心肌缺血适应的基础和临床研究进展

The basic and clinical research progress of myocardial ischemic conditioning

适应是指机体减轻器官缺血-再灌注损伤的内在保护机制。心肌缺血预适应指在长时间缺血前给予心肌数轮短暂的缺血-再灌注处理对心肌起到保护作用。后续研究发现缺血后适应、缺血期适应、远程缺血适应及药物模拟适应均可起到心肌保护作用。虽然临床上对于适应现象有着巨大的兴趣,但目前的临床应用仍然有限,主要的原因包括处理方案缺乏标准化、影响保护作用的因素较多。远程缺血适应是目前最有前景的无创心肌保护方式之一,其推广应用有赖于进一步的设计合理、大样本及规范化的临床研究开展。

Conditioning is the intrinsic mechanism that an organ protects itself from fetal injuries. Myocardial ischemic preconditioning means repeated short-term ischemia-reperfusion could protect the myocardium from fetal injuries. Further research revealed other phenomena including postconditioning,remote conditioning and drug simulated conditioning which could all protect the myocardium. Although there is immense interest in the conditioning phenomenon,its clinical application was limited,largely as result of unstandardized procedure,and various influencing factors. With remote ischemic conditioning regarded as one of the most promising non-invasive myocardial protecting measures,the success of its clinical translation may need further well designed,large size and properly conducted clinical trials.