摘要
目的随着急性心肌梗死(acute myocardial infarction,AMI)发病率的不断增加,以及再灌注治疗的广泛开展,缺血再灌注损伤(ischemical reperfusion injury,IRI)已经引起了广泛关注,但尚未找到一种能有效减轻IRI的治疗方法。近年来,国内外基于动物模型的研究发现:高迁移率族蛋白B1(high mobility group box 1 protein,HMGB1)可能在IRI过程中发挥着中枢作用,并且目前有关AMI患者经经皮冠状动脉内介入术(percutaneous coronary intervention,PCI)血浆中HMGB1浓度变化及其机制的研究还鲜见报道。文中初步探讨HMGB1是否参与AMI患者PCI中心肌IRI过程,及其在此过程中产生的心肌保护作用和可能机制。方法采用酶联免疫吸附法,分别测定17例经冠状动脉造影术(coronary arteriography,CAG)检查正常的健康志愿者(对照组),41例AMI经急诊PCI治疗患者(AMI手术组)术前即刻、术后24h和48h血浆中HMGB1和血管内皮生长因子(vascular endothelial growth factor,VEGF)变化水平,并记录AMI手术组梗死相关血管(infarction related artery,IRA)开通即刻出现的再灌注心律失常(reperfusion arrhythmia,RA)类型、术后24 h脑钠肽(brain natriuretic peptide,BNP)水平、住院期间不良临床事件(心力衰竭、心源性猝死)及其他基本临床数据。结果 AMI手术组患者在IRA开通即刻均观察到RA;术后24 h HMGB1水平明显高于术前即刻及术后48 h(P<0.05),并且各时间点HMGB1水平与VEGF水平呈正相关(P<0.05);AMI手术组院内出现不良临床事件与无不良事件的患者相比较,各时间点HMGB1水平明显降低(P<0.05)。结论HMGB1参与了AMI患者行PCI手术中IRI的过程;HMGB1水平对于AMI患者的远期预后有一定预测作用;HMGB1可能通过促进VEGF的分泌而参与梗死后心肌的修复过程,并可能通过此作用对改善心功能、保护心肌细胞产生一定作用。
Objective With the increasing incidence of acute myocardial infarction （AMI） and wide application of the reper- fusion therapy, extensive attention has been drawn to ischerrfia-reperfusion injury （IRI）, but no effective method ever found for its treat- ment. Recent studies based on animal models show that high mobility group protein B1 （HMGB1） may play a critical role in 1RI. Our aim is to determine whether HMGB1 is involved in IRI in AMI patients undergoing percutaneous coronary intervention （ PCI ）, and to evaluate the myocardial protective effect of HMGB1 and its possible mechanisms. Methods We used ELISA to detect the levels of plasma HMGB1 and vascular endothelial growth factor （VEGF） in 17 healthy volunteers with normal coronary arteriography （control group） and 41 AMI patients undergoing emergency PCI （AMI operation group） immediately, 24 hours and 48 hours after surgery. We also re- corded the infarction related arteries （IRA）, the types of reperfusion arrhythmia at the time of IRA opening, the level of brain natriuretic peptide, adverse cardiac events during hospital stay and other basic clinical data. Results Reperfusion arrhythmia was found in all the AMI patients at the time of IRA opening. The HMGB1 level was significantly higher in the AMI group at 24 than at 48 hours after opera- tion （P 〈0.05）, with a positive correlation with that of VEGF at different time points （P 〈0.05）, but it was remarkably lower in those with adverse cardiac events during hospital stay than in those without at different time points （P 〈 0.05）. Conclusion HMGB1 is in- volved in myocardial ischemia-reperfusion injury in AMI patients undergoing percutaneous coronary intervention, and its level has a pre- dictive value in the long-term prognosis of AMI. It may participate in the process of myocardial repair by its secretomotor pathway for VEGF, and thereby play a role in improving cardiac function and protecting cardialcytes.
出处
《医学研究生学报》
CAS
北大核心
2012年第5期499-502,共4页
Journal of Medical Postgraduates
关键词
高迁移率族蛋白B1
急性心肌梗死
心肌缺血再灌注损伤
经皮冠状动脉内介入术
High mobility group protein B1
Acute myocardial infarction
Myocardial ischemia-reperfusion injury
Percuta- neous coronary intervention
