血管紧张素转换酶抑制剂对心肌再灌注损伤的作用

Effect of Angiotensin Converting Enzyme Inhibitors on Myocardial Reperfusion Injury

心肌再灌注损伤可表现为再灌注性心律失常、心肌顿抑和心肌坏死。研究表明心脏局部的肾素血管紧张素系统和冠状动脉内皮细胞功能失常在心肌再灌注损伤中起重要作用。血管紧张素转换酶抑制剂能抑制转换酶活性 ,减少血管紧张素 的形成 ,并能作用于激肽酶 ,抑制缓激肽的降解 ,后者可促进前列环素和一氧化氮 (NO)的产生。近年来血管紧张素转换酶抑制剂被用于防护心肌再灌注损伤 ,在防护再灌注性心律失常、心肌顿抑和心肌坏死等方面显示了较好的治疗效果。

Myocardial reperfusion injury may lead to the outcomes including reperfusion arrhythmias, myocardial stunning and cell death. Studies have suggested a significant role of both the cardiac renin angiotensin system (RAS) and the function of endothelial cells of coronary vessels in myocardial reperfusion injury. Angiotensin converting enzyme inhibitors (ACEI) not only inhibit converting enzyme activity leading to the reduced formation of angiotensin Ⅱ, but also prevent the degradation of bradykinin through the pathway of kininase Ⅱ which promote the production of prostacyclin and nitric oxide. In recent years, angiotensin converting enzyme inhibitors have been used to prevent myocardial reperfusion injury, and showed beneficial results in attenuating the reperfusion arrhythmias, myocardial stunning and cell death.