心肌梗死早期缺血再灌注与心交感神经损伤的实验研究  

The experimental investigation of the relationship between ischemic reperfusion and sympathetic nervous injuring in early myocardial infarction

作　　者：周谊[1] 乔宏庆[1] 马福成[2] 张旭东[3] 林国成[1] 

机构地区：[1]第四军医大学西京医院核医学科,陕西西安710033 [2]第四军医大学西京医院病理科,陕西西安710033 [3]第四军医大学西京医院整形科,陕西西安710033

出　　处：《心脏杂志》2004年第1期29-32,36,共5页Chinese Heart Journal

摘　　要：目的 :研究急性或亚急性心肌梗死缺血 /再灌注与心交感神经损伤的关系。方法 :2 4只雄性新西兰大白兔冠状动脉左前降支完全闭塞 45min,并再灌注 (或无再灌注 ) 4h或 7d,以 13 1碘 -间位碘代苄胍 (13 1I-MIBG)、99m锝 -甲氧基异丁基异腈 (99m Tc-MIBI)双核素放射自显影 ,依据美蓝、TTC组织染色 ,确定心肌危险梗死灶与实际梗死灶 ,透射电镜下观察各组间交感末梢超微结构。结果 :再灌注 4h或 7d,危险梗死灶与实际梗死灶都比无再灌组小 ,13 1I-MIBG及 99m Tc-MIBI自显影在同一区域摄取存在差异性 ,以急性无再灌注组 ,13 1I-MIBG缺损面积 (3 8.8%±3 .1% )比所有实际梗死灶及 99m Tc-MIBI显影缺损大 (P<0 .0 1) ,与亚急性危险梗死灶 (3 7.9%± 3 .2 % )接近 (P>0 .0 5) ,介于正常心肌细胞之间 ,交感神经肾上腺颗粒丧失突出。结论 :急性无灌注组心肌梗死区 ,心交感神经末梢颗粒损害早而广 ,再灌注能阻止神经损伤 ,以急性灌注组尤其明显。AIM :To investigate the relationship between ischemic re perfusion and sympathetic nervous injuring in acute or subacute myocardial infarction. M ETHODS:Autoradiography with 131 I-Metaiodobenzylguanidine ( 131 I-MIBG ) and 99m Tc- sestamibi ( 99m Tc-MIBI) was performed in 24 male new zealand white rabbits of whi ch left anterior descending coronary artery was complete occluded for 45 min fol lowed by 4 h (AMI) reperfusion(or non-reperf usion)or 7 days(subacute MI). The area at risk and the infarct size were determined by st aining with methylene blue and triphenyl tetrazolium chloride (TTC), respectivel y. Sympathetic nerve terminals ultrastructural injuring was analyzed by transmis sion electron microscopy.RESULTS:In non-reperfusion groups. whether risk or infa rct areas, myocardial uptaked 131 I-MIBG and 99m Tc-MIBI sh ow defect larger than r eperfusion group, especially for acute non-reperfusion groups, 131 I-MIBG autorad iaography imaging defected area (38.8%±3.1%) was larger than any other infarct s ize and all of 99m Tc-MIBI imaging defect size (P<0. 01),but sim ilar to subacute groups of the risk area (37.9%±3.2%, P>0.05). Sympathetic nerve terminals show loss of adrnergic granular cores under normal structures between normal and necr osis myocytes. CONCLUSION : The experimental results suggest that sym pathetic n erve granular cores injuring sensitive earlier and larger than myocardial infarc tion in non-reperfused AMI group.Reperfusion could protect sympathetic nervous f rom injury especially in AMI group;and showed that MIBG scintigraphy as a non- i nvasive tracer to measure sympathetic injuring extensive and degree in early AMI .

关 键 词：心肌梗塞 缺血再灌注 心交感神经损伤 双核素自显影 动物实验 

分 类 号：R542.22[医药卫生—心血管疾病]