人工生物瓣膜的研究现状及展望  

Current status and prospects of bioprosthetic heart valves

作　　者：陈世崧 刘晓红 徐志云 Chen Shisong;Liu Xiaohong;Xu Zhiyun(Department of Cardiovascular Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长海医院心血管外科,上海市200433

出　　处：《中国组织工程研究》2023年第7期1096-1102,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家重点研发项目(2016YFC1100900),项目负责人:徐志云;宁波市重点研发项目(2018B10092),项目负责人:刘晓红。

摘　　要：背景:心脏瓣膜病是心脏外科中的常见病,而人工心脏瓣膜置换手术是症状性瓣膜疾病的规范治疗。近年来,生物瓣膜作为人工心脏瓣膜的重要组成部分,在材料和处理方式上取得了一些突破,但仍存在一定缺点。目的:总结部分现有人工生物瓣膜的相关研究并对其未来进行展望。方法:第一作者于2022年3月应用计算机在中国知网和PubMed数据库检索2012年1月至2022年3月人工生物瓣膜的相关文献,以“生物瓣膜、生物材料、脱细胞、交联剂、内皮化、TAVR”为中文检索词,以“bioprosthetic valves,biomaterials,decellularization,cross-linking agents,endothelialization,TAVR”为英文检索词,最终纳入79篇文献进行综述。结果与结论:①生物瓣膜具有优越的生物相容性和血液动力学性能,血栓形成较少,患者无需终身抗凝,但生物瓣膜易钙化,导致结构性瓣膜退化,使其耐久性降低。②牛和猪是传统异种瓣膜的主要生物材料来源,目前新型材料主要来源于转基因猪和鱼鳔。③脱细胞技术可以降低生物瓣膜的免疫原性,而脱细胞联合方法可以在保护细胞外基质的基础上提高脱细胞效率。④化学交联剂具有细胞毒性,会导致瓣膜钙化,可通过替代交联剂或修改交联方法降低不良反应;天然交联剂人体相容性好,可一定程度缓解钙化。⑤生物瓣膜内皮化具有抗凝血和抗炎作用,多种涂层技术可以促进生物瓣膜表面内皮化。⑥多种新型介入瓣膜正在研发或投入临床,发展迅速。BACKGROUND:Heart valve disease is common among cardiac surgical disorders,and prosthetic heart valve replacement surgery is the standard treatment for symptomatic valve disease.Bioprosthetic valves,an essential component of prosthetic heart valves,have made some breakthroughs in materials and therapies,but still have some drawbacks.OBJECTIVE:To summarize some existing related researches on bioprosthetic valves and prospect the future.METHODS:The first author searched the relevant literature from January 2012 to March 2022 by computer on CNKI and PubMed databases in March 2022,using“bioprosthetic valves,biomaterials,decellularization,cross-linking agents,endothelialization,TAVR”as the Chinese and English search terms.Finally,79articles were included for review.RESULTS AND CONCLUSION:(1)Bioprosthetic valves have superior biocompatibility and hemodynamic properties,less thrombosis,and no lifelong anticoagulation for patients,but bioprosthetic valves are prone to calcification,leading to structural valve degradation and making them less durable.(2)Bovine and porcine are the primary biomaterials for traditional xenogeneic valves,and new materials are now mainly derived from transgenic pigs and fish bladders.(3)Decellularization techniques can reduce the immunogenicity of biologic valves,while decellularization combination methods can improve decellularization efficiency while protecting the extracellular matrix.(4)Chemical cross-linking agents are cytotoxic leading to calcification.Alternative fixatives or modified cross-linking methods can reduce adverse reactions;natural cross-linking agents are human-compatible and alleviate calcification.(5)Biological valve endothelialization has anticoagulant and anti-infammatory effects,and a variety of coating techniques can facilitate the progression of endothelialization.(6)A variety of new interventional valves are being developed or put into the clinic and developing rapidly.

关 键 词：生物瓣膜 生物材料 脱细胞 交联剂 戊二醛 多酚化合物 内皮化 TAVR 综述 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R654.2