肝素缓释支架置入联合心肌钻孔对急性心肌梗死猪心肌细胞再生的影响

Effect of heparin slow-release stent implantation combined with myocardium drilling on myocardial regeneration of pigs with acute myocardial infarction

背景:课题组前期发明了一种新的心肌再血管化的方法,即肝素缓释支架置入联合心肌钻孔,可明显改善心肌灌注。目的:观察肝素缓释支架置入联合心肌钻孔在猪急性心肌梗死后心肌细胞再生中的作用。方法:通过结扎冠状动脉前降支制作猪急性心肌梗死模型,随机分为模型对照组、支架置入组,6只/组。支架置入组于心肌梗死区采用自制高速钻孔器由心外膜打2个直径为3.5mm透壁孔道,每个孔道内置入1枚肝素缓释支架。置入后静脉注射BrdU用以标记DNA复制。观察治疗前后基质细胞衍生因子1mRNA表达及心肌灌注、新生心肌、心功能等变化。结果与结论:与模型对照组比较,置入6周后支架置入组基质细胞衍生因子1的表达明显增强(P<0.001),灌注质量缺损百分率的差值明显降低(P<0.001),左室射血分数明显提高(P<0.05),新生心肌明显增加(P<0.001),缺血区存活心肌明显增多(P<0.001)。证实心肌钻孔与肝素缓释支架置入可以通过提高基质细胞衍生因子1表达和增加缺血区灌注,增强心肌梗死区损伤心肌细胞的修复,改善心功能。

BACKGROUND：A new method,i.e.,heparin slow-release stent implantation combined with myocardium drilling,is discovered for myocardial revascularization,which remarkably improves myocardial perfusion.OBJECTIVE：To investigate the effect of heparin slow-release stent implantation combined with myocardium drilling on myocardial regeneration of pigs with acute myocardial infarction.METHODS：Anterior descending coronary of pig was ligated to induce myocardial infarction model,which was randomly divided into control and implantation groups,with 6 pigs for each group.Self-made borer was used in the implantation group to drill two transmural channels（3.5 mm diameter）on epicardium.A heparin slow-release stent was fixed in the transmural channel.Following intravenous injection,BrdU was used to label DNA duplication so as to observe stromal cell-derived factor-1（SDF-1） mRNA expression,myocardial perfusion,newborn yocardium,and heart function prior to and following implantation.RESULTS AND CONCLUSION：As compared with control group,SDF-1 expression was enhanced in the implantation group at 6 weeks after stent implantation（P0.001）,perfusion mass defect percentage was significantly decreased（P0.001）,ejection fraction of left ventricle was increased（P0.05）,newborn myocardium was increased（P0.001）,and survival myocardium in the ischemic region was increased（P0.001）.The results demonstrated that heparin slow-release stent implantation combined with myocardium drilling could repair damaged myocardial cells and improve heart function through increasing SDF-1 expression and myocardial perfusion.