电针内关穴预处理对经皮冠状动脉介入治疗病人心肌保护作用的临床研究  

Myocardial Protection of Electroacupuncture Pretreatment at Neiguan(PC6)in Patients Undergoing Percutaneous Coronary Intervention

作　　者：朱怡[1] 李毅 东贵荣[1] ZHU Yi;LI Yi;DONG Guirong(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中西医结合心脑血管病杂志》2023年第2期193-197,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金项目(No.30304117328);上海市科学技术委员会科研计划项目(No.16401970401)。

摘　　要：目的:观察电针内关穴预处理对冠心病经皮冠状动脉介入治疗(PCI)术后病人血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶及外周血单核细胞Toll样受体4(TLR4)、髓样分化因子88(MyD88)及核转录因子-κB(NF-κB)mRNA表达的影响,从临床角度探讨电针内关穴对心肌缺血再灌注损伤(MIRI)的预防作用和可能的作用机制。方法:纳入冠心病行PCI术病人57例,将其分为电针预处理组28例和对照组29例。电针预处理组在常规药物治疗基础上取内关穴和大陵穴,术前给予30 min电针干预,对照组仅给予常规药物治疗。通过酶联免疫吸附法(ELISA)检测两组治疗前后血清cTnI、CK和CK-MB变化;实时荧光定量聚合酶链反应(RT-PCR)法检测两组外周血单核细胞中TLR4、MyD88和NF-κB mRNA相对表达量。结果:PCI术后病人血清cTnI、CK及外周血单核细胞TLR4、MyD88和NF-κB mRNA表达均有一定程度升高,与术前相比,除CK外,差异均有统计学意义(P<0.05);电针内关穴预处理能有效抑制PCI术后病人血清cTnI和CK含量(P<0.05);并且电针预处理能有效降低MyD88、NF-κBmRNA的表达(P<0.05),以及对TLR4 mRNA表达也有一定的抑制趋势(P>0.05)。结论:电针内关穴对MIRI起预防保护作用,机制可能与其调节TLR4/MyD88/NF-κB信号通路有关。Objective:To observe the effects of electroacupuncture pretreatment at Neiguan(PC6)on patients with coronary heart disease after percutaneous transluminal coronary intervention(PCI).Methods:Fifty-seven patients with coronary heart disease who underwent PCI were enrolled and divided into electroacupuncture preconditioning group(28 cases)and control group(29 cases).In the electroacupuncture preconditioning group,PC6 and PC7 were selected on the basis of conventional cardiology drug treatment.Electroacupuncture intervention was given preoperatively in 30 minutes,and conventional cardiology medicine was used in the control group.Serum cardiac troponin I(cTnI),creatine kinase(CK),and creatine kinase MB(CK-MB)were detected by enzyme linked immunosorbent assay(ELISA)before and after treatment in both groups.The mRNA relative expression levels of Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor-κB(NF-κB)in peripheral blood mononuclear cells of 2 groups were detected by reverse transcription-polymerase chain reaction(RT-PCR).Results:The expressions of cTnI and CK in serum,and TLR4,MyD88,NF-κB mRNA in peripheral blood monocytes were increased after surgery,and the differences were statistically significant compared with those before surgery except CK(P<0.05).Electroacupuncture pretreatment at PC6 acupoint could effectively inhibit the concentrations of cTnI and CK in serum of patients after surgery(P<0.05).Electroacupuncture pretreatment significantly decreased the mRNA expression of MyD88 and NF-κB in peripheral blood monocytes(P<0.05),and inhibited the mRNA expression of TLR4(P>0.05).Conclusion:Electroacupuncture pretreatment at PC6 showed a protective effect on myocardial ischemia-reperfusion injury(MIRI),and the mechanism may be related to the TLR4/MyD88/NF-κB signaling pathway.

关 键 词：心肌缺血再灌注损伤 经皮冠状动脉介入治疗 内关穴 Toll样受体4/髓样分化因子88/核转录因子-κB信号通路 

分 类 号：R541.4[医药卫生—心血管疾病]