天津医药

• 实验研究 •    

肝素缓释可降解支架在心肌血运重建中的应用研究

刘月驹1,张光伟2,刘晓程2,史蓉芳2,赵晓斌2,刘天军3,吕丰3   

  1. 1. 泰达国际心血管病医院
    2. 天津医科大学泰达国际心血管病医院
    3. 中国医学科学院北京协和医科大学生物医学工程研究所分子设计实验室
  • 收稿日期:2009-11-18 修回日期:2010-01-20 出版日期:2010-08-15 发布日期:2010-08-15
  • 通讯作者: 张光伟

Experimental Study of Slow-Release Stent of Heparin in Myocardial Revascularizition after Acute Myocardial Infarction

  • Received:2009-11-18 Revised:2010-01-20 Published:2010-08-15 Online:2010-08-15

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摘要： 目的：本实验旨在观察肝素缓释支架在急性心肌梗死后心肌血运重建中的作用。方法：通过结扎前降支冠状动脉制作猪急性心梗模型，然后随机分为3组：A组（n=6）为对照组；B组（n=6）为心肌打孔组，C组（n=6）为心肌打孔+支架植入组。在B组和C组中，于心肌梗死区采用自制高速钻孔器由心外膜打2个直径为3.5mm透壁孔道，每个孔道内植入一枚肝素缓释支架。分别于治疗前和治疗后6周观察组织学改变、新生血管密度、心肌灌注、心功能变化。 结果：治疗后6周，B组孔道完全闭塞，C组孔道仍然开放，内壁被一层内皮细胞覆盖。C组中新生血管密度（OD值=4268±331 pixels/hpf）较A组（2557±241 pixels/hpf, P<0.001）和B组（2412±221 pixels/hpf, P<0.001）明显增加；治疗前后灌注质量缺损百分率的差值（△MDP=-1.43±0.39%）较A组（2.83±0.31%, P<0.001）和B组（2.54±0.27%, P<0.001）明显改善；存活心肌面积（OD值=68224±4190 pixels/hpf）较A组（36345±3714 pixels/hpf, P<0.001）和B组（41138±3989 pixels/hpf, P=0.003）明显增加；左室射血分数（56±3%）较A组（49±2%, P=0.037）和B组（48±2%, P=0.019）明显提高。结论：肝素缓释支架可以维持穿心肌孔道开放，促进心肌梗死后血管再生，增加心肌灌注，提高心肌存活，改善心功能，可能成为心肌梗死后再血管化的有效方法。

关键词: 心肌梗死, 新生血管化, 支架, 肝素

Abstract: Aim To investigate the effect of slow-release stent of heparin implantation into transmural channels on myocardial revascularizition after acute myocardial infarction. Methods After the mid third of left anterior descending (LAD) was ligated, miniswine were grouped into control group (A group, n=6), transmyocardial drilling revascularization (TMDR) group (B group, n=6), TMDR+stent implantation group (C group, n=6). In B and C groups, two transmural channels with 3.5 mm in diameter were established by using a self-made drilling device, followed by implantation of two stents into the channels in C group. Vascular density, myocardial perfusion, histological and morphological analyses, and left ventricular (LV) function were evaluated at pre-treatment and 6 weeks post-treatment. Results At 6 weeks post-treatment, vascular density was significantly increased in C group (OD =4268±331 pixels/hpf), compared with A group (2557±241 pixels/hpf, P<0.001) and B group (2412±221 pixels/hpf, P<0.001). Changes of Mass defect percent (△MDP) significantly decreased in B group (-1.43±0.39%), compared to A group (2.83±0.31%, P<0.001) and B group (2.54±0.27%, P<0.001). There were more viable cardiaomyocytes in C group (OD=68224±4190 pixels/hpf) than that in A group (36345±3714 pixels/hpf, P<0.001) and in B group (41138±3989 pixels/hpf, P=0.003). LV ejection fraction (EF) significantly increased in C group (56±3%), relative to A group (49±2%, P=0.037) and B group (48±2%, P=0.019). There were no significant differences in these parameters between A group and B group. Conclusions Slow-release stent of heparin implanted into transmural channel could keep the channel open and promote luminal endothelialization by continuous anticoagulation, promoted angiogenesis, increased myocardial perfusion, enhanced myocardial viability, improved LV function, may be a new method for myocardial revascularization of acute myocardial infarction.

Key words: Myocardial infarction, Revascularization, Stent, Heparin