【摘要】 目的:探讨通心络、卡维地洛、缬沙坦对兔急性心肌梗死(AMI)晚期再灌注微血管内皮功能及完整性的保护作用。方法:选用大耳白兔48只,随机分成以下6组:假手术组、缺血(即AMI)再灌注(I-R)对照组以及通心络、卡维地洛、缬沙坦和抵克力得+阿斯匹林防治组,每组8只。各组灌药3d后行冠状动脉结扎2h,再松解2h。分别测定AMI前、后和再灌注后血一氧化氮(NO)、内皮素(ET)含量,测定再灌注后血循环内皮细胞数(CEC)、梗死面积和心肌灶性出血发生率。结果:①AMI前,通心络组的NO2-/NO3-显著高于其它各组(均P<0.01),而ET则均无显著差异。AMI后和再灌注后2h,各组NO2-/NO3-比AMI前均显著降低(P<0.05,P<0.01),ET均显著增高(P<0.05,P<0.01);但与I-R组相比,NO2-/NO3-在通心络组仍显著为高(均P<0.01),且均显著高于其它治疗组(P<0.05,P<0.01);而ET在通心络和缬沙坦组均显著为低(P<0.05,P<0.01),但比其它治疗组均无显著差异。②I-R组的CEC计数比假手术组显著增高(均P<0.01);但与I-R组相比,CEC计数在通心络组显著降低(P<0.05),在抵克力得组则显著升高(P<0.05)。③I-R组的MI面积为24.9%,各治疗组均显著低于I-R组(均P<0.01)。④心肌灶性出血发生率I-R组为62.5%,在通心络和缬沙坦组则显著隆至12.5%和25%(P<0.05,P<0.01)。⑤AMI再灌注后2h,血NO2-/NO3-和ET水平分别与MI面积呈显著负相关和正相关(NO2-/NO3-:r=-0.884,P<0.01;ET:r=0.946,P<0.01)。结论:①兔AMI晚期再灌注时,心肌微血管内皮功能及完整性明显受损,伴MI面积增大和心肌灶性出血增加;②通心络和缬沙坦一样对AMI晚期再灌注时心肌微血管内皮功能及完整性有明显的保护作用,通心络作用可能更优,值得进一步研究。更多还原

【Abstract】 AIM: To compare the protective effects of tongxinluo, a Chinese medicine, and carvedilol and valsartan on myocardium microvascular endothelial function and integrity after late reperfusion of acute myocardial infarction （AMI） in rabbits. METHODS: Forty-eight rabbits were randomly assigned to the following groups: （1） sham operated rabbits; （2） ischemia-reperfusion （I-R） controls; （3） tongxinluo （1.0 g·kg -1·d -1）; （4） carvedilol （5 mg·kg -1·d -1）; （5） valsartan （10 mg·kg -1·d -1） and （6） ticlopidine + aspirine （30 and 20 mg·kg -1·d -1, respectively） groups. After 3 d of drug treatment, the left coronary artery in the rabbit was ligated for 2 h and loosed subsequently for another 2 h. The serum levels of nitric oxide （NO₂^-/NO₃^-） and endothelin （ET） at baseline before AMI, 2 h after both AMI and reperfusion were examined. Also, the number of circulating endothelial cells （CEC）, MI size and percentage myocardium focal bleeding incidence were determined 2 h after reperfusion. RESULTS: （1） The baseline level of NO₂^-/NO₃^- was significantly higher in tongxinluo group than that in other groups （all P<0.01）, whereas the content of ET was not significantly different among the groups. 2 h after both AMI and reperfusion, NO₂^-/NO₃^- was significantly reduced （P<0.05, P<0.01） and ET was significantly increased in each group as compared with their baseline （P<0.05, P<0.01）. Yet among the groups, NO₂^-/NO₃^- was still significantly higher and ET was significantly lower in tongxinluo-treated group than that in the other groups （P<0.05, P<0.01）. （2） CEC number was significantly increased in I-R controls as compared with sham group （P<0.01）, and was significantly reduced in the tongxinluo-treated groups as compared with I-R controls （P<0.05）. （3） MI size was significantly reduced in the four treatment groups as compared with I-R controls （all P<0.01）. （4） The percentage of myocardium focal bleeding incidence was significantly lower in tongxinluo and valsartan-treated groups than that in I-R controls （P<0.05, P<0.01）. CONCLUSION: Tongxinluo as well as valsartan effectively protects myocardium endothelial function and integrity during AMI and late reperfusion, with the effects of tongxinluo being superior.更多还原