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目的:评价急性心肌梗死(acute myocard ial infarction,AM I)再灌注后一氧化氮合酶(NOS)的变化及抗血小板药物对其影响。方法:中华小型猪24只,随机分成对照组、氯吡格雷与阿司匹林合用治疗组、替罗非斑治疗组和假手术组,每组8只。冠状动脉结扎3 h,松解1 h制备AM I再灌注模型。采用硝酸还原酶法检测AM I前、后和再灌注后血一氧化氮(NO)的含量;采用催化L-Arg法和逆转录-聚合酶链反应(RT-PCR)的方法观察正常、再流和无再流区心肌组织内NOS及其mRNA的表达。结果:(1)替罗非斑组可提高血NO水平(P<0.05-0.01),增加再流区心肌组织中cNOS活性及其mRNA表达,减少再流区心肌组织中iNOS活性及其mRNA表达(均P<0.05-0.01)。而氯吡格雷与阿司匹林合用不能提高血NO水平,增加再流区心肌组织中cNOS活性及其mR-NA表达,仅能减少再流区心肌组织中iNOS活性及其mRNA表达。结论:替罗非斑可能通过保护内皮细胞起到了减少无再流的作用,而氯吡格雷与阿司匹林合用并不能保护内皮功能,仅能减轻再灌注后的炎性反应。
Objective: To evaluate the changes of nitric oxide synthase (NOS) after acute myocardial infarction (AMI) reperfusion and the effects of antiplatelet drugs on it. Methods: Twenty - four Chinese miniature pigs were randomly divided into control group, clopidogrel combined with aspirin group, tirofiban group and sham operation group, with 8 rats in each group. Coronary artery ligation 3 h, release 1 h prepared AM I reperfusion model. Nitric acid reductase method was used to detect the levels of blood nitric oxide (NO) before, during and after AMI. The normal and the control groups were observed by the method of catalytic L-Arg and reverse transcription-polymerase chain reaction (RT-PCR) Expression of NOS and its mRNA in Myocardial Tissues with and without Reflux. Results: (1) Tirofiban group could increase the levels of blood NO (P <0.05-0.01), increase cNOS activity and mRNA expression in myocardium and reduce iNOS activity and mRNA expression (All P <0.05-0.01). Clopidogrel combined with aspirin can not increase blood levels of nitric oxide and increase cNOS activity and mR-NA expression in the reflow myocardium, and can only reduce iNOS activity and mRNA expression in the reflow myocardium. CONCLUSION: Tiroflavin may reduce the effect of no-reflow by protecting endothelial cells. However, combination of clopidogrel with aspirin does not protect the endothelial function and can only reduce the inflammatory reaction after reperfusion.