胚胎干细胞移植结合TMR及VEGF对大鼠心梗的修复作用

目的：探讨胚胎干细胞移植结合透室壁性心肌血管重建术（transmyocardial revascularization,TMR）及血管内皮生长因子（vascular endothelial growth factor,VEGF）对大鼠心梗的修复作用.方法：制备实验性大鼠心梗模型,1周后实施TMR,术后10min于TMR微孔道凝血块内及其周围注射重组VEGF,孔周三点注射移植由绿色荧光蛋白标记的胚胎生殖细胞.4周后测量血液动力学指标评价心功能,并测量左心室重与体重之比,梗塞面积,毛细血管密度,评价移植区的组织学和形态学变化.结果：与单独移植细胞组相比,干细胞移植联合TMR、VEGF组心室肥大减轻,梗塞面积减少（P＜0.01）,梗塞区毛细血管密度增加（P＜0.01）,心功能明显改善（P＜0.01）.结论：胚胎生殖细胞移植联合TMR、VEGF与单纯的细胞移植相比,能更有效地促进心梗区血管生成和移植细胞存活,改善梗塞心肌的心功能.

To repair myocardial infarct of rats through embryo stem cells transplantation incorporated with TMR and VEGF

Objective: To investigate the feasibility and efficiency of em bryo germ cells (EG s)transplantation incorporated with VEGF(vascular endothelial growth factor, VEGF)and TMR(transmyocardialrevascularization, TMR) for repairing myocardial infarct. M ethods: O ne w eek after ligating of leftanteriordescending coronary artery, the recipient rats were treated with TMR. 10 minutes later, recombinant VEGF wasinjected into thrombus of the drilling channel and myocardium bordering channel, and then embryo germ cellstransfected with green fluorescent protein gene were injected into three different sites bordering the channel ofTMR subsequently. Cardiac function was assessed by homodynamic measurements 4 weeks after the operation.Ratio of left ventricular weight and body weight, capillary density and infarct size in the infarct region weremeasured with previous experimental method. Histology and morphology of grafted infarct region were alsoevaluated. Results:Fourw eeks afterthe operation,reverse ofventricularrem odeling,a significantincrease incapillary density and reduction in infarct size were observed in the infarct hearts of the myocardial infarct (MI)rats of combination therapy (P<0.01),com pared w ith M Iratsreceiving cellstransplantation alone.M oreover,MI rats treated with combination therapy showed a significantly higher cardiac function in homodynamicmeasurements (P<0.01)than othercontrolgroup.Conclusions:Com bination ofEG stransplantation,TM R andVEGF administration enhance neovascularizion and viability of transplanted cells in myocardial infarct area,and improve eventually ventricle function. Compared with cell graft alone, it may be superior to attenuate theprogression of cardiac dysfunction in the rat model.