KTP激光心肌打孔联合血管内皮生长因子转染对犬心功能的影响

Effects of transmyocardial KTP laser revascularization combined with vascular endothelial growth factor(VEGF) gene therapy on cardiac function in do gs

目的探讨在KTP激光心肌打孔(TMLR)基础上联合血管内皮生长因子(VEGF)基因转染治疗对急性心肌梗死犬心功能的影响。方法家犬18只,随机均分为单纯心肌梗死组(SMI组)、TMLR组和TMLR+转VEGF基因组(TMLR+VEGF组)。结扎左前降支中段造成急性心肌梗死,TMLR组在梗死区以KTP激光行TMLR,TMLR+VEGF组在TMLR后于孔道边缘心肌内注射PAdTrack/VEGF165裸质粒2mg。术后8周,应用M型、二维及多普勒组织成像(DTl)技术检测左室局部和整体功能。结果①反映左心室整体收缩功能的指标,在SMI组、TMLR组和TMLR+VEGF组依次增大(P<0·05),并且TMLR+VEGF组分别与SMI组、TMLR组比较,差异均有显著性(P<0·05);②反映左室局部功能的主要指标,在以上三组依次增大(P<0·05);③反映心脏舒张功能的指标,在以上三组依次增大,但三组之间无统计学差异意义(P>0·05)。结论KTP激光心肌打孔联合VEGF165基因治疗,能增强KTP激光心肌打孔血运重建的疗效,进一步改善梗死心肌局部功能和整体收缩功能,但对整体舒张功能无明显影响。

Objective To study the effects of transmyocardial laser revascularization （TMLR） with VEGF gene therapy on cardiac function, Methods Eighteen dogs were randomly divided into 3 groups： simple myocardial infaretiongroup （SMI）, TMLR group and TMLR with VEGF gene group （TMLR ＋ VEGF）. Acute myocardial infarction model was established. TMLR was performed on infarct myocardium in both TMLR and TMLR ＋ VEGF group, the PAdTrack/VEGF165 expression plasmid （2 mg） was injected in the vicinity of the myocardial hole made by KTP laser in TMLR ＋ VEGF group.No treatment was given in SMI group. The cardiac regional and global function were assessed by echocardiography after eight weeks of treatment. Results ①The cardiac global systolic function increased in SMI, TMLR and TMLR ＋ VEGF groups; there were significant difference between TMLR ＋ VEGF and TMLR groups and between TMLR ＋ VEGF and SMI groups （P 〈 0.05）. ②The diastolic function increased in all groups, but there were not significant difference among thethree groups （ P 〉 0.05）. ③The regional systolic function increased, and no significant difference was observed among three groups （ P 〈 0.05）. Conclusion TMLR combined with transfeetion of VEGF165 gene might improve both cardiac regional and global systolic function but did not improve global diastolic function, and it was more effective than TMLR alone in the treatment of acute myocardial iscbemia.