急性心肌梗死猝死患者心肌细胞凋亡的研究  

Study on myocyte apoptosis in sudden death with acute myocardial infarction

作　　者：马中富[1] 马虹[1] 叶任高[1] 罗斌[2] 朱全胜[2] 吴金浪[2] 

机构地区：[1]中山医科大学附属第一医院,广东广州510080 [2]中山医科大学基础学院,广东广州510089

出　　处：《中国危重病急救医学》2000年第3期137-141,共5页Chinese Critical Care Medicine

基　　金：卫生部科学研究基金!( 961116)

摘　　要：目的 :探讨细胞凋亡在急性心肌梗死时心肌细胞死亡中的意义。方法 :用末端原位标记 (TU NEL )法、DNA电泳和电镜 3种方法检测急性心肌梗死猝死患者和心脏正常的车祸死亡者心肌细胞的凋亡。结果 :TU NEL 法发现 ,猝死者梗死区的心肌细胞凋亡数 (5 5 7.95± 1 4 4.1 0 )× 1 0 - 3明显高于正常对照组 (34 .30±2 0 .6 8)× 1 0 - 3(P=0 .0 0 0 0 ) ;心肌细胞凋亡数在冠脉 1支病变者为 (5 0 6 .38± 1 75 .88)× 1 0 - 3<2支病变者为(5 5 4.38± 92 .1 5 )× 1 0 - 3<3支病变者为 (6 6 8.2 5± 1 2 7.1 9)× 1 0 - 3,虽然均明显高于正常对照组 (P均 <0 .0 5 ) ,但 3组之间比较则无统计学差别 (P均 >0 .0 5 ) ;冠脉 2～ 3支病变者梗死区的心肌细胞 DNA电泳可见相差约1 80～ 2 0 0 bp的阶梯片段 ;电镜发现猝死者梗死区内的心肌细胞核膜完整、染色质浓集、电子密度增加的凋亡特征 ,有的则出现核膜破裂、染色质溶解成碎屑的坏死现象。结论 :细胞凋亡在急性心肌梗死猝死者的心肌细胞死亡中起重要作用。Objective:To explore the significance of myocyte apoptosis in acute myocardial infarction (AMI).Methods:Myocyte apoptosis in patients with sudden death caused by AMI and in healthy subjects who died in traffic accident were studied by means of TdTmediated dUTP Nick End Labeling (TUNEL),DNA laddering on agarose gel electrophoresis and electron microscopy.Results:The permillage of myocyte apoptosis measured by TUNEL in infarct area in patients with sudden death caused by AMI was significantly higher than that in control group 〔(557 95±144 10)×10 -3 vs.(34 30±20 68)×10 -3 , P =0 000 0〕.The permillages of myocyte apoptosis in 1vessel,2vessel and 3vessel disease were (506 38±175 88)×10 -3 ,(554 38±92 15)×10 -3 ,and (668 25±127 19)×10 -3 ,respectively,which were significantly higher than those of control group (all P <0 05).No significant difference was found among the three groups.DNA laddering on agarose gel electrophoresis showed that the DNA fragments of about 180200 bp were found only in those patients with involvement of two and three vessels.The electron microscopy showed that the characteristics of myocyte apoptosis included intact nuclear membrane,condensed chromatin and increased electron denes.However,some myocytes possessed the characteristics of necrosis,i.e.broken cellular membrane,dissolution of chromatin and lysis of nuclei.Conclusions:Myocyte apoptosis may play a key role in the process of myocyte death in infarct area in patients with sudden death caused by AMI.

关 键 词：细胞凋亡 急性 猝死 心肌梗塞 

分 类 号：R542.22[医药卫生—心血管疾病]