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目的:通过观察螺内酯对非梗死区心肌凋亡及纤维化的影响,探讨其对非梗死区心肌的保护作用。方法:雄性大耳白兔随机分成A(n=8)、B(n=8)、C(n=8)3组,A、B组结扎前降支复制心梗模型,C组穿线但不结扎。A组予螺内酯(20 mg.kg-1.d-1,口服)1,周后比较各组非梗死区心肌细胞凋亡指数(AI)及Ⅰ、Ⅲ型胶原纤维蛋白(Coll-Ⅰ、Coll-Ⅲ)表达情况。比较主动脉及左室的血流动力学指标[平均收缩压(MSP)、平均舒张压(MDP)、平均动脉压(MAP)、等容收缩/舒张指标(±dp/dt max)]。测定并比较醛固酮浓度变化。结果:A、B两组的AI,Coll-Ⅰ、Coll-Ⅲ表达程度均明显高于C组(P<0.05),其中A组在AI、Coll-Ⅲ表达程度方面低于B组(P<0.05);血流动力学方面:A、B组主动脉及左室的MSP、MAP、MDP及左室的±dp/dtmax均低于C组(P<0.05),A组主动脉的MSP、左室MSP、左室MAP及左室±dp/dt max均高于B组;A、B两组术后的醛固酮浓度明显高于C组,A组的醛固酮浓度低于B组。结论:采用螺内酯干预能降低血醛固酮浓度,减轻心梗后非梗死区心肌细胞的凋亡及纤维化,增加冠脉灌注压,改善左室泵血功能和顺应性。
Objective: To observe the effect of spironolactone on myocardial apoptosis and fibrosis in non-infarcted area and explore its protective effect on non-infarcted myocardium. Methods: Male white rabbits were randomly divided into three groups: A (n = 8), B (n = 8) and C (n = 8) ligation. A group of spironolactone (20 mg.kg-1.d-1, orally) 1, week after the comparison of myocardial apoptosis index (AI) and type Ⅰ, Ⅲ collagen protein -Ⅲ) expression. Aortic and left ventricular hemodynamic parameters were compared (MSP, MDP, MAP, and ± dp / dt max). The changes of aldosterone concentration were measured and compared. Results: The expressions of AI, Coll-Ⅰ and Coll-Ⅲ in group A and B were significantly higher than those in group C (P <0.05), and the expression of AI and Coll-Ⅲ in group A was lower than that in group B (P < 0.05). In hemodynamics, MSP, MAP, MDP and ± dp / dtmax of left ventricle in aorta and left ventricle were lower in group A and group B than those in group C (P <0.05) The left ventricular MSP, left ventricular MAP and left ventricular ± dp / dt max were higher than those in group B. The concentrations of aldosterone in group A and B were significantly higher than those in group C, and the concentrations of aldosterone in group A were lower than those in group B. Conclusion: Intervention with spironolactone can decrease serum aldosterone concentration, reduce myocardial cell apoptosis and fibrosis in non-infarcted area after myocardial infarction, increase coronary perfusion pressure and improve left ventricular pumping function and compliance.