远端缺血预处理对血清miRNA表达水平的影响及对心肌保护作用的研究  

Study on the effects of distal ischemic preconditioning on serum miRNA expression and cardioprotective effects

作　　者：郑浩[1] 陈菲菲[1] 王珏[1] 

机构地区：[1]温州医科大学附属第一医院,浙江温州325000

出　　处：《中国现代医生》2016年第30期5-8,共4页China Modern Doctor

基　　金：浙江省温州市科技局技术开发研究项目(Y20120124)

摘　　要：目的 观察远端缺血预处理对血清miRNA的表达水平的影响及对心肌的保护作用。方法 选择2012年7月~2013年12月本院收治的合并心力衰竭的瓣膜病患者60例,随机分为对照组和观察组,各30例。两组患者入院后行相关评估,麻醉诱导后,观察组患者行远端缺血预处理,对照组同样放置压力带,但不进行充气,后建立体外循环并行手术。检测患者手术前、手术24 h后患者血清肌钙蛋白I（cTnI）、脑钠素（BNP）、肌酸激酶同工酶（CK-MB）的变化;采用实时定量荧光PCR（qRT-PCR）来测定miRNA的表达;观察两组患者术后呼吸机使用时间、ICU停留时间,并采用超声心动图监测手术后7 d左心室射血分数（LVEF）;记录两组患者术后心律失常评分及自动复跳率。结果 手术24 h后,两组患者生化指标较手术前均有所升高,但观察组升高程度不及对照组,差异有统计学意义（P〈0.05）;手术24 h后,两组患者miRNA表达水平较手术前均有所升高,观察组miRNA-1升高程度不及对照组,miRNA-21、miRNA133a升高程度大于对照组,差异均有统计学意义（P〈0.05）;观察组患者心律失常评分均小于对照组,手术中心脏复跳后LVEF及自动复跳率均高于对照组,差异均有统计学意义（P〈0.05）。结论 远端缺血处理可减少再灌注后心肌损伤,产生一定的心肌保护作用,并有可能通过抑制miRNA-1的表达、促进miRNA-133、miRNA-21的表达来发挥作用。Objective To observe the effects of distal ischemic preconditioning on serum miRNA expression and myocardial protection. Methods A total of 60 patients with valvular heart disease complicated with heart failure who were admitted to our hospital from July 2012 to December 2013 were selected and randomly assigned into the control group （n=30） and the observation group （n=30）. Related assessment was carried out in the two groups of patients after admission. After the induction of anesthesia, the patients in the observation group were given distal ischemic preconditioning. The control group was also placed with the pressure band, but not inflated, and then the extracorporeal circulation was performed concurrently with the surgery. Changes of cTnI, BNP and CK-MB were measured before the surgery and 24 hours after surgery; real-time quantitative PCR （qRT-PCR） was used to determine miRNA expression; the time of using respirator, and length of ICU stay wee observed in the two groups after the surgery, and left ventricle ejection fraction（LVEF） at 7 days after the surgery was monitored by echocardiography; the arrhythmia score and the rate of spontaneous resuscitation were recorded. Results The biochemical indices of the two groups 24 hours after the surgery were higher than those before the surgery,.but the increase in the observation group was less than that in the control group. After 24 hours of surgery, miRNA expression levels in both groups were higher than those before the surgery. The increase of miRNA-1 in the observation group was less than that in the control group, and the increases of miRNA-21 and miRNA133a were more than those in the control group. The results were statistically significant（P〈0.05）; the arrhythmia score of the patients in the observation group was shorter than that in the control group. LVEF after resuscitation in the surgery and the rate of auto-resuscitation were significantly higher than those in the control group, and the results were statistically different（P〈0

关 键 词：远端缺血处理 MIRNA 心肌损伤 再灌注 心律失常 

分 类 号：R363[医药卫生—病理学]