远程缺血预处理-减轻心肌再灌注损伤的机制

Mechanism of remote ischemic preconditioning to reduce myocardial reperfusion injury

目前有关减少缺血再灌注损伤(ischemia reperfusion injury,IRI)的经典方法是缺血预处理(ischemic preconditioning,IPC),即通过对心脏进行反复多次短暂的缺血刺激,来提高心肌本身对随后较长时间的缺血再灌注损伤的耐受力。IPC已经应用于如冠状动脉球囊血管成形术、冠状动脉旁路移植手术等一些临床情况中,通过多个简短的球囊起伏或冠状动脉结扎来实现缺血预处理,可是这些IPC操作创伤大、风险高,因此其临床应用受到了限制。1993年PRZYKLENK等提出远程缺血预处(remote ischemic preconditioning,RIPC)的概念,即对某一器官进行短暂非致死性缺血预处理后,可对随后发生缺血事件的远隔器官产生保护作用的现象。RIPC较之IPC具有方便安全、临床操作简便易行、经济成本较低、对靶器官损伤小等优点,在临床上具有广泛的应用前景。本文将重点对RIPC减轻心肌IRI的相关机制进行探讨。

At present,ischemic preconditioning(IPC)is the classic method to reduce ischemia reperfu⁃sion injury(IRI),by repeating short⁃term ischemic stimulation of the heart,the myocardium itself could improve the tolerance of the subsequent long⁃term ischemia⁃reperfusion injury.IPC has been used in some clinical practices such as coronary balloon angioplasty and coronary artery bypass grafting,etc.Multiple short balloon undulations or coronary artery ligation are used to achieve ischemic preconditioning.However,these ischemic preconditioning are invasive and having high risks,so its clinical application is limited.In 1993,Przyklenk et al.proposed the concept of remote ischemic preconditioning(RIPC),that is,after a transient non⁃lethal ischemic preconditioning of an organ,it could produce a protective effect on the remote organs that subsequently undergo an ischemic event.Compared with IPC,RIPC has advantages of convenience and safety,simple and easy clinical applica⁃tion,low economic cost and small damage to target organs,etc.,and has a wide application prospect in clinical practice.This review focuses on the mechanisms of RIPC in reducing myocardial IRI.