线粒体介导心肌细胞损伤在急性心肌梗死合并心源性休克中的作用

Role of mitochondrial-mediated cardiomyocytes injury in acute myocardial infarction with cardiogenic shock

急性心肌梗死合并心源性休克(AMI-CS)是指心脏在短时间内心排血量急剧降低,从而导致各器官严重灌注不足而引起的全身微循环功能障碍,是急性心肌梗死(AMI)患者最常见的死亡原因。目前临床治疗AMI-CS的主要策略为血运重建,从而降低AMI-CS的病死率。但心肌组织缺血后复灌可导致缺血/再灌注(I/R)损伤,引起心肌线粒体功能障碍,大量活性氧(ROS)堆积。因此,心肌细胞线粒体介导的细胞凋亡是心肌细胞死亡的主要原因。本文从线粒体通透性转换孔(mPTP)的开放、线粒体自噬、线粒体融合与分裂3个方面对线粒体在AMI-CS发生发展中的作用及其相关机制进行综述,以期为临床上AMI-CS的防治提供新思路,识别潜在的防治靶点。

Acute myocardial infarction with cardiogenic shock(AMI-CS)refers to the rapid decrease in cardiac output in a short period of time,and it leads to severe insufficient perfusion of various organs and causes systemic microcirculatory dysfunction,which is the most common cause of the death of patients with acute myocardial infarction(AMI).At present,the main strategy for clinical treatment of AMI-CS is revascularization,which reduces the mortality of AMI-CS.However,myocardial ischemia and reperfusion can cause ischemia/reperfusion(I/R)injury,induce myocardial mitochondrial dysfunction,and a large amount of reactive oxygen species(ROS)accumulation.Mitochondrial-mediated apoptosis of cardiomyocytes is the main reason of cardiomyocyte death during reperfusion injury.This article summarizes the role of mitochondrial in AMI-CS,which focus on three aspects of mitochondrial permeability transition pore(mPTP)opening,mitochondrial autophagy and mitochondrial fusion/division.It is expected to provide new ideas for clinical AMI-CS and identify potential complications targets.