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1.
目的 探讨腺苷对缺血再灌注后心肌的保护作用,及其与缺血后处理的关系.方法 40只健康大耳白兔,随机分为对照组、拮抗剂组、缺血后处理组、腺苷治疗组4组,每组10只.制备在体兔心肌缺血再灌注模型,检测心肌收缩功能指标,测量心肌梗死范围,观察缺血再灌注即刻应用腺苷及缺血后处理对兔缺血再灌注后心肌的影响.结果 腺苷治疗组和缺血后处理组与对照组和拮抗剂组相比,再灌注之后左室内压峰值、左室内压最大上升速率和左室内压最大下降速率的恢复率差异有统计学意义(P<0.05);梗死范围均明显低于对照组和腺苷受体拮抗剂组(P<0.01);心肌酶学LDH和CK含量较对照组和腺苷受体拮抗剂组明显降低(P<0.01).结论 腺苷/腺苷受体途径是缺血后处理的重要途径之一,能够减轻缺血再灌注损伤,保护心肌.  相似文献   

2.
缺血后处理是保护心肌的一种新方法,其机制与抑制氧自由基堆积、抑制钙超载、抑制中性粒细胞的活化及激活再灌注损伤的补救激酶途径和ATP敏感性钾通道开放等有关。  相似文献   

3.
缺血后处理对大鼠急性心肌缺血再灌注损伤的影响   总被引:1,自引:0,他引:1  
目的观察在体条件下缺血后处理对大鼠心肌缺血再灌注损伤的作用及可能的途径。方法建立大鼠在体缺血再灌注模型,将30只大鼠随机分为假手术组、缺血再灌注组、缺血后处理组、缺血预适应组。于再灌注末测定心肌酶,超氧化物歧化酶(SOD)及丙二醛(MDA)的含量,并测定心肌组织梗死面积。结果与缺血再灌注组相比,缺血后处理组与缺血预适应组心肌梗死面积明显减小,血浆肌钙蛋白I及MDA的含量均降低(P<0.05),血浆SOD活性升高(P<0.05)。结论缺血后处理可减轻心肌缺血再灌注损伤,具有心肌保护效应。  相似文献   

4.
目的 对比观察曲美他嗪(TMZ)后处理与缺血后处理(IPOC)对大鼠心肌缺血再灌注损伤(MIRI)的保护作用.方法40只Wistar 大鼠随机分为4组(n=10):假手术组、模型组、曲美他嗪组(TMZ组)、缺血后处理组(IPOC组).结扎左冠状动脉前降支,建立大鼠心肌缺血/再灌注损伤模型,记录各组心肌梗死面积,光镜HE染色观察心肌组织细胞形态,透射电镜观察心肌细胞微观结构,测定血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)活性变化.结果 TMZ组、IPOC组与模型组比较:①心肌梗死面积减少(P<0.05);②心肌细胞损伤程度相当,较模型组有明显改善;③心肌细胞超微结构损伤程度相当,较模型组有明显改善;④心肌酶CK、LDH、AST活性较模型组均有明显降低(P<0.05).结论 TMZ后处理与IPOD对MIRI心肌均有明显的保护作用,二者作用差异不明显.  相似文献   

5.
缺血后处理减轻大鼠肥厚心肌缺血再灌注损伤的观察   总被引:9,自引:0,他引:9  
目的探讨缺血后处理对心肌肥厚大鼠离体心脏缺血再灌注损伤的影响及其信号机制。方法通过腹主动脉结扎建立大鼠心肌肥厚模型,用Landendorff装置建立心肌肥厚大鼠离体心脏缺血再灌注模型。观察缺血后处理对心肌肥厚大鼠离体缺血再灌注心脏左心室收缩压,冠状动脉流量,肌酸磷酸激酶和乳酸脱氢酶释放,心肌梗死范围,心肌组织中蛋白激酶B/Akt(Akt)、糖原合成酶激酶-3β(GSK-3β)磷酸化的影响。结果与缺血再灌注对照组相比,缺血后处理组心脏左心室收缩压、冠状动脉流量显著高,冠状动脉循环流出液中肌酸磷酸激酶、乳酸脱氢酶含量低,心肌梗死范围减小,心肌组织中磷酸化Akt(Ser473)、磷酸化GSK-3β(Set9)水平高,磷脂酰肌醇-3激酶(PI3K)抑制剂渥曼青霉素(wortmannin)能够抑制缺血后处理所致的磷酸化Akt(Ser473)、磷酸化GSK-3β(Set9)水平升高,但只能部分消除缺血后处理的心脏保护效应。结论缺血后处理能够减轻心肌肥厚大鼠离体心脏缺血再灌注损伤,PI3K/Akt/GSK-3信号途径参与介导缺血后处理对离体缺血再灌注肥厚心肌的保护作用。  相似文献   

6.
心肌缺血后长时间的冠状动脉再灌注前对缺血心肌进行反复、短暂的再缺血干预,以减轻再灌注损伤,称为缺血后处理。它是缺血心脏有效的内源性保护现象,可以减轻缺血-再灌注后心肌坏死与功能障碍,减少恶性心律失常的发生。人们对其发生机理、信号通路以及潜在的临床应用等方面已作了较多研究。现对缺血后处理的研究现状做一综述。  相似文献   

7.
目的通过在体兔心肌缺血再灌注模型,研究再灌注损伤补救酶(RISK)信号转导通路是否参与肾缺血后处理对急性心肌缺血再灌注损伤的保护作用。方法32只兔随机分为4组,每组8只。对照组:结扎冠状动脉前降支1h,再灌注5h。实验A组于再灌注同时对左侧肾动脉行结扎30s、开通30s的3次反复循环,余同对照组;实验B组于再灌注15min后对左侧肾动脉行结扎30s、开通30s的3次反复循环,余同对照组;药物组于再灌注前5min耳缘静脉注射磷脂酰肌醇3激酶(PI3K)抑制剂LY294002(0.3mg/kg),余同实验A组。分别于再灌注3h、再灌注5h取兔血,测定各组血超氧化物歧化酶(SOD)和丙二醛(MDA)的水平。实验终末,取结扎血管支配部位心肌进行免疫组化处理,观察心肌组织蛋白激酶B(Akt)和内皮一氧化氮合酶(eNOS)含量以及心肌组织结构的变化。结果实验A组血SOD含量高于其它组(P<0.01),MDA含量低于其它组(P<0.01),实验A组心肌组织Akt和eNOS含量明显高于其它组(P<0.01);其余组间各项观察指标无显著差异。结论RISK信号转导通路参与肾缺血后处理对急性心肌缺血再灌注损伤的保护作用;肾缺血后处理必须在心肌再灌注后数分钟内立刻进行才能发挥其心肌保护作用。  相似文献   

8.
老年大鼠心肌缺血再灌注损伤的缺血后处理保护   总被引:3,自引:2,他引:1  
目的:评价老年大鼠急性心肌缺血再灌注后的损伤以及缺血后处理的保护作用,并比较与成年大鼠之间的区别.方法:成年及老年雄性SD大鼠,左侧开胸,建立心肌缺血/再灌注模型.实验共分为6组,成年及老年大鼠各3组(n=8/成年组,n=6/老年组):成年大鼠缺血再灌注组(I/Radult)及老年大鼠缺血再灌注组(I/Raged);成...  相似文献   

9.
目的 观察缺血后处理对高血脂大鼠缺血再灌注心肌Bcl-2及Bax蛋白表达的影响.方法 选择高血脂SD大鼠36只,随机分为3组:假手术组、缺血再灌注组、缺血后处理组,每组12只.制备大鼠心肌缺血再灌注模型.缺血再灌注组:收紧结扎线缺血40 min,放松结扎线再灌注240 min;缺血后处理组:缺血40 min后,再灌注10 s,缺血10 s,连续3个循环,然后再灌注240 min;假手术组:开胸后穿线做套环,但不收紧结扎线.再灌注结束后自右颈动脉采血测定血清肌酸激酶(CK)活性,用TUNEL法检测再灌注心肌凋亡程度,采用免疫组织化学方法检测Bcl-2及Bax蛋白的表达情况.结果 ①血清中CK活性的测定:再灌注结束后缺血后处理组和缺血再灌注组CK活性明显高于假手术组[分别为(789.68±67.34),(932.86±84.17),(252.48±19.78)U/L,P<0.05],缺血后处理组明显低于缺血再灌注组(P<0.05).②心肌凋亡细胞计数:再灌注结束后假手术组未见明显细胞凋亡(<5%),缺血后处理组心肌细胞凋亡率明显低于缺血再灌注组[分别为(11.9±2.7)%,(21.2±3.5)%,P<0.05].③与缺血再灌注组相比,缺血后处理组Bcl-2蛋白表达增加(P<0.05),Bax蛋白表达减低(P<0.05).结论 缺血后处理可以增加高血脂大鼠缺血再灌注心肌Bcl-2蛋白表达、降低Bax蛋白表达,进而抑制凋亡.  相似文献   

10.
缺血后处理-心肌再灌注保护新策略   总被引:1,自引:2,他引:1  
缺血后处理(ischemia postconditioning)是指在心肌缺血后,长时间再灌注之前,对心脏进行数次短暂的再灌注/缺血循环的处理方法。与缺血预适应一样,它能减轻再灌注损伤,具有心肌保护作用。目前有多种后处理方法应用于基础和临床研究中。本文就后处理的处理方法、作用机制、临床应用及与预处理的关系作一综述。  相似文献   

11.
目的 观察福辛普利钠预处理结合缺血后适应(IPoC)对大鼠心肌缺血再灌注(I/R)损伤后氧化应激和促炎性细胞因子的影响.方法 Spragn-Dawley大鼠60只,随机分为假手术组(心脏前降支下置线不结扎,n=15),I/R组(心脏前降支结扎30 min,再灌注1 h,n=15),IPoC组(心脏前降支结扎30 min,予以3次10 s的再灌注/缺血循环,再持续灌注1 h,n=15),福辛普利钠+IPoC组(福辛普利钠片0.9 mg/kg,连续灌胃14 d,于末次灌胃2 h后,施以IPoC组的干预过程,n=15).后三组大鼠再灌注1 h,所有实验大鼠腹主动脉取血并分离出心脏组织.比色法测定血清肌酸激酶同工酶(CK-MB)和肌钙蛋白T(cTnT)的含量,NBT染色测定大鼠左心室心肌梗死面积,比色法测定超氧化物歧化酶(SOD)含量,硫代巴比妥酸法测定丙二醛(MDA)含量,放射免疫法测定血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)含量,酶联免疫吸附测定法测定心肌组织IL-1β、IL-6和TNF-α水平.结果 IPoC组大鼠血清CK-MB和cTnT水平均显著低于I/R组(P均<0.01),大鼠心肌梗死面积明显小于I/R组(P<0.01),血清SOD含量高于I/R组(P<0.01),MDA含量低于I/R组(P<0.01),血清和心肌组织炎症因子IL.1β、IL-6和TNF-αt水平均显著低于I/R组(P值分别小于0.05、0.05和0.01).福辛普利钠+IPoC组大鼠心肌梗死面积和CK-MB含量均低于IPoC组(P均<0.05),血清SOD含量高于IPoC组(P<0.05),血清IL-6和心肌组织TNF-α水平均低于IPoC组(P值分别小于0.05和0.01).结论 福辛普利钠预处理可加强IPoC对I/R大鼠心肌的保护作用,其机制可能与抑制氧化应激和早期炎症反应有关.  相似文献   

12.
目的 探讨线粒体连接蛋白43(connexin43,Cx43)和线粒体ATP敏感性钾通道(mitoK_(ATP)~+)在缺血后处理保护兔心肌缺血再灌注损伤中的作用.方法 新西兰大白兔64只,建立心肌缺血再灌注模型,给予冠状动脉左前降支30 min缺血,240 min再灌注.随机分为4组,每组16只:假手术组、缺血再灌注组、缺血后处理组和5-羟葵酸加缺血后处理组.测定血浆磷酸肌酸激酶同工酶(CK-MB),肌钙蛋白I(cTnI)含量以及心肌梗死面积,采用电子显微镜观测心肌线粒体结构变化,Western blot检测线粒体Cx43蛋白表达.结果 缺血后处理组心肌梗死面积为(19.1±3.9)%,明显低于缺血再灌注组(35.7±5.8)%,P<0.01.再灌注4 h末血浆CK-MB与cTnI活性,缺血后处理组明显低于缺血再灌注组和5-羟葵酸加缺血后处理组(P<0.01).与假手术组比较,其他各组线粒体均损伤明显(P均<0.01);缺血后处理组线粒体损伤程度轻于缺血再灌注组(P<0.01);缺血后处理组线粒体损伤程度明显轻于5-羟葵酸加缺血后处理组(P<0.01).缺血再灌注组和5-羟葵酸加缺血后处理组线粒体Cx43蛋白表达均显著低于假手术组(P均<0.05);缺血后处理组心肌线粒体Cx43蛋白表达明显高于缺血再灌注组(P<0.05);缺血后处理组心肌线粒体Cx43蛋白表达明显高于5-羟葵酸加缺血后处理组(P<0.05).结论 线粒体Cx43可能参与了缺血后处理的心肌保护作用,其机制可能与mitoK_(ATP)~+有关.  相似文献   

13.
目的 探讨缺血后处理对ST段抬高型心肌梗死(STEMI)再灌注损伤的保护作用.方法 2006年10月至2009年1月在北华大学附属医院心内科住院并在12 h内行直接冠状动脉介入治疗(PCI)的STEMI患者64例,分为对照组(34例)及缺血后处理组(30例).对照组给予单纯再灌注治疗,缺血后处理组采用再灌注30 s/再缺血30 s,交替3次后再持续灌注的方法.比较两组再灌注心律失常的发生率、发病72 h的CK和CK-MB峰值及72 h的CK值动态变化、冠状动脉血流速度(CTFC)、室壁运动计分(WMSI)、左心室射血分数(LVEF)、QRS计分法测定心肌梗死面积(QRS-MIS)、心肌呈色分级(MBG)的变化.结果 对照组和缺血后处理组再灌注心律失常频发室性早搏发生率分别为52.9%(18/34)和26.7%(8/30,P<0.05),短阵室性心动过速的发生率分别为58.8%(20/34)和23.3%(7/30,P<0.05),CK峰值分别为(1732±480)U/L和(1162±548)U/L(P<0.01),CK-MB峰值分别为(280±99)U/L和(165±70)U/L(P<0.01),CTFC分别为(26.97±3.42)帧和(22.23±3.81)帧(P<0.05),WMSI分别为1.82±0.83和1.27±0.52(P<0.05),LVEF分别为0.47 ±0.10和0.55±0.08(P<0.05),心肌梗死面积分别为(14.65±6.88)%和(10.60±4.97)%(P<0.05),MBG分别为1.47±0.61和2.27±0.64(P<0.05).结论 心肌缺血后处理能显著减轻STEMI患者心肌再灌注损伤,有显著的心肌保护作用.
Abstract:
Objective To observe the effect of ischemia postconditioning during the first minutes of reperfusion for the myocardial reperfusion injury in ST-segment elevation acute myocardial infarction (STEMI)patients undergoing emergency percutaneeus coronary intervention(PCI). Methods STEMI patients undergoing emergency PCI in affiliated hospital of Beihua University between October 2006 and January 2009 were randomly divided into two groups: the control group(n = 34)without any intervention after PTCA, and the postconditioning group(n = 30)with ischemia postconditioning within first minutes of reflow by 3 episodes of 30-second inflation and 30-second deflation with the angioplasty balloon. Reperfusion arrhythmias, CK and CKMB, corrected TIMI frame count(CTFC), wall motion score index(WMSI)and left ventricular ejection fraction(LVEF)by echocardiography were compared between the two groups. MI areas were evaluated with the ECG-54 criteria/32 system and myocardial blush grade(MBG)was measured. Results The incidence of reperfusion arrhythmias-frequent ventricular premature(26. 7% vs.52. 9%)and short array ventricular tachycardia beat(23.3% vs. 58. 8%)as well as values of peaks CK [(l162±548)U/L vs.(1732±480)U/L, P<0. 01], CKMB[(165±70)U/L vs.(280±99)U/L,P<0. 01],CTFC(22.23 ±3.81 vs. 26.97 ±3.42), WMSI(1.27 ±0.52 vs. 1.82 ±0.83),and infarction areas determined by ECG methods(10. 60% ±4. 97% vs. 14. 65% ±6. 88%, all P <0. 05)were all significantly lower in the postconditioning group than in control group while LVEF(0. 55 ± 0. 08 vs.0. 47 ±0. 10)and MBG(2. 27 ± 0. 64 vs. 1.47 ± 0. 61, all P < 0. 05)were signiticantly higher in the postconditioning group than in control group. Conclusions Ischemia postconditioning can significantly reduce myocardial reperfusion injury in patients with STEMI.  相似文献   

14.
急性心肌梗死发病率的增高,促进了再灌注治疗如溶栓及经皮冠脉介入治疗的应用.这却引起了心肌细胞死亡、血流动力学障碍、再灌注心律失常及内皮功能障碍等缺血再灌注损伤[1].众多研究证实,缺血后适应对缺血再灌注损伤心肌具有保护作用,能够降低梗死面积[2]、减少细胞凋亡[3]、改善内皮功能[4]及减轻组织的水肿[4]等.缺血后适应,即在心肌缺血再灌注的即刻对冠脉进行短暂、重复的开通及再闭过程,随后恢复冠状动脉血流[4].后适应的可操作性,决定了其在临床中应用的可能性.本文就后适应在心肌缺血再灌注损伤中的保护应用及其机制进行综述.  相似文献   

15.
目的:探讨远距缺血后适应(RIP)对兔局部短期缺血再灌注心肌的保护作用.方法:将24只新西兰白兔随机平均分成4组:假手术对照组(S组)、缺血再灌注对照组(IR组)、缺血后适应组(Post组)、RIP组.采用TUNEL分析检测各组心肌组织的细胞凋亡情况,Western blot方法检测Bcl-2、Bax蛋白的表达.结果:...  相似文献   

16.
The experimental evidence supporting the mitochondrial permeability transition pore (mPTP) as a major mediator of lethal myocardial reperfusion injury and therefore a critical target for cardioprotection is persuasive. Although, its molecular identity eludes investigators, it is generally accepted that mitochondrial cyclophilin-D, the target for the inhibitory effects of cyclosporine-A on the mPTP, is a regulatory component of the mPTP. Animal myocardial infarction studies and a recent clinical proof-of-concept study have demonstrated that pharmacologically inhibiting its opening at the onset of myocardial reperfusion reduces myocardial infarct size in the region of 30–50%. Interestingly, the inhibition of mPTP opening at this time appears to underpin the infarct-limiting effects of the endogenous cardioprotective strategies of ischemic preconditioning (IPC) and postconditioning (IPost). However, the mechanism underlying this inhibitory action of IPC and IPost on mPTP opening is unclear. The objectve of this review article will be to explore the potential mechanisms which link IPC and IPost to mPTP inhibition in the reperfused heart.  相似文献   

17.
Remote postconditioning   总被引:11,自引:0,他引:11  
Objectives A series of brief coronary artery reperfusions and reocclusions applied during the early minutes of coronary artery reflow (“postconditioning”) attenuates reperfusion injury. However, it is not known whether brief ischemia–reperfusion applied to a distant organ at the onset of myocardial reperfusion (i.e. “remote postconditioning”, remote PostC) reduces infarct size in the reperfused myocardium. In an in vivo anesthetized rat model of myocardial infarction induced by coronary artery occlusion and reperfusion, this study tested the hypothesis that remote postC induced by a single 5 minute episode of renal artery (RA) occlusion and reperfusion applied immediately before the onset of coronary artery reperfusion protects the myocardium from reperfusion injury by mechanisms involving endogenous adenosine receptor activation. Methods All rats were subjected to a total of 30 minutes of left coronary artery occlusion (LCAO) and 3 hours of reperfusion. The rats were randomized to one of six groups: 1) Control: LCAO and reperfusion only with no other intervention; 2) Remote PostC: after 24 minutes of LCAO the RA was occluded for 5 minutes and released 1 min before coronary artery reperfusion; 3) Permanent RA occlusion: the RA was permanently occluded after 24 minutes LCAO continuing to the end of reperfusion; 4) Delayed Remote PostC: after 26 minutes LCAO the RA was occluded for 5 minutes, and its release was delayed until 1 min after coronary artery reperfusion; 5) CON + SPT: rats with LCAO and reperfusion received 10 mg/kg IV of the non–selective adenosine receptor antagonist 8–sulfophenyl theophylline [SPT] administered 5 minutes before coronary artery reperfusion; and 6) Remote PostC + SPT: after 24 minutes of LCAO the RA was occluded for 5 minutes and released 1 minute before coronary artery reperfusion in the presence of 10 mg/kg SPT given 5 min before coronary artery reperfusion. Results Myocardial infarct size (percentage necrosis/area at risk, mean ± SEM) was reduced by 50% in Remote PostC (25 ± 4%) compared to Control (49 ± 4%, p = 0.003), consistent with a reduction in plasma CK activity (44 ± 5 vs. 67 ± 6 U/ml, p = 0.023). In contrast, permanent RA occlusion before LCAO and reperfusion failed to reduce myocardial infarct size (47 ± 5%) vs Control. Delaying the release of the RA occlusion (delayed Remote PostC) abrogated the myocardial infarct reduction observed with Remote PostC (48 ± 6%). SPT alone had no effect on infarct size (47 ± 4% in CON + SPT vs. 49 ± 4% in CON); however, Remote PostC+SPT abrogated the myocardial infarct size reduction in Remote PostC (50 ± 3% in Remote PostC + SPT vs. 25 ± 4% in Remote PostC). Conclusions Remote renal postconditioning applied immediately before the onset of coronary artery reperfusion provides potent myocardial infarct size reduction likely exerted during the first minutes of coronary artery reperfusion. This inter–organ remote postconditioning phenomenon is likely mediated in part by release of adenosine by the ischemic–reperfused kidney and subsequent activation of adenosine receptors.  相似文献   

18.
目的评价丹参酮ⅡA后处理对大鼠心肌缺血再灌注损伤的保护作用。方法SD大鼠随机分为假手术组(A组)、缺血再灌注组(B组)和丹参酮ⅡA后处理组(c组),每组8只。A组:制备大鼠心肌缺血再灌注模型,只穿线,不结扎左冠状动脉;B组:缺血再灌注组,缺血40min,再灌注120min;C组:后处理组,结扎左冠状动脉40min,再灌注120min,再灌注前3min和再灌注后2min内静脉注入丹参酮ⅡA。缺血再灌注160min时,经颈总动脉插管抽取动脉血约2ml,离心取血清,测定血清中CK、LDH、MDA和SOD含量。采用TUNEL法观察各组心肌细胞的凋亡指数,并在光镜及电镜下观察细胞形态学变化。结果与B组相比,c组CK和LDH明显降低,凋亡指数亦明显降低;C组SOD活性明显高于B组,MDA含量明显低于B组;c组心肌组织形态学结构得到较大改善。结论丹参酮ⅡA后处理对大鼠心肌缺血再灌注有保护作用。  相似文献   

19.
目的:研究缺血后处理对大鼠缺血/再灌注心肌髓过氧化物酶(MPO)及可溶性细胞间粘附分子(sICAM)的影响。方法:选择健康SD大鼠48只,随机分为3组:假手术组、缺血再灌注组(对照组)和缺血后处理组。每组16只。制备大鼠心肌缺血再灌注模型。缺血再灌注组.收紧结扎线缺血40min,放松结扎线再灌注240min;缺血后处理组.缺血40min后.再灌注10S.缺血108,连续3个循环,然后再灌注240min;假手术组,开胸后穿线做套环,但不收紧结扎线。再灌注结束后检测血清肌酸激酶(CK)活性、sICAM含量及心肌MPO活性。结果:①血清CK活性:试验后缺血后处理组和缺血再灌注组(对照组)的CK活性明显高于假手术组[分别为(736.28±21.72),(987.62±28.58),(256.34±19.34)U/L,P〈0.01],缺血后处理组的明显低于对照组(P〈0.01)。②心肌MPO活性:缺血后处理组和对照组的均显著高于假手术组(P〈0.01)。缺血后处理组的较对照组显著降低[(0.86±0.08)U/G:(1.28±0.26)U/G。P〈0.01]。③血清sICAM含量:缺血后处理组和对照组血清的sICAM含量均显著高于假手术组(P〈0.01)。缺血后处理组的较对照组显著降低[(54.28±11.69)ng/ml:(76.62土13.45)ng/ml.P〈0.01]。结论:缺血后处理可减轻缺血再灌注损伤,其机制可能与减轻氧化损伤、抑制白细胞的粘附有关。  相似文献   

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