药5 w后测定血清超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量、全心及左室肥厚指数(HW/BW,LVHW/BW)、非梗死区心肌解偶联蛋白2(UCP2)的水平.结果 联合应用辅酶Q10及阿托伐他汀能明显升高SOD活性,降低血清MDA的含量及心肌肥厚指数、下调UCP2的水平(P ＜0.05 ～0.001).结论 辅酶Q10联合阿托伐他汀可能通过抗氧化作用,下调心肌梗死后心衰大鼠心肌细胞内UCP2的水平,降低心肌肥厚指数,改善心肌重构.     

雷米普利对心肌梗死后心衰大鼠非梗死区胶原的抑制作用

目的 研究心肌梗死后心衰大鼠非梗死区心肌血管紧张素Ⅱ(Ang Ⅱ)及其Ⅰ型受体(AT1-R)表达对心室重构的影响及雷米普利的干预作用.方法 结扎大鼠左冠状动脉前降支并饲养6 w的16只存活大鼠,随机分为模型组及雷米普利组,每组8只,另取8只大鼠为假手术组,连续灌胃给药4 w后测定大鼠血流动力学参数,ELISA方法检测血清及左心室非梗死区AngⅡ的含量,RT-PCR 法测定左心室非梗死区心肌组织AT1-R mRNA表达水平,Masson染色观察非梗死区心肌胶原的沉积.结果 雷米普利能明显升高左心室内压最大上升和最大下降速率(±dp/dt_(max)),降低左心室收缩压(LVSP)、左心室舒张末压(LVEDP)(P<0.05或P<0.01),但对心率(HR)、收缩压(SBP)、舒张压(DBP)无明显影响(P>0.05),同时明显降低血清及左心室非梗死区AngⅡ的含量及下调AT1-R mRNA 表达水平(P<0.01或P<0.001),Masson染色可见非梗死区心肌胶原沉积明显减轻.结论 雷米普利对梗死后心衰大鼠非梗死区心肌间质胶原重构有显著的抑制作用,其作用机制与下调AT1-R表达水平及减轻胶原沉积有关.     

心痛贴对急性心肌梗死犬氧化应激、心肌代谢和超微结构的影响

目的 观察心痛贴(XTT)对犬急性心肌梗死的保护作用机制.方法 30只犬随机分成5组:假手术组、模型组、XTT小剂量组、大剂量组、阳性药对照组.结扎犬冠状动脉左前降支(LAD)复制急性心肌梗死模型,将XTT贴于犬左前胸近腋窝部位,测定给药后6 h血清超氧化物歧化酶(SOD)、脂质过氧化物(LPO)、游离脂肪酸(FFA)、氧化氮(NO)含量变化,透射电镜观察心肌细胞超微结构改变.结果 XTT能降低血清FFA及LPO含量,提高NO含量和SOD活性(P<0.05、0.01),可改善心肌梗死后心肌细胞超微结构.结论 XTT可改善心肌细胞超微结构,对缺血心肌具有明显保护作用,与其增强抗氧化酶活性,减少脂质过氧化反应,纠正心肌FFA代谢紊乱,提高NO水平有关.     

阿托伐他汀联合辅酶Q1O对心肌梗死后心力衰竭大鼠游离脂肪酸及三磷酸腺苷水平的影响

目的 探讨联合应用阿托伐他汀及辅酶Q10改善心衰大鼠能量代谢的作用机制.方法 将大鼠左冠状动脉前降支结扎,存活的24只大鼠饲养6 w,随机分为4组:假手术组、模型组、阿托伐他汀组、阿托伐他汀+辅酶Q10组,每组6只,灌胃给药5 w后测定血清游离脂肪酸(FFA)及非梗死区心肌组织三磷酸腺苷(ATP)含量.结果 联合应用辅酶Q10及阿托伐他汀组大鼠心肌组织中ATP的含量升高,血清FFA的含量降低(P＜0.05).结论 联合应用辅酶Q10及阿托伐他汀可能通过纠正心衰时FFA及ATP的代谢紊乱,改善心衰时心肌重构过程中的能量代谢.     

熊果酸对急性心肌梗死小鼠氧化应激和脂质代谢的影响

目的观察熊果酸对急性心肌梗死小鼠心肌的保护作用机制。方法 30只C57小鼠随机均分为假手术组、急性心肌梗死模型组和熊果酸组。熊果酸组和急性心肌梗死模型组结扎冠状动脉左前降支6 h,收集各组小鼠心脏和血清。硝基四氮唑(NBT)染色检测心肌梗死面积,HE染色检测心肌病理形态,全自动生化分析仪检测血清乳酸脱氢酶(LDH)、磷酸肌酸激酶(CPK)、心肌肌钙蛋白I(cTnⅠ)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)水平,硫代巴比妥酸(TBA)法检测心肌丙二醛(MDA)、脂质过氧化物(LPO)和游离脂肪酸(FFA)含量,黄嘌呤氧化酶法检测心肌过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GPx)和超氧化物歧化酶(SOD)活性,放射免疫法检测血浆6-酮-前列腺素F1α(6-Keto-PGF1α)及血栓素A2(TXA2)含量。结果与假手术组相比,急性心肌梗死模型组心肌梗死面积、血清LDH、cTnⅠ、CPK、TC、TG及LDLC水平、心肌LPO和MDA含量、血浆TXA2、心肌梗死区和非梗死区FFA含量以及心肌病理形态改变均明显增加,但血清CAT、GPx和SOD活性以及HDLC和6-Keto-PGF1α含量均明显减少。与急性心肌梗死模型组相比,熊果酸组心肌梗死面积、血清LDH、cTnⅠ、CPK、TC、TG和LDLC水平、心肌LPO和MDA含量、血浆中TXA2、心肌梗死区和非梗死区FFA含量以及心肌病理形态改变均明显减少,而血清CAT、GPx和SOD活性以及HDLC和6-Keto-PGF1α含量均明显增加。结论熊果酸对急性心肌梗死有明显的保护作用,其作用机制与抑制氧化应激损伤和改善脂质代谢紊乱相关。     

参飞颗粒对大鼠酒精性脂肪肝的保护作用

目的观察参飞颗粒对大鼠酒精性脂肪肝(AFLD)的保护作用。方法 150只雄性Wistar大鼠,取12只作为正常组,其余大鼠制备AFLD模型:1~4 w灌胃给予40%白酒8 g/kg,5~8 w给予50%白酒9 g/kg,9~16 w给予50%白酒10 g/kg。第9周模型大鼠根据体重随机分为模型组、参飞颗粒(1、2、4 g/kg)组及阳性药水飞蓟宾(80 mg/kg)组,各组分别灌胃给予相应药物,正常及模型组给予同体积的0.5%羧甲基纤维素钠。给药8 w后,水合氯醛麻醉,腹主动脉取血,检测血清总胆固醇(TC)、甘油三酯(TG)、极低密度脂蛋白(VLDL)、游离脂肪酸(FFA)、丙二醛(MDA)含量及超氧化物歧化酶(SOD)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)活性。结果与正常组比较,模型组大鼠血清TC、TG、VLDL、FFA及MDA含量明显升高,SOD活性降低,AST、ALT活性升高。与模型组比较,参飞颗粒4g/kg剂量组能明显降低大鼠血清中TC、TG、VLDL、MDA、FFA含量及ALT活性,升高SOD活性。结论参飞颗粒对大鼠AFLD具有保护作用,其作用机制可能与调节脂质代谢、对抗脂质过氧化损伤及改善肝功能有关。     

西洋参茎叶总皂苷对心室重构大鼠的保护作用

目的 研究西洋参茎叶总皂苷(PQS)对急性心梗后心室重构大鼠的保护作用.方法 结扎大鼠左冠状动脉前降支制备心室重构模型,将Wistar大鼠随机分为假手术组、模型组及PQS小剂量组(75 mg/kg)、大剂量组(150 mg/kg),连续灌胃给药6 w后测量心肌形态学,测定血清MDA、NO含量及SOD活性,放射免疫分析法测定血浆ET水平.结果 西洋参茎叶总皂苷组连续给药6 w后能明显降低脏器指数、血清MDA含量及血浆ET水平,升高血清SOD活性及NO的含量.结论 PQS可能通过对抗自由基的氧化损伤,改善心肌代谢对心室重构的大鼠发挥保护作用.     

阿托伐他汀联合辅酶Q10对心肌梗死后心力衰竭大鼠丙二醛、超氧化物歧化酶及心肌纤维化的影响

目的 观察联合应用阿托伐他汀及辅酶Q10对心肌梗死后心衰大鼠丙二醛(MDA)、超氧化物歧化酶(SOD)以及心肌纤维化的影响,探讨阿托伐他汀联合辅酶Q10在治疗心衰中的作用.方法 Wistar大鼠氟烷麻醉后,结扎左冠状动脉前降支,术后6 w成功建立心衰模型.将大鼠随机分为4组(每组6只):假手术组、模型组、模型+阿托伐他汀组、模型+阿托伐他汀+辅酶Q10组,给药组均于术后第7周开始给药,其中阿托伐他汀给药浓度为10 mg·kg-1·d-1,辅酶Q10给药浓度为30 mg·kg-1·d-1,连续给药5 w,1次/d.5 w后硫代巴比妥酸法测定血清中MDA含量,黄嘌呤氧化酶法测定血清中SOD活性,光镜观察心肌纤维化的程度.结果 模型+阿托伐他汀组较模型组血清中MDA含量显著减少(P＜0.01),SOD活性显著增强(P＜0.01),心肌纤维化程度减轻;模型+阿托伐他汀+辅酶Q10组较模型+阿托伐他汀组MDA含量减少(P＜0.05),SOD活性增强(P＜0.05),心肌纤维化程度减轻.结论 阿托伐他汀联合辅酶Q10较单独应用阿托伐他汀能进一步保护心肌,减少心肌梗死后心衰大鼠血清中MDA含量,增加SOD活性,减轻心肌纤维化程度.     

犬心肌缺血后脂质过氧化损伤及绞股蓝总皂甙的干预效应

目的 观察绞股蓝总皂甙对犬冠脉结扎急性心肌缺血后脂质过氧化和超微结构的影响.方法 采用麻醉开胸犬结扎左冠状动脉前降支(LAD)制备急性心肌缺血模型,观察绞股蓝总皂甙对磷酸肌酸激酶(CK)、乳酸脱氢酶(LDH)、游离脂肪酸(FFA)、过氧化脂质(LPO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物(GSH-Px)的影响.用JEM-1200EX型透射电子显微镜观察心肌细胞超微结构的变化.结果 绞股蓝总皂甙降低血清CK、LDH的活性,降低血清FFA、LPO含量,提高SOD、GSH-Px活性.改善缺血心肌电镜下的细胞损伤.结论 绞股蓝总皂甙对实验性心肌缺血犬脂质过氧化损伤具有保护作用.     

益气温阳法对大鼠心肌缺血再灌注心律失常的研究

目的 探讨中药复方对大鼠缺血再灌注心律失常的影响及作用机制. 方法 将40只Wistar大鼠随机分为假手术组(穿线不结扎)、模型组、中药治疗组、西药对照组(心律平组).各组均同步记录Ⅱ导联体表心电图(ECG ),所有信号均输入RM-6280四导生理记录仪.结扎30 min,再灌注30 min记录心电图心律失常发生情况,随后取缺血区心肌标本,检测心肌组织丙二醛(MDA)含量及超氧化物歧化酶(SOD)活力.结果 模型组大鼠ECG表现多为室性早搏(VP)、室性心动过速(VT),总发生率较假手术组有统计学意义(P＜0.05).中药治疗组ECG显著改善,VP与VT的发生率明显降低,与模型组比较有统计学意义(P＜0.01).模型组与假手术组比较,MDA活性明显升高,SOD 活性明显降低(P＜0.01),中药治疗组MDA活性明显降低,SOD活性较模型组明显升高(P＜0.01),中药治疗组和西药对照组SOD、MDA活性无统计学意义(P＞0.05).结论 中药复方对大鼠心肌缺血再灌注心律失常具有明显保护作用,主要与增强心肌的抗氧化酶活性,减少自由基对心肌的氧化损伤有关.     

曲美他嗪与雷米普利对心力衰竭大鼠心肌细胞凋亡及半胱氨酸天冬氨酸蛋白酶3的影响

目的探讨曲美他嗪与雷米普利单用及联合应用对慢性心力衰竭大鼠左心室心肌细胞凋亡情况以及半胱氨酸天冬氨酸蛋白酶3(Caspase-3)表达水平的影响。方法雄性Wistar大鼠50只随机分为假手术组、模型组、曲美他嗪组、雷米普利组和联合用药组(曲美他嗪+雷米普利),每组10只。采用肾上腹主动脉缩窄法制作慢性心力衰竭模型,观察各组左心室舒张末压、左心室压力最大上升及下降速率(±dp/dtmax);TUNEL法检测心肌细胞凋亡指数;SP免疫组织化学法检测各组大鼠左心室心肌Caspase-3水平的表达,RT-PCR测定Caspase-3mRNA水平。结果与模型组比较,曲美他嗪组、雷米普利组和联合用药组左心室舒张末压、心肌凋亡指数明显降低,±dp/dtmax明显升高,差异有统计学意义(P<0.01),Caspase-3蛋白及mRNA表达水平明显降低,差异有统计学意义[(0.14±0.01、0.14±0.02和0.08±0.02)vs(0.22±0.02),(0.54±0.02、0.54±0.02和0.32±0.02)vs(0.91±0.02),P<0.01]。结论曲美他嗪与雷米普利单用及联合应用均可有效改善心功能、抑制心肌细胞凋亡,联合用药的疗效优于单独用药。     

曲美他嗪与雷米普利对慢性心力衰竭大鼠心肌组织转化生长因子β_1表达的影响

目的探讨曲美他嗪和雷米普利单用及联合应用对慢性心力衰竭大鼠左心室心肌组织转化生长因子β1(TGF-β1)的影响。方法利用肾上腹主动脉缩窄法制作雄性Wistar大鼠慢性心力衰竭模型,随机分为模型组、曲美他嗪组、雷米普利组、联合用药组和假手术组,每组10只。观察各组大鼠左心室重量指数(LVMI)和左心室舒张末压(LVEDP)、左心室压力最大上升及下降速率(±dp/dtmax),采用Massion染色法光镜下观察左心室心肌形态结构变化,SP免疫组织化学法检测各组大鼠左心室心肌中TGF-β1表达情况,RT-PCR测定各组大鼠左心室心肌TGF-β1mRNA水平。结果与模型组比较,曲美他嗪组、雷米普利组和联合用药组±dp/dtmax明显升高,LVEDP、LVMI、TGF-β1阳性表达和TGF-β1mRNA水平明显降低,联合用药组改变更为显著。光镜下显示,曲美他嗪组、雷米普利组及联合用药组心肌损害程度较模型组明显减轻,联合用药组改变更为显著。结论曲美他嗪与雷米普利单用及联合应用均可有效改善心功能、减轻心肌纤维化,其中联合用药优于单独用药。     

Aldosterone receptor blockade improves left ventricular remodeling and increases ventricular fibrillation threshold in experimental heart failure

OBJECTIVES: To investigate the effects of aldosterone receptor blockade in postinfarction heart failure. METHODS: Eighty-seven rats with moderate myocardial infarction were randomized to receive either no drug or canrenone, the active metabolite of spironolactone, 20 mg/kg/day, or ramipril, 1 mg/kg/day, or a combination of the two drugs. Treatment was initiated 1 month after coronary ligation and lasted 4 weeks. Echocardiography was performed at baseline and after 4 weeks. LV catheterization, isolated heart studies, morphometric histology, myocardial norepinephrine and SERCA-2 mRNA were assessed at the end of the treatment period. RESULTS: Infarct sizes were 33+/-3, 32+/-3, 34+/-3, and 34+/-4% in the placebo, canrenone, ramipril, and combination groups, respectively. Canrenone attenuated LV remodeling, improved LV systolic and diastolic function, and markedly reduced interstitial and perivascular fibrosis. These effects were increased by concomitant ramipril therapy. Moreover, myocardial norepinephrine content was decreased while ventricular fibrillation threshold significantly augmented by canrenone. SERCA-2 levels remained unchanged. CONCLUSIONS: Canrenone attenuated LV dilation and interstitial remodeling, and improved LV filling dynamics and systolic function in the rat model of postinfarction heart failure. Addition of ramipril conferred further cardioprotection. Canrenone also reduced myocardial norepinephrine content and increased ventricular fibrillation threshold. The data provide a potential explanation for the decreased sudden death observed in the RALES study.The mechanisms of action of aldosterone inhibition are still poorly understood, despite its proven efficacy in heart failure. Rats with postinfarction heart failure were randomized to receive for 1 month either no drug or canrenone, or ramipril, or a combination of canrenone and ramipril. Canrenone treatment was associated with a significant attenuation of LV dilation, better LV diastolic and systolic dynamics, and a marked reduction of reactive fibrosis. These effects were enhanced by concomitant ramipril therapy. Moreover, canrenone increased ventricular fibrillation threshold and reduced myocardial norepinephrine content. The data may explain the reduced mortality demonstrated by the RALES.     

Effect of ramipril and furosemide treatment on interstitial remodeling in post-infarction heart failure rat hearts

Extracellular matrix (ECM) remodeling and increased matrix metalloproteinase (MMP) expression and activity have been observed to be relevant in the development of heart failure (HF). We examined the effects of ramipril alone or with furosemide on ECM in a heart failure model. HF was induced by occlusion of the left coronary artery in spontaneously hypertensive rats (SHR). Rats were assigned to placebo (n=9), ramipril 1 mg/kg/day (n=11), furosemide 2 x 2 mg/kg/day (n=7) or both (1 mg/kg/day + 2 x 2 mg/kg/day n=8). LV-function, collagen content, MMP/TIMP (tissue inhibitor of matrix metalloproteinases) protein- and mRNA-expression were examined in non-infarcted LV tissue. MMP-2/TIMP-4 ratio was increased in HF. Ramipril reduced MMP-2 expression (active form), collagen type I mRNA expression and content and increased TIMP-4 levels associated with decreased left ventricular end diastolic pressure (LVEDP), mortality rate and increased LV pressure (LVP). Combination therapy with furosemide is less efficient with regard to collagen content and MMP-2 (active form) reduction but did not worsen beneficial effects of ramipril on LV function and mortality rate. Furosemide alone had no effect on MMP-2 (active form) expression, collagen content, LV function and mortality rate. Prevention of LV dilatation by ramipril was associated with decreased gelatinolytic activity and increased MMP-inhibition in heart failure SHR. Furthermore, ramipril reduced fibrosis by enhanced interstitial collagenase expression. Furosemide did not show the beneficial effects of ramipril on ECM remodeling but did not worsen LV function. Positive effects of furosemide treatment alone on LV remodeling and function were not observed.     

Type 2 diabetes-induced cardiovascular complications: comparative evaluation of spironolactone,atenolol, metoprolol,ramipril and perindopril

The present study was carried out to study the effect of spironolactone, atenolol, metoprolol, ramipril and perindopril on cardiovascular complications in neonatal model of diabetes in rats, induced by administering 90?mg/kg streptozotocin (STZ), i.p. in 2-day-old rats. Our data suggest that spironolactone, metoprolol and perindopril prevent not only the STZ-induced metabolic abnormalities but also cardiovascular complications as evident from the reduction in cholesterol, triglyceride and decrease in cardiac hypertrophy which are the initial symptoms of congestive heart failure. Metoprolol and perindopril appears to be beneficial agents as compared to atenolol and ramipril.     

Effects of diuretic treatment on cardiac and circulating RAS in chronic heart failure post-myocardial infarction in rats

BACKGROUND: Cardiac angiotensin converting enzyme (ACE) is activated by an increase in wall stress and is involved in remodeling processes. Heart failure is often treated with ACE inhibitors and diuretics although diuretic treatment could activate the renin-angiotensin system (RAS). AIMS: To examine the effects of diuretic treatment on cardiac and circulating RAS in post-infarction chronic heart failure. METHODS: Myocardial infarction was produced by coronary artery ligation in spontaneously hypertensive rats. The rats were randomly assigned to receive either ramipril (1 mg/kg/day), furosemide (4 mg/kg/day), or combination therapy for 6 weeks, commencing 2 weeks after infarction. RESULTS: All three treatment protocols equivalently attenuated reactive hypertrophy of the right ventricle and ventricular septum and improved left ventricular systolic function. Both cardiac ACE mRNA and activity were significantly increased in untreated rats. This increase was attenuated by both ramipril and furosemide and further depressed by the combination. The increase in activity was completely inhibited by either agent alone. Plasma renin activity was upregulated by ramipril or ramipril plus furosemide but not influenced by infarction or furosemide alone. CONCLUSIONS: Furosemide and ramipril significantly reduced cardiac ACE and remodeling. Diuretics work favorably and do not interfere with the effects of ACE inhibitors. Possibly, a reduction in wall stress due to decreased volume overload accounts for the effects of diuretics on cardiac ACE in the treatment of post-infarction remodeling in hypertensive hearts. These data suggest a new mechanism for the frequently observed beneficial effect of diuretics in heart failure.     

雷米普利联合缬沙坦对慢性心力衰竭患者心脏重构及心功能的影响

目的观察雷米普利、缬沙坦联合对慢性心力衰竭患者心脏重构及心功能的影响。方法150例慢性心力衰竭患者分为两组,对照组应用雷米普利及常规治疗,治疗组加用缬沙坦,治疗6个月后观察心功能与心脏结构的变化。结果在应用雷米普利的基础上加用缬沙坦可以明显改善左心室射血分数、左心室舒张末期内径和左心室短轴缩短率及心胸比例。结论联合治疗可以改善心脏重构和心功能。     

免疫球蛋白对心梗后心衰大鼠心功能及非梗死区胶原的影响

目的 研究免疫球蛋白对心肌梗死后心衰大鼠心功能的影响及非梗死区胶原的抑制作用.方法 将结扎左冠状动脉前降支并饲养6 w的24只存活雌性Wistar大鼠,分为假手术组、模型组及免疫球蛋白组,每组8只.连续腹腔注射给药4 w后测定大鼠血流动力学参数,Masson染色观察非梗死区心肌胶原的沉积.结果 免疫球蛋白能明显升高左心室内压最大上升和最大下降速率(+dp/dtmax及-dp/dtmax),能明显升高左心室收缩压(LVSP),降低左心室舒张末压(LVEDP)(P＜0.05或P<0.01),但对心率(HR)、收缩压(SBP)、舒张压(DBP)无明显影响(P>0.05).Masson染色可见非梗死区心肌胶原沉积明显减轻.结论 免疫球蛋白对梗死后心衰大鼠非梗死区心肌间质胶原重构有显著的抑制作用,其作用机制与减轻胶原沉积有关.     

Cost-effectiveness of the treatment of heart failure with ramipril: a Spanish analysis of the AIRE study

AIMS: To estimate the cost-effectiveness of adding ramipril to conventional treatment in patients with heart failure after myocardial infarction from the perspective of the Spanish National Health System. METHODS AND RESULTS: A retrospective analysis of the AIRE study was made, using previously published data from the clinical trial combined with local Spanish resource and cost data. A typical rehospitalisation for a heart failure episode would last an average of 11.6 days with an average cost of 350.80 per day. The incremental cost of ramipril per life-year gained in the baseline case was 1550.10 after 3.8 years of follow-up. Sensitivity analysis showed that the basic conclusions were robust in spite of extreme variations in the values of the key parameters of the model. CONCLUSION: The use of ramipril in addition to conventional treatment in heart failure patients after myocardial infarction is cost-effective both according to currently accepted international standards of what constitutes a cost-effective intervention and also indirectly by comparing the results with similar pharmaceutical products financed under the Spanish National Health System.