心肌梗死后心肌重塑与β_3肾上腺素能受体的作用

Myocardial remodeling and the role of beta3-adrenergic receptor after myocardial infarction

目的:了解β3肾上腺素能受体在心血管系统中的作用,以及在梗死后心肌重塑中的作用。资料来源:检索Medline1990-01/2004-05与β3肾上腺素能受体、心肌梗死及心肌重塑相关的文章,检索词“β3adrenergicreceptor,myocardialremodeling,myocardialinfarction”,并限定语言种类为英语。同时检索中国期刊全文数据库1994-01/2004-05与β3肾上腺素能受体、心肌梗死及心肌重塑相关的文章,限定文章语言种类为中文,检索词“肾上腺素能受体,心肌梗死,重塑”。资料选择:对资料进行初审,选择包括处理组和对照组的文献,筛除明显不符合研究目的文献,对剩余的文献开始查找全文。纳入标准为:①随机对照研究。②实验或临床研究包含平行对照组。排除重复性研究和综述类文章。资料提炼:共收集到31篇关于β3肾上腺素能受体、心肌梗死及心肌重塑的文章,11个实验研究符合纳入标准。排除的20篇为重复研究。资料综合:对11篇有关β3肾上腺素能受体和心肌梗死后心肌重塑的文献进行综合分析,β3肾上腺素能受体在心力衰竭心脏中介导负性肌力作用。重塑对心肌梗死后心力衰竭的发展有重要的影响,多种因素共同参与调节。结论:β3受体的激活在慢性心力衰竭中产生有害的作用。β1β3受体丰量的变化及它们的变力效应失衡可能是心力衰竭发生的基础。开始时,β3受体的上调可能有利于阻止心肌进一步损伤,随着心力衰竭的发展,这种不脱敏的持续作用将变为适应不良,持续的负性肌力作用将导致心肌抑制。

OBJECTIVE: To study the role of β3-adrenergic receptor in cardiovascular system and in myocardial remodeling after myocardial infarction. DATA SOURCES: An online search of Medline database was undertaken to identify relevant articles about β3 adrenergic receptor, myocardial infarction and myocardial remodeling published in English from January 1990 to May 2004 by using theof 'β3 adrenergic receptor, myocardial infarction, myocardial remodeling'; Chinese articles about β3 adrenergic receptor, myocardial infarction and myocardial remodeling published from January 1994 to May 2004 were searched in China National Knowledge Infrastructure with the keywords of 'β3 adrenergic receptor, myocardial infarction, myocardial remodeling'. STUDY SELECTION: All articles were primarily checked, those containing treatment group and control group were selected, and the articles that were obviously not concordant with the topic were deleted, and then the full-texts of the rest articles were searched. Inclusion criteria: ① randomized control trial; ② experiment or clinical study containing paralleled control group. Repetitive studies and reviews were excluded. DATA EXTRACTION: A total of 31 articles about β3-adrenergic receptor, myocardial infarction and myocardial remodeling were collected, 11 experimental studies met the inclusion criteria, and the 20 being excluded ones were repetitive studies. DATA SYNTHESIS: The 11 articles about β3-adrenoeptors and myocardial remodeling after myocardial infarction were summarized and analyzed. β3-adrenoeptors played a role in mediating negative inotropic effects in heart failure. Remodeling had important influence on the development of heart failure after myocardial infarction, and multiple factors were involved in the regulation. CONCLUSION: The activation of β3-adrenoeptors is harmful in the occurrence of chronic heart failure. The changes of the abundance of β1 and β3 receptors and the imbalance of their inotropic effects may be the basis for the occurrence of heart failure. At the beginning, the up-regulation of β3 receptor may be good for the further myocardial injury; With the development of heart failure, this maintenance of non-desensitization will turn to maladjustment, the continuous negative inotropic effects will lead to myocardial restriction.