磷酸肌酸对大鼠心肺复苏后心肌细胞凋亡的影响  

Effect of exogenous phosphocreatine on cardiomycytic apoptosis and expression of Bcl-2 and Bax after cardiopulmonary resuscitation in rats

作　　者：晏平[1] 陈寿权[2] 李章平[2] 章杰[2] 薛继可[2] 王万铁[3] 黄唯佳[2] 程俊彦[2] 李惠萍[2] 

机构地区：[1]广州医学院附属第一医院急诊科,广州51000 [2]温州医学院附属第一医院急诊科 [3]温州医学院病理生理教研室

出　　处：《中华急诊医学杂志》2011年第7期698-702,共5页Chinese Journal of Emergency Medicine

基　　金：浙江省温州市科技计划项目（Y20080084,Y20090241）;温州医学院科研基金项目（HX2008015）

摘　　要：目的通过观察大鼠心肺复苏（CPR）后心肌细胞凋亡及凋亡相关蛋白Bax，Bcl-2的表达及外源性磷酸肌酸（CP）干预的影响，研究大鼠CPR后心肌损伤机制及外源性CP的保护作用。方法将32只成年雄性sD大鼠随机分为对照组（A组）、常规复苏组（B组）、常规剂量CP组（C组，胸外按压时首次给药CP0．5∥kg，2h后再次给药1．0g／kg）、大剂量CP组（D组，胸外按压时首次给药CP1．0g／kg，2h后再次给药2．0g／kg）。每组动物8只。建立窒息型大鼠心搏骤停（CA）-CPR模型，ROSC后24h取心肌标本待测。以脱氧核糖核昔酸末端转移酶介导的缺口末端标记法（TUNEL）检测ROSC后24h的心肌细胞凋亡指数（AI）；以免疫组化法检测ROSC后24h的心肌细胞Bcl-2，Bax蛋白表达。数据比较采用方差分析。结果与A组比较，CPR后24hB，C，D各组心肌凋亡指数及Bax，Bcl-2蛋白表达均显著升高（均P〈0．01），Bcl-2／Bax值均明显降低（P〈0．叭）；与B组比较，c组和D组心肌的凋亡指数及Bax，Bcl-2蛋白表达均明显降低，Bcl-2／Bax值均明显上升（P〈0．01）；与C组比较，D组的凋亡指数及Bax，Bcl-2蛋白表达均明显降低，Bcl-2／Bax值明显上升（P〈0．05）。结论外源性磷酸肌酸可明显抑制窒息型大鼠CPR后心肌细胞凋亡，对心肺复苏后心肌损伤具有保护作用，该作用以大剂量时更明显。Objective To observe the changes of cell apoptosis and levels of Bcl-2 and Bax protein in myocardium after cardiopulmonary resuscitation （CPR） in rats and to study the protective effects of different doses of exogenous phosphocreatine （creatine phosphate, CP） on cell apoptosis. Methods A total of 32 male adult SD rats were randomly divided into 4 groups, namely control group （ group A）, CPR group （ group B） , low dose CP group （ group C, phosphoereatine 0. 5 g/kg given at beginning of CPR and 1.0 g/ kg 2 hour after CPR） and high dose CP group （ group D, phosphocreatine 1.0 g/kg at beginning of CPR and 2. 0 g/kg 2 hours after CPR） . Cardiac arrest was induced by asphyxiation and CPR was started 7 min after asphyxiation in groups B, C and D. Myocardium samples were taken 24 hours after CPR for detecting myocardium cell apoptosis by TUNEL method. The levels of Bcl-2 and Bax protein were measured by using immunohistoehemistry. Experimental data were processed with variance analysis in SPSS package. Results Compared with group A, myocardium cell apoptosis index （AI） , and the levels of Bcl-2 and Bax protein increased significantly in groups B, C and D （P 〈 O. 01 ）, and Bcl-2/Bax ratio decreased significantly （P 〈O. 01 ） . Compared with group B, myocardium cell AI and levels of Bcl-2 and Bax protein decreased significantly in groups C and D （ P 〈 0. 01 ）, and Bcl-2/Bax ratio increased significantly （ P 〈 0.01 ） . Compared with group C, myocardium cell AI and levels of Bcl-2 and Bax decreased significantly in group D （P 〈 0. 05 ）, and Bcl-2/Bax ratio increased significantly （ P 〈 O. 05 ） . Conclusion Exogenous phosphocreatine, especially inlarge dose, could inhibit apoptosis of myocardium cells and alleviate myocardium injury after CPR in rats.

关 键 词：心搏骤停 心肺复苏 心肌损伤 磷酸肌酸 细胞凋亡 Bcl-2 BAX TUNEL 

分 类 号：R459.7[医药卫生—急诊医学]