体外心脏震波重建猪急性心肌梗死后早期心肌微循环的实验研究  

Extracorporeal Cardiac Shock Wave Therapy Improved Myocardial Microvascular Circulation after Acute Myocardial Infarction at Early Stage in Pigs

作　　者：陶四明[1] 郭涛[2] 王钰[2] 蔡红雁[2] 羊超[2] 

机构地区：[1]云南省第二人民医院心脏内科,昆明650021 [2]昆明医学院第一附属医院心脏内科,昆明650031

出　　处：《四川大学学报（医学版）》2011年第2期222-226,共5页Journal of Sichuan University(Medical Sciences)

基　　金：云南省社会攻关项目(编号2006SG10);云南省社会发展计划项目(编号2008CD007)资助

摘　　要：目的观察低能量体外心脏震波治疗对猪急性心肌梗死后早期缺血心肌微循环重建的影响。方法 25只实验猪,随机选取20只制作急性心肌梗死模型后随机分为心脏震波治疗组(n=15)和阳性对照组(n=5),余下5只为假手术组(阴性对照)。震波治疗组动物在心肌梗死后第3、5、7 d各接受1次体外心脏震波治疗。1月后通过血管造影评价冠状动脉侧枝循环指数,取梗死交界区心肌组织行RT-PCR检测血管内皮生长因子(VEGF)mRNA表达水平和免疫组织化学法检测毛细血管密度。结果与对照组相比,体外心脏震波治疗后梗死心肌局部VEGF mRNA表达水平上调(P<0.05),同时促进局部心肌组织新生毛细血管增生(P<0.05)。冠状动脉侧枝循环分级显示震波治疗促进梗死区域侧枝循环建立。结论急性心肌梗死早期应用体外心脏震波治疗可有效诱导缺血区血管新生,上调促血管新生因子表达水平并重建局部心肌微循环,可能对缓解心梗后心室重塑发展具有重要作用。Objective To explore the effect of low-energy extracorporeal shock wave therapy to improve myocardial micro-vascular circulation after acute myocardial infarction at the early stage in pig model.Methods A total of 25 domestic pigs were used in this study.Model of acute myocardial infarction（AMI） was created successfully by the implantation of angioplasty balloon in mid-distal segment of left anterior descending coronary artery（n=20）.These AMI animals were divided two groups.Extracorporeal shock wave therapy to the ischemic myocardial region was performed for the group of shock wave therapy（n=15） at 3 days after acute myocardial infarction;The remaining AMI animals were treated in the same manner,but without the shock wave therapy（n= 5）;The other health animals（n=5） were used as blank control group.The number of endothelium cell,capillary density,VEGF mRNA level and collateral vessel Rentrop score in each group were evaluated and compared.Results Shock wave treatment up-regulated the mRNA expression of VEGF in the model of acute myocardial infarction（P〈0.05）.Furthermore,the number of capillaries was significantly higher in the shock wave group than that of positive and blank control group（P〈0.05）.The Rentrop score of collateral vessel indicated the reconstruction of collateral circulation in shock wave group.ConclusionExtracorporeal cardiac shock wave therapy could effectively induce angiogenesis,up-regulate the expression of angiogenic factor,resulting in an improvement in micro-vascular circulation reconstruction of ischemic myocardial region.

关 键 词：急性心肌梗死 血管新生 冲击波治疗 心肌微血管 

分 类 号：R542.22[医药卫生—心血管疾病]