陈玲玲　方侃　李龙倜

[摘要] 目的 探討维生素E（Vit E）对大鼠心肌缺血-再灌注损伤（MIRI）的影响及机制。 方法 选取雄性健康Wistar大鼠60只，按照随机数字表法将其分为Vit E组、模型组和对照组，各20只。前两组在平左心耳下缘2 mm处结扎左冠脉前降支（LAD），30 min后松解结扣再灌注，复制MIRI模型；对照组只用丝线穿过LAD但不结扎。Vit E组在造模成功即刻肌注Vit E注射液4.5 mg/（kg·d），模型组、对照组术后肌注生理盐水4.5 mg/（kg·d），连续给药2周。检测并比较不同干预对各组抗氧化指标、缺血梗死程度及血流动力学指标的影响。 结果 ①与模型组比较，Vit E组左心室收缩末期压力（LVESP）明显升高，而左心室舒张末期压力（LVEDP）、血浆心钠素（ANP）明显降低，差异均有高度统计学意义（均P < 0.01）；②与模型组比较，Vit E组血清超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、一氧化氮（NO）活性/含量明显升高，而丙二醛（MDA）含量明显降低，差异均有高度统计学意义（均P < 0.01）；③与模型组比较，Vit E组梗死区（IA）面积、缺血危险区（IDA）面积、IA/IDA、IDA/LV均明显降低，差异均有高度统计学意义（均P < 0.01）。 结论 Vit E通过抗氧化应激、清除氧自由基作用改善大鼠MIRI，增强心脏功能。

[关键词] 心肌缺血-再灌注损伤；氧化应激；维生素E；血流动力学

[中图分类号] R542.2 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0012-04

Discussion on the influence and mechanism of vitamin E for myocardial ischemia-reperfusion injury of rats

CHEN Lingling1* FANG Kan1* LI Longti2 WANG Ping1 PENG Guihai1 WANG Chongquan1

1.Department of Cardiology， Taihe Hospital Affiliated to Hubei University of Medicine， Hubei Province， Shiyan 442000， China； 2.Nursing Department， Taihe Hospital Affiliated to Hubei University of Medicine， Hubei Province， Shiyan 442000， China

[Abstract] Objective To discuss the influence and mechanism of vitamin E （Vit E） for myocardial ischemia-reperfusion injury （MIRI） of rats. Methods Sixty male health Wistar rats were selected and divided to Vit E group， model group and control group by random number table method， with 20 rats in each group. For the first two groups， the left anterior descending （LAD） in 2 mm near inferior margin of left auricle was ligatured， the knot was released after 30 min and taken reperfusion， then MIRI model was duplicated. For the control group， the silk yarn just was threaded through LAD rather than taken reperfusion. For Vit E group， 4.5 mg/（kg·d） of Vit E injection was injected intramuscularly as soon as the molding was done； for the model group and control group， 4.5 mg/（kg·d） of normal saline was injected intramuscularly after the operation， and the administration was conducted successively for 2 weeks. The influences of different intervention on the antioxidant index， degree of ischemic infarction and hemodynamic index in each group were tested and compared. Results ①Compared with model group， the left ventricular end systolic pressure （LVESP） in Vit E group was significantly increased， while the left ventricular end-diastolic pressure （LVEDP）， atrial natriuretic peptide （ANP） were significantly decreased， the differences were highly statistically significant （P < 0.01）； ②compared with the model group， the contents of superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， nitric oxide （NO） activity in Vit E group were significantly increased， while the contents of malondialdehyde （MDA） were significantly decreased， the differences were highly statistically significant （P < 0.01）； ③compared with model group， the area of infarction area （IA） and ischemia risk area （IDA）， IA/IDA， IDA/LV in Vit E group were significantly decreased， the differences were highly statistically significant （P < 0.01）. Conclusion Vit E can improve the MIRI of rats and enhance the cardiac function through antioxidant stress， oxygen free radical removal effects.

[Key words] Myocardial ischemia-reperfusion injury； Oxidative stress； Vitamin E； Hemodynamics

冠心病（CHD）是冠脉粥样硬化后高度狭窄导致相应心肌急性缺血、坏死而引起的一系列综合征，其病死率、致残率较高。心血管介入治疗、冠脉旁路移植及药物溶栓等，是被广泛运用的再灌注方法，也是安全、有效的治疗CHD的手段。但是，这些措施在治疗的同时存在进一步损伤心肌的危险[1-4]，即心肌缺血-再灌注损伤（MIRI），其机制尚不完全明了。氧化应激被认为是MIRI导致心肌细胞死亡和功能不可逆丧失的主要机制之一[5-6]。国内外研究均证实，维生素E（Vit E）有较强的抗氧化能力，对心脏疾病有综合作用[7-9]。本研究通过冠脉前降支结扎术复制MIRI大鼠模型，采用Vit E注射液进行干预性治疗，观察大鼠血流动力学、血清抗氧化指标、血浆心钠素（ANP）浓度、心肌缺血梗死程度等变化，探讨Vit E抗大鼠MIRI的作用机制，从而有助于为心肌缺血性疾病提供新的治疗靶点和防治方法。……