FG控制bFGF在激光心肌隧道内释放对急性缺血心肌冠脉侧支循环及心肌内血流影响的实验研究

Basic fibroblast growth factor release in transmyocardial laser channel controlled by fibrin glue on coronary collateral and intramyocardial circulation in acute myocardial ischemia

目的 评价FG控制bFGF在激光心肌打孔隧道内释放对犬急性缺血心肌冠脉侧支循环及心肌内血流的影响。方法 18条健康杂种犬结扎左前降支中段造成急性缺血心肌模型 ,随机分成三组 ,即急性心肌缺血组 (AMI组 )、激光心肌打孔组 (TMLR组 )和碱性成纤维细胞生长因子组 (bFGF组 )。术后 2个月用冠脉血流显像技术评价左室前壁心外膜冠脉侧支及心肌内的血流情况。结果 AMI组仅 2条犬探及到左室前壁心外膜冠脉血流信号 ,1条犬显示左室前壁内血流信号 ,3条犬显示前室间隔内血流信号。TMLR组有 3条犬探及心外膜冠脉血流信号 ,2条犬显示左室前壁内血流信号 ,4条犬显示前室间隔内血流信号。bFGF组 5条犬均可探及到左室前壁心外膜冠脉及前室间隔内血流信号 ,4条犬显示左室前壁内血流信号。TMLR组和bFGF组检测到心外膜表面冠脉侧支及心肌内血流信号的犬条数多于AMI组 ,其中bFGF组更为明显 ,三组之间的差异有非常显著性意义 (χ2 =9.5 1,P <0 .0 1)。结论 用FG控制bFGF在激光心肌打孔隧道内释放 ,能够进一步促进缺血区冠脉侧支循环的建立 ,更加有利于改善缺血心肌的灌注。

Objective To evaluate the effect of basic fibroblast growth factor release in transmyocardial laser channels controlled by fibrin glue (FG) on the epicardial coronary collateral and intramyocardial coronary circulation in dogs with acute myocardial ischemia. Methods Eighteen mongrel dogs underwent ligation of left anterior descending arteries (LAD) as models of acute ischemic myocardium were randomized into three groups. AMI, TMLR and bFGF groups. TMLR procedure was carried out 30 minutes after coronary ligation in both TMLR and bFGF groups, and then bFGF-FG was planted in laser channels in bFGF group. Fifteen dogs underwent color Doppler coronary flow imaging two months after LAD occlusion (other 3 dogs died of cardiac function failure, pulmonary infection and accident suffocation at 42, 56 and 60 days after operation, in AMI, TMLR and bFGF groups, respectively). Results The epicardial coronary collateral flow of left ventricular anterior wall was detected by color Doppler coronary flow imaging in 2, 3, 5 dogs, and intramyocardial coronary flow of left ventricular anterior wall in 1, 2, 4 dogs and anterior interventricular septum in 3, 4, 5 dogs in AMI, TMLR and bFGF groups, respectively. There were significant differences among three groups (χ 2=9.51, P <0.01), and between bFGF and AMI, TMLR groups ( P<0.01 and P <0.05, respectively). Conclusion bFGF release in transmyocardial laser channels controlled by FG may spur further formation of coronary collateral circulation and enhance improvement of ischemic myocardial perfusion.