急性ST段抬高型心肌梗死溶栓后循环微粒数量和功能的变化及其参与溶栓后缺血再灌注损伤的机制  

Changes in number and function of circulating microparticles in acute ST segment elevation myocardial infarction after thrombolysis and mechanism of its participation in post-thrombolysis ischemia-reperfusion injury

作　　者：王旭兰[1] 吴皓宇[2] 张涛 王亚萍[2] 王群让 常凤军[2] WANG Xu-lan;WU Hao-yu;ZHANG Tao;WANG Ya-ping;WANG Qun-rang;CHANG Feng-jun(Department of Rehabilitation Treatment Technology,School of Medicine,Xianyang Vocational and Technical College,Xianyang 712000,China;Department of Cardiovascular Medicine,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Department of Nursing,Shangqiu Medical College,Shangqiu 476000,China;Department of Cardiology,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]咸阳职业技术学院医学院康复治疗技术专业教研室,陕西省咸阳市712000 [2]陕西省人民医院心血管内科,西安市710068 [3]商丘医学高等专科学校护理系,河南省商丘市476000 [4]陕西中医药大学附属医院心内科,咸阳市712000

出　　处：《广西医学》2022年第6期627-630,共4页Guangxi Medical Journal

基　　金：陕西省自然科学基础研究计划(2017JQ8025);河南省教育厅高等学校重点研究项目(19B320013);咸阳职业技术学院课程思政建设研究与实践课题(2020KCSZ064);国家“双高计划”建设学校课程思政研究与实践课题(SGKCSZ2020-1511);咸阳职业技术学院“双高计划”专项研究项目(2021SGB02)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(ASTEMI)溶栓后循环微粒数量和功能的变化及其参与溶栓后缺血再灌注损伤的机制。方法(1)选取20例行溶栓治疗的ASTEMI患者(ASTEMI组)及20例健康志愿者(对照组)。抽取对照组体检时及ASTEMI组溶栓前、溶栓2 h后的静脉血,通过分步离心法提取循环微粒并检测其含量。(2)取18只SD大鼠并随机分为动物对照组、实验1组、实验2组各6只。将对照组、ASTEMI组溶栓前和溶栓2 h后的循环微粒经阴茎背静脉分别注入动物对照组、实验1组、实验2组大鼠体内孵育。6 h后处死大鼠,取其心肌组织检测内皮型一氧化氮合酶(eNOS)、诱导型一氧化氮合酶(iNOS)的表达水平,并取胸主动脉检测血管舒张率。结果(1)ASTEMI组溶栓前循环微粒含量高于对照组,ASTEMI组溶栓2 h后的循环微粒含量高于溶栓前(均P<0.05)。(2)动物对照组、实验1组、实验2组大鼠心肌组织中的eNOS表达水平依次降低,iNOS表达水平依次升高,血管舒张率依次下降(均P<0.05)。结论ASTEMI患者体内循环微粒数量增加,导致iNOS过表达而eNOS表达下调,从而引起血管舒张功能障碍,而溶栓治疗导致循环微粒数量进一步增加及其上述作用增强,这可能是溶栓后发生冠状动脉缺血再灌注损伤的机制之一。Objective To investigate the changes in the number and function of circulating microparticles in acute ST segment elevation myocardial infarction(ASTEMI)after thrombolysis as well as the mechanism of its participation in post-thrombolysis ischemia-reperfusion injury.Methods(1)Twenty patients with ASTEMI undergoing thrombolysis therapy(ASTEMI group)and 20 healthy volunteers(control group)were enrolled.Venous blood was collected from the control group during the physical examination and from the ASTEMI group before and two hours after thrombolysis.Circulating microparticles were extracted by the step centrifugation method,and their contents were detected.(2)Eighteen SD rats were selected and randomly divided into animal control group(n=6),experimental group 1(n=6),and experimental group 2(n=6).Circulating microparticles of the control group and the ASTEMI group before and two hours after the thrombolysis were injected into the rats in the animal control group,the experimental group 1,and the experimental group 2,respectively,via dorsal veins of the penes for in vivo incubation.Six hours later,the rats were killed to harvest their myocardial tissues for detecting the expression levels of endothelial nitric oxide synthase(eNOS)and inducible nitric oxide synthase(iNOS),and the thoracic aorta was harvested to determine the vasodilatation rate.Results(1)The ASTEMI group had a higher content of circulating microparticles before thrombolysis than the control group;in the ASTEMI group,the content of circulating microparticles two hours after thrombolysis was higher than that before thrombolysis(all P<0.05).(2)The expression level of myocardial tissue eNOS decreased,the expression level of iNOS increased,and the vasodilatation rate decreased in the order of the animal control group,the experimental group 1 and the experimental group 2(all P<0.05).Conclusion Circulating microparticles are increased in number in the bodies of ASTEMI patients,which contributes to iNOS overexpression and down-regulated expression of eNOS,thus r

关 键 词：急性ST段抬高型心肌梗死 溶栓 循环微粒 内皮型一氧化氮合酶 诱导型一氧化氮合成酶 血管舒张功能 缺血再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]