纤维蛋白胶控制bFGF在激光心肌隧道内释放对急性缺血心肌重构的影响

Effect of Basic Fibroblast Growth Factor Release in Transmyocardial Laser Channel Controlled by Fibrin Glue on Acute Ischemic Myocardial Remodeling

目的 评价纤维蛋白胶 (FG)控制bFGF在激光心肌打孔隧道内释放对犬急性缺血心肌重构的影响。方法 18只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 ,即单纯冠脉结扎组 (AMI组 )、冠脉结扎加激光心肌打孔组 (TMLR组 )和冠脉结扎加激光心肌打孔隧道注入碱性成纤维细胞生长因子纤维蛋白胶组 (bFGF组 )。术后 2个月用超声和显微病理技术观察缺血心肌形态及结构的变化。结果 左房室腔内径三个实验组之间无统计学差异 (P >0 .0 5 )。AMI组有 2只犬、TMLR组有 1只犬存在心尖部室壁瘤 ,bFGF组无室壁瘤现象。左室前壁及前室间隔厚度 (TL VAW、TAIVS)在bFGF组、TMLR组和AMI组依次减小 ,其中bFGF组TLVAW与AMI和TMLR组之间的差异有显著性意义 (P <0 .0 5 )。AMI组缺血区存在大量的坏死心肌细胞 ,TMLR组部分心肌细胞变性坏死、部分结构正常 ,bFGF组大部分心肌细胞结构正常 ,小部分变性坏死。结论 用FG控制bFGF在激光心肌打孔隧道内释放 ,能够减轻或阻止心肌缺血性损害以及缺血心肌的重构。

Objective To determine the effect of basic fibroblast growth factor release in transmyocardial laser channels controlled by fibrin glue(FG) on acute ischemic myocardial remodeling in dog models.Methods Eighteen mongrel dogs,whose left anterior descending arteries (LAD) were occluded in order to develop acute ischemic myocardium models,were randomized into three groups:AMI,TMLR and bFGF group.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 echocardiography and pathology two months after LAD occlusion.Results There was no difference in the diameter of left atrium and ventricle among three groups (P>0.05).The aneurysms of left ventricular wall in apices were formed in 2 and 1 animals in AMI and TMLR groups respectively,and none in bFGF group.Thickness of the anterior interventricular septum and left ventricular anterior wall (TLVAW and TAIVS) decreased in bFGF,TMLR and AMI groups gradually by turns,of which there were significant differences in TLVAW between bFGF and TMLR or AMI groups (P<0.05).Necrosis in nearly all ischemic myocardium of AMI group,was observed,while necrosis in part and normal appearance in part of ischemic myocardium of TMLR group,and in number of and few of bFGF group.Conclusion bFGF release in transmyocardial laser channels controlled by FG may lessen and prevent the impairment and remodeling of acute ischemic myocardium.