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目的:观察曲美他嗪口服预处理对再灌注损伤心肌蛋白酶活化受体-2(PAR-2)的表达影响,探讨其对心肌缺血再灌注损伤的保护作用。方法:将40例行体外循环二尖瓣瓣膜置换术患者随机分为曲美他嗪组和对照组,每组20例,曲美他嗪组术前予以曲美他嗪预处理2周(曲美他嗪片20mg/次,3次/d)。术中取开放升主动脉恢复心肌血供30min时的右房心肌,采用实时定量PCR检测心肌组织PAR-2的mRNA水平;免疫组织化学法检测心肌组织PAR-2的蛋白水平;在主动脉开放后30min、6h、24h经颈内中心静脉置管处取血,测定肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)和肌红蛋白(MYO)的水平。结果:①与对照组比较,曲美他嗪组心肌组织PAR-2的mRNA及蛋白表达水平明显升高(P<0.05),CK-MB、cTnI、MYO的水平(主动脉开放后30min、6h)显著降低(P<0.05)。结论:曲美他嗪对心肌缺血再灌注损伤具有显著的保护作用,其机制可能与上调PAR-2的表达有关。
Objective: To observe the effect of oral trimetazidine preconditioning on the expression of PAR-2 and the protective effect of trimetazidine on myocardial ischemia-reperfusion injury. Methods: Forty patients undergoing mitral valve replacement undergoing cardiopulmonary bypass were randomly divided into trimetazidine group and control group. Twenty patients in each group were treated with trimetazidine pretreatment for 2 weeks Meizalin tablets 20mg / time, 3 times / d). The left atrium of the right atrium was isolated from the ascending aorta and the myocardial blood was collected for 30 minutes. The mRNA level of PAR-2 in myocardium was measured by real-time quantitative PCR. The protein level of PAR-2 in myocardium was detected by immunohistochemistry. After 30min, 6h, 24h, blood was collected through the central venous catheter and the levels of CK-MB, cTnI and myoglobin were measured. Results: ①Compared with the control group, the mRNA and protein expression of PAR-2 in myocardium of trimetazidine group were significantly increased (P <0.05), the levels of CK-MB, cTnI and MYO (30 min after aortic opening, 6h ) Was significantly lower (P <0.05). Conclusion: Trimetazidine has a significant protective effect on myocardial ischemia-reperfusion injury, which may be related to the up-regulation of PAR-2 expression.