论文部分内容阅读
目的研究急性冠状动脉微血管栓塞过程中,冠状静脉窦内肿瘤坏死因子α(TNF-α)及内皮素-1(ET-1)的异常变化同心肌微循环功能障碍程度的相关性。方法10头小型猪经导管于前降支(LAD)内多次注入微栓塞球(45μm)致使急性冠状动脉微血管栓塞。分别于微栓塞前及注入5、10、12、14和15万微球量时:(1)放射免疫法测定冠状静脉窦内血浆ET-1、TNF-α的变化;(2)放置于LAD内的多普勒导丝测量血流储备(CFR)评价微血管的功能。结果不同微栓塞水平各组同微栓塞前比较冠状动脉CFR均有显著性降低,但组间差异无统计学意义。10万微球量时ET-1和TNF-α达到分泌峰值。12-15万微球量,ET-1分泌较前略有降低,而TNF-α无变化。CFR同ET-1呈负性相关而同TNF-α无相关性。结论心肌微循环功能障碍程度同冠状动脉微血管栓塞的程度不成正比,而与冠状静脉窦内ET-1的变化密切相关,提示急性冠状动脉微血管栓塞中冠状静脉窦内ET-1的变化可能是判断心肌微循环功能障碍程度的重要依据。
Objective To study the relationship between the abnormal changes of tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1) in the coronary sinus and the degree of myocardial microcirculation dysfunction during acute coronary microvascular embolism. Methods Acute coronary microvascular embolism was induced by injecting micro-embolism ball (45μm) into the anterior descending artery (LAD) in 10 miniature pigs via catheterization. The changes of plasma ET-1 and TNF-α in coronary sinus were measured by radioimmunoassay before micro-embolization and at 5, 10, 12, 14 and 150,000 microspheres respectively. (2) Doppler guide wire within the measurement of blood flow reserve (CFR) evaluation of microvascular function. Results Different micro-embolism levels in each group with micro-embolization before coronary artery CFR were significantly lower, but no significant difference between groups. The amount of ET-1 and TNF-α reached the secretion peak at 100,000 microballs. 12-15 million microspheres, ET-1 secretion slightly lower than before, but no change in TNF-α. CFR negatively correlated with ET-1 but not with TNF-α. Conclusions The degree of myocardial microcirculation dysfunction is not in direct proportion to the degree of coronary microvascular embolism, but closely related to the changes of ET-1 in coronary sinus. It suggests that the change of ET-1 in coronary sinus may be the judgment of acute coronary microvascular embolism Myocardial microcirculation dysfunction is an important basis.