ACEI对急性心肌梗死溶栓治疗时胰岛素敏感性的影响

Effect of ACEI on Insulin Sensitivity of Acute Myocardial Infarction Treated with Thrombolytic Therapy

目的观察犬急性心肌梗死(AM I)溶栓治疗时应用血管紧张素转化酶抑制剂(ACEI)对胰岛素敏感性的影响。方法20条杂种犬制备AM I后溶栓再通模型,在溶栓时随机分为对照组(n=10)与卡托普利组(n=10)。手术前、开胸后、AM I时及血管再通后0、60、120、180 m in分别采血检测血糖、胰岛素、血管紧张素Ⅱ(ATⅡ)、一氧化氮(NO)、肌酸激酶MB同功酶(CK-MB)和红细胞膜上胰岛素受体(EIR),并计算胰岛素敏感性指数(ISI),观察上述指标的变化。结果与AM I发生时相比,血管再通120 m in后,对照组的ISI和ATⅡ进一步升高,EIR和NO进一步减少(P<0.05);而卡托普利组的ISI和ATⅡ逐渐降低,EIR和NO逐渐增多(P<0.05)。卡托普利组CK-MB的升高程度明显小于对照组(P<0.01)。结论ACEI对AM I溶栓治疗时的胰岛素敏感性具有改善作用,这与其抑制肾素-血管紧张素-醛固酮系统激活和减轻胰岛素受体、血管内皮功能及心肌受损有关。

Objective To observe the effect of angiotensin-converting enzyme inhibitor（ACEI） on insulin sensitivity in dogs with acute myocardial infarction（AMI） after thrombolytic treatment. Methods Twenty dogs were made as AMI models and then underwent thrombolytic treatment. The dogs were divided into the control group （ n = 10） and the captopril group （n = 10） randomly. Insulin, plasma glucose, erythrocyte insulin receptor （EIR）, nitrogen （NO） and angiotensin Ⅱ （ATⅡ ） were detected and insulin sensitivity index （ISI） was calculated. The changes of these values in the two groups were contrasted. Results After reperfusion for 120 min, in the control group, ISI and AT H got much more rise while EIR and NO fell much more （ P 〈 0.05） , while in the captopril group, ISI and ATⅡ fell while EIR and NO rose gradually compared with those of AMI （P 〈 0.05）. The elevation degree of creatine kinase-MB （CK-MB） was much lower in the captopril group than that in the control group （P 〈 0. 01 ）. Conclusion ACEI could ameliorate insulin sensitivity in the course of thrombolysis in AMI. The mechanism may relate to the inhibition of renin-angiotensin-aldosterone system activation and alleviation of the harm to insulin receptors, vascular endothelial function and myocardia.