主动脉内球囊反搏对猪急性心肌梗死后血管内皮新生因子及血管新生作用的研究

目的观察主动脉内球囊反搏（IABP）对急性心肌梗死（AMI）模型猪的治疗性血管新生作用，揭示其治疗性血管新生作用的时效关系及机制。方法建造AMI模型猪，共23头，随机分为IABP治疗组及对照组两组，治疗组12头，对照组11头，体重25．5～33．5kg，雌雄不限，两组之间的基线特征差异无统计学意义。在成功制作小型猪急性心肌缺血模型后，第0、1、7、14天免疫荧光法（West-blot）、双抗体夹心酶联免疫吸附测定法（ELISA）测定BNP、cTnI、CK-MB、VEGF因子；第0、7、14天冠状动脉造影检测冠状动脉侧支形成；第14天免疫组织化学法检测心肌血管新生相关因子：血管内皮生长阕子（VEGF）含量；病理组织切片、光学显微镜技术评估血管新生。结果①治疗前治疗组及对照组基线特征差异无统计学意义（P〉0．05），两组心功能治疗前差异无统计学意义（P〉O．05）；治疗后泵功能及反映泵功能的血清学指标（BNP）变化差异有统计学意义（JP〈0．05）。②两组心肌梗死模型不同时段VEGF的表达差异有统计学意义（P〈O．05）。对照组的血清VEGF表达从术后第1天起至第7天持续快速上升，至第7天到达峰值，第14天的VEGF表达仍高于第1天。治疗组各时间点的血清VEGF表达趋势与对照组一致，且第7天和第14天VEGF的表达与对照组相应时间点差异有统计学意义（P〈0．05）。③两组免疫组化法检测心肌VEGF含量差异有统计学意义（P〈0．05）。④冠状动脉造影检测冠状动脉侧支形成，第7天和第14天治疗组冠状动脉侧支形成明显多于对照组（P〈O．05）。结论IABP能够促进血管新生，改善侧支循环形成及心功能。其作用可能与通过升高VEGF达到促进血管新生有关。

Effect of IABP therapy on VEGF and angiogenesis in miniature swine with acute myocardial infarction

Objective To study the effect of intra-aortic balloon eounterpulsation （IABP） therapy on angiogenesis in miniature swine with acute myocardial infarction, and vascular endothelial growth iactor （VEGF） levels, collateral circulation and cardiac function, as well as the possible mechanisms to improve collateral circulation. Methods A miniature swine model of acute myocardial infarction was generated. A total of 31 pigs were randomly divided into two groups, of which 15 pigs were assigned to IABP group and 16 to control group, weighing from 25.5 to 33.5 kg. The baseline characteristics of the pigs were similar. All cases suffered from acute myocardial infarction （AMI）, and each group underwent the same basic treatments including antiplatelet, anti-arrhythmia and anti-heart failure. Brain natriurtie peptide （BNP）, troponin （cTnI）, crcatine kinase-MB（CK-MB） and VEGF levels were monitored by Western-blot or ELLISA. Collateral vessel development of coronary artery wasassessed by coronary angiography （CAG） examination. Effect of IABP therapy on angiogenesis was assessed by immunohistochemical and pathological section examination. Results （1）There were no statistically differences of baseline level between two groups （P〉0.05）. The cardiac function had no statistically differences before treatment （P〉 0.05 ）, while after treatment, there were statistically differences （P〈0.05）.（2）The changes of VEGF levels had no statistically differences before treatments between the two groups （P〉O.05）. IABP groups had significantly higher plasma VEGF levels than control group after treatments （P〈O.05）. The VEGF levels was persistently rising from the first day to 14th after treatment in each group, and the changes of VEGF levels were statistically different at 7th, 14th day after treatment, respectively. （3）The changes of collateral vessel development of coronary artery had statistically differences after treatments in each group （P〈0.05）. （4）Especially at 7th, 14th day after treatment, there was more collateral circulation in IABP group by CAG examination. Conclusion IABP can improve collateral circulation and cardiac function. The mechanisms may include increasing VEGF levels, thus improving angiogenesis