去肾交感神经术对犬心肌梗死后氧化应激和心室重构的影响

发布时间：2018-04-01 10:20

本文选题：去肾交感神经术　切入点：心肌梗死　出处：《天津医科大学》2015年硕士论文

【摘要】：背景急性心肌梗死(AMI)是严重威胁人类健康的重要疾病,而AMI后慢性心力衰竭(CHF)是幸存患者的主要临床并发症。研究表明心室重构是CHF的发病基础。心室重构是一个复杂的病理生理过程,肾交感神经系统激活在此过程中具有重要作用。氧化应激是心室重构的重要起始因素,对CHF的发生、发展也具有重要影响。去肾交感神经术(RDN)是治疗难治性高血压一种新的手段,相关研究显示其对左室肥厚、室性心动过速、睡眠呼吸暂停低通气综合征等高交感神经活性的其他疾病也有治疗作用。目的本研究旨在观察RDN对犬心肌梗死(MI)后心肌氧化应激和心室重构的影响。方法明胶海绵栓塞法制作AMI模型。将18只健康犬随机分为3组:假手术组(n=6):只行冠脉造影检查,1周后行肾动脉造影;心肌梗死组(MI组,n=6):建立MI模型后1周只行肾动脉造影;RDN组(n=6):建立MI模型后1周行RDN治疗。4周后通过超声心动图测量各组犬左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、短轴缩短率(FS);测定心率(HR)、左室收缩压(LVSP)、左室舒张末压(LVEDP)等血流动力学参数。通过RT-PCR方法检测心肌p47phox m RNA相对表达量,并检测心肌氧化应激指标:丙二醛(MDA)含量、超氧化物歧化酶(SOD)和抗超氧阴离子自由基(ASAFR)活性。免疫组化法检测肾脏酪氨酸羟化酶(TH)相对表达量。通过肌氨酸氧化酶法检测术后血清肌酐水平,评估手术安全性。结果MI后4周,与假手术组比较,MI组和RDN组LVEF、FS和LVSP均降低(均P0.05),而LVEDD、LVESD、LVEDP均增加(均P0.05);RDN组与MI组相比,LVEF增加(P=0.028),LVEDD和LVESD降低(均P0.05),而FS和LVSP没有统计学差异(P=0.092/0.931)。三组之间HR没有统计学差异(P=0.621)。MI组和RDN组梗死周边区心肌组织SOD活力较假手术组降低(P0.001),而ASAFR活性、MDA含量和p47phox m RNA相对表达量增加(P0.05);RDN组与MI组相比SOD活力增加(P0.05),而ASAFR活性、MDA含量和p47phox m RNA相对表达量减少(均P0.05)。与MI组相比,RDN组肾脏TH阳性神经相对表达量减少(P0.05)。假手术组、MI组和RDN组血清肌酐值两两比较均无统计学差异(P=0.706)。结论RDN可以降低犬MI后心肌氧化应激水平、延缓心室重构、改善心功能、降低肾交感神经活性,并且对肾功能没有明显影响。
[Abstract]:Background Acute myocardial infarction (AMI) is a serious threat to human health. However, chronic heart failure after AMI is the main clinical complication in surviving patients. Studies have shown that ventricular remodeling is the basis of CHF. Ventricular remodeling is a complex pathophysiological process. The activation of the renal sympathetic nervous system plays an important role in this process. Oxidative stress is an important starting factor for ventricular remodeling, which is associated with the occurrence of CHF. RDN is a new method for the treatment of refractory hypertension. Studies have shown that RDN is associated with left ventricular hypertrophy and ventricular tachycardia. Other diseases with high sympathetic activity, such as sleep apnea hypopnea syndrome, were also treated. Objective to investigate the effects of RDN on myocardial oxidative stress and ventricular remodeling after myocardial infarction in dogs. Methods Gelatin sea was used to study the effects of RDN on myocardial oxidative stress and ventricular remodeling in dogs with myocardial infarction. 18 healthy dogs were randomly divided into 3 groups: sham operation group (n = 6) and renal arteriography only after 1 week of coronary angiography. Myocardial infarction group (MI group): 1 week after the establishment of MI model, only renal arteriography was performed in the RDN group. The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDD), left ventricular end-diastolic diameter (LVEDDD), left ventricular end-diastolic diameter (LVEDDD) and left ventricular end-diastolic diameter (LVEDDD) were measured by echocardiography 1 week after the establishment of MI model and 4 weeks after RDN treatment. The hemodynamic parameters such as heart rate, left ventricular systolic pressure, left ventricular systolic pressure and left ventricular end-diastolic pressure were measured. The relative expression of p47phox m RNA in myocardium was detected by RT-PCR. The content of myocardial oxidative stress index: malondialdehyde (MDA) was measured. The activity of superoxide dismutase (SOD) and anti-superoxide anion free radical (ASAFR). The relative expression of renal tyrosine hydroxylase (THH) was detected by immunohistochemical method. The serum creatinine level was detected by creatine oxidase method. Evaluation of surgical safety. Results 4 weeks after MI, Compared with the sham operation group, the LVEF FS and LVSP of MI group and RDN group were all decreased (P0.05), but LVEDDD LVESDD LVEDP was increased (P0.05 + RDN group increased P0.028% LVEDD and LVESD decreased compared with MI group (P0.05%), but there was no statistical difference between FS and LVSP group (P 0.0922 / 0.931). There was no statistical difference in HR between the three groups. Compared with the sham operation group, the SOD activity in the myocardial tissue around the infarct area in the MI and RDN groups was lower than that in the sham operation group, while the content of ASAFR and the relative expression of p47phox m RNA were increased. The SOD activity in the RDN group was higher than that in the MI group, while the content of ASAFR activity and the relative table of p47phox m RNA in the RDN group were higher than those in the MI group. Compared with MI group, the relative expression of th positive nerve was decreased in RDN group. There was no significant difference in serum creatinine level between MI group and RDN group. Conclusion RDN can decrease the level of myocardial oxidative stress after MI in dogs. [WT5 "HZ] [WT5" HZ] [WT5 "HZ] [WT5" BZ] [WT5 "HZ] [WT5" BZ] there is no significant difference in serum creatinine levels between the sham operation group and the RDN group. It can delay ventricular remodeling, improve cardiac function, decrease renal sympathetic nerve activity, and has no obvious effect on renal function.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.22

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