王江友,陈涵,宋丹,刘成伟,彭剑,苏晞,鄢华,张龙岩

• 1:武汉亚洲心脏病医院心内科

摘要(Abstract)：

目的探讨左西孟旦对猪急性冠状动脉微栓塞(CME)后心肌细胞炎症反应的影响及意义。方法将健康巴马系小型猪随机分为CME+左西孟旦组、假手术组及CME组,每组5只。采用经皮冠状动脉介入治疗法,于左前降支中段(发出第一对角支)处,经微导管在40 min内注入42μm的微栓塞球45 ml(假手术组注射等量生理盐水),再用10 ml生理盐水冲洗微导管并注入冠状动脉内。CME+左西孟旦组在CME建立前以左西孟旦预处理[从耳缘静脉以0.05μg/(kg·min)使用24 h,术前60 min再以0.2μg/(kg·min)负荷使用]。术后12 h采用超声心动图检测心功能包括左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、心排血量(CO)及左心室短轴缩短率(FS),以Western blot检测活化肿瘤坏死因子α(TNF-α)表达水平。结果 CME组术后12 h FS[(24.49±2.86)%比(41.28±2.86)%,P=0.023]、LVEF[(49.83±4.64)%比(66.86±3.97)%,P=0.035]、CO[(2.58±0.42) L/min比(4.32±0.89) L/min,P=0.042]与假手术组比较均显著下降,而LVEDd[(38.26±1.93) mm比(32.39±1.52) mm,P=0.043]比假手术组显著增加,差异均具有统计学意义。CME+左西孟旦组FS[(32.42±3.98)%比(24.49±2.86)%,P=0.029]、LVEF[(58.42±5.28)%比(49.83±4.64)%,P=0.043]、CO[(3.58±0.92) L/min比(2.58±0.42)L/min,P=0.038]与CME组比较均呈现升高趋势,LVEDd [(33.92±1.56)mm比(38.26±1.93) mm,P=0.037]比CME组呈现降低趋势,差异均有统计学意义。Western blot定量分析显示,CME组与对照组比较,心肌组织TNF-α蛋白表达水平较高(P=0.039);CME+左西孟旦组与CME组比较,心肌组织TNF-α蛋白表达水平较低(P=0.042),差异均有统计学意义。结论左西孟旦预处理可明显减少CME后心肌细胞炎症反应并改善心功能,其机制可能是通过抑制心肌细胞促炎蛋白TNF-α表达来实现。

关键词(KeyWords)： 左西孟旦;冠状动脉;微栓塞;炎症反应

Abstract:

Keywords:

基金项目(Foundation): 武汉市卫生计生科研基金资助(WX17Q36);; 湖北省卫生计生科研基金资助(WJ2018H0108);; 中国中青年临床研究基金-VG基金(2017-CCA-VG-001)

作者(Author): 王江友,陈涵,宋丹,刘成伟,彭剑,苏晞,鄢华,张龙岩

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