世界中医药

作者	单位
邢文龙1，唐跃2，刘红旭1，吴爱丽2，周琦1，佟彤1，李享1，杨志海1	1 首都医科大学附属北京中医医院，北京，100010； 2 中国医学科学院阜外心血管病医院实验动物中心，北京，100037

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中文摘要:

目的：探索氧化应激反应在中华小型猪PCI围手术期心肌损伤（Peri-procedure Myocardial Injury，PMI）过程中的作用，以及益气逐瘀方参元丹（SYD)的心肌保护作用及机制。方法：中华小型猪24只，随机分为假手术组（n=6)，模型组（n=6)，SYD低剂量组［0.06 g/(kg·d)，n=6］，SYD高剂量组［0.24 g/(kg·d)，n=6］。于小型猪冠脉狭窄处行球囊扩张+拉伤+大支架置入法建立PCI围手术期心肌损伤模型，测定并对比各组手术前1 h，术后4 h，12 h，24 h血清肌酸磷酸激酶同工酶（ck-mb）、肌钙蛋白I（cTNI）及超氧化物歧化酶（SOD）、丙二醛（MDA）、还原性谷胱甘肽（TSH）。结果：各组术前心肌酶水平无统计学意义（P>0.05)，术后心肌酶升高，但低于正常参考值5倍，提示发生PCI围手术期心肌损伤，造模成功。参元丹低剂量组、高剂量术后各时间点心肌酶水平均低于模型组，差异具有统计学意义（P<0.05)。术后12 h、24 h参元丹高剂量组心肌酶水平低于参元丹低剂量组，差异具有统计学意义（P<0.05)。模型组术后SOD、GSH水平较假手术组下降，MDA水平较假手术组升高，差异具有统计学意义（P<0.05)；模型组术后SOD、GSH水平较术前降低，MDA水平较术前升高，差异具有统计学意义（P<0.05)；参元丹高剂量组与低剂量组均能够升高SOD、GSH，同时降低MDA，差异具有统计学意义（P<0.05)，但仅在术后4 h，参元丹高剂量组与低剂量组作用存在统计学意义（P<0.05)，高剂量组优于低价量组。结论：中华小型猪PMI模型造模成功，参元丹具有改善PMI的内源性心肌保护作用。参元丹高剂量组较低剂量组作用更加明显，提示参元丹的心肌保护作用可能呈剂量相关。氧化应激因子在手术前后存在差异，提示氧化应激反应可能参与到了PMI的发生发展过程，参元丹具有加速抗氧化因子生成，维持抗氧化因子有效浓度，降低氧化因子。参元丹的心肌保护作用可能与其抗氧化应激反应相关。

English Summary:

To observe the effect of oxidative stress reaction in miniature pig PCI perioperative myocardial injury (PMI) process, and discuss the mechanism of Yiqi Zhuyu Shen Yuan Dan (SYD) on myocardial injury. Methods: Twenty-four Chinese miniature pigs were randomly divided into four groups, namely, control group(n=6), model group(n=6), SYD low dose group［0.06 g/(kg·d) n=6］, SYD high dose group ［0.24 g/(kg·d), n=6］. Balloon dilatation, injury and stenting were used to make PCI pig models. Serum creatine phosphokinase isoenzyme (CK-MB), troponin I(cTNI) and superoxide dismutase (SOD), malondialdehyde (MDA) and reducing glutathione (TSH) were detected and compared before 1 hour of surgery and after 4hr, 12hr, and 24hr of surgery. Results: No statistical differences were found among groups in pre-operation cardiac enzyme levels (P>0.05), while after treatment, myocardial enzyme increases, while less than 5 times the normal reference value. It indicated the success of building injury models. Myocardial enzyme levels at each time point in SYD low dose group, high dose after surgery were lower than those of the model group, and the difference is statistically significant (P<0.05). After 12 hr, 24 hr, myocardial enzyme level in SYD high dose group is lower than that of SYD low dose group, and the difference is statistically significant (P<0.05). Compared with control group, SOD and GSH levels in the model group decreased while the MDA level increased with statistical difference(P<0.05). SOD and GSH levels in model group has decreased than pre-operation, while MDA increased, with statistical difference(P<0.05). SOD and GSH levels in the SYD low dose and high dose group increased and MDA levels decreased, with statistically significant difference(P<0.05). However, 4 hours after surgery, statistical differences showed between SYD high dose group and low dose group(P<0.05), and high dose group is superior to low dose group. Conclusion: Chinese miniature pig PMI models are successfully built, and Shen Yuan Dan has improved PMI endogenous myocardial injury. SYD high dose group has better performance than low dose group, which indicates the protective function of Shen Yuan Dan may relate to different does. Oxidative stress factor varied before and after the surgery, which may involve with the development of PMI. Shen Yuan Dan can accelerate the generation pace of anti-oxidation factor, maintain its effective concentration, and thus to reduce oxidation factor. This could possibly be its protective mechanism.

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