TMLR对缺血心肌乳酸代谢及线粒体的影响  

Effect of transmyocardial laser revascularization on myocardial lactatic metabolism and mitochondria of myocardial cells

作　　者：陈炬[1] 李少华[1] 张惠忠[1] 华平[1] 潘越江[1] 孙培吾[2] 

机构地区：[1]中山大学附属第二医院胸心外科,广东广州510120 [2]中山大学附属第一医院胸心外科,广东广州510080

出　　处：《中国病理生理杂志》2004年第12期2219-2222,共4页Chinese Journal of Pathophysiology

基　　金：广东省自然科学研究基金资助项目(No.950318)

摘　　要：目的探讨激光心肌血运重建术(TMLR)对急性心肌缺血(AMI)的作用与机制。方法将18条犬随机等分为假手术组、AMI组和TMLR组,采用连续型NdYAG激光行TMLR术。测动脉和冠状窦血乳酸含量(A.Lat和CS.Lat),心肌乳酸代谢速率(MLR)和心肌乳酸吸收分数(MLE);超微电镜结合生物体视学原理定量观察心肌细胞线粒体形态和数量。结果结扎左前降支冠状动脉(LAD)后60min,AMI组和TMLR组CSLat分别为(763±427)mmol/L和(578±398)mmol/L,P<005;MLR分别为(003±001)mmol·100g心肌-1·min-1和(006±002)mmol·100g心肌-1·min-1,P<005;MLE分别为(1204±304)%和(2184±849)%,P<005。LAD结扎后4h,AMI组和TMLR组线粒体体密度分别为(2751±793)%和(3126±385)%,P>005;面密度分别为(125±018)μm-1和(164±028)μm-1,P<001;数密度分别为(010±003)μm-3和(018±005)μm-3,P<001;平均体积分别为(527±285)μm3和(280±054)μm3,P<005;平均外径分别为(206±036)μm和(178±012)μm,P<005。结论TMLR可纠正急性心肌缺血犬的心肌乳酸代谢障碍和减轻心肌细胞损伤。AIM: We studied the therapeutic effect and mechanism of transmyocardial laser revascularization (TMLR) for the acute myocardial ischemia (AMI). METHODS: 18 dogs were divided randomly and evenly into the control group, the AMI group and the TMLR group. A continuous wave Nd: YAG laser was used for TMLR. Concentration of lactate in artery and coronary sinus (A.Lat and CS.Lat), myocardial metabolic rate of lactate acid (MLR) and myocardial lactate extraction (MLE) were measured before the left anterior descending coronary artery (LAD) ligation and 60 min after the LAD ligation. Myocardial biopsy was made 4 h after the LAD ligation to quantitatively observe the shape and number of mitochondria in myocardial cells by a electric microscope. RESULTS: 60 min after the LAD ligation, CS.Lat were (7.63±4.27) mmol/L in the AMI and (5.78±3.98) mmol/L in the TMLR, respectively (P<0.05); MLR were (0.03±0.01) mmol·100 g -1 myocardium·min -1 in the AMI and (0.06±0.02) mmol·100 g -1 myocardium·min -1 in the TMLR, respectively (P<0.05); MLE were (12.04±3.04) in the AMI and (21.84±8.49)% in the TMLR, respectively (P<0.05). The volume density of mitochondria were (27.51±7.93)% in the AMI and (31.26±3.85)% in the TMLR, respectively (P>0.05). The area density of mitochondria were (1.25±0.18) μm -1 in the AMI and (1.64±0.28) μm -1 in the TMLR, respectively (P<0.01). The number density of mitochondria were (0.10±0.03) μm -3 in the AMI and (0.18±0.05) μm -3 in the TMLR, respectively (P<0.01). The average volume of mitochondria were (5.27±2.85) μm3 in the AMI and (2.80±0.54) μm3 in the TMLR, respectively (P<0.05). The average diameter of mitochondria were (2.06±0.36) μm in the AMI and (1.78±0.12)μm in the TMLR, respectively (P<0.05). CONCLUSION: The study suggests that TMLR may effectively improve myocardial lactatic metabolism and protect the myocardial cells from ischemic injury in dogs with the AMI. [

关 键 词：狗 心肌缺血 激光心肌血运重建术 乳酸 线粒体 

分 类 号：R363[医药卫生—病理学]