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目的:通过经导管建立的急性微血管栓塞的动物模型,研究不同微栓塞水平对微血管完整性及心肌内皮素-1(ET-1)的影响。方法:10头小型猪经导管于前降支(LAD)内多次注入微栓塞球(45μm),致使微血管栓塞。在微栓塞前,以及注入5万、10万、12万、14万和15万微球量时:①放射免疫法测定冠状静脉窦内ET-1的变化以评价心肌ET-1的代谢;②冠状动脉内注射腺苷18μg达到最大充血状态,多普勒导丝测量LAD内血流储备(CFR)以评价微血管的完整性。结果:不同微栓塞水平同微栓塞前相比,CFR均有显著性降低;ET-1呈“双期”改变:5万微球量时显著性增加,10万剂量时到达分泌峰值,随后略有降低并持续至15万微球剂量。CFR同ET-1呈负性相关(r=-0.31,P=0.02)。结论:微血管完整性破坏的程度和心肌ET-1的变化密切相关,但两者同冠状动脉微栓塞的程度均不成正比。
OBJECTIVE: To investigate the effects of different microemboli levels on the integrity of microvessel and endothelin-1 (ET-1) in an animal model of acute microvascular embolism established by catheterization. Methods: Ten miniature pigs were transcatheterly injected with micro-embolism ball (45μm) through the catheter in the anterior descending artery (LAD), resulting in microvascular embolism. Before micro-embolization and injection of 50,000, 100,000, 120,000, 140,000 and 150,000 microspheres: (1) The level of ET-1 in the coronary sinus was measured by radioimmunoassay to evaluate the metabolism of myocardial ET-1; Intracerebroventricular injection of adenosine at a dose of 18 μg reached maximal congestive state, and Doppler guidewire measured intracranial LAD flow reserve (CFR) to assess microvascular integrity. Results: The levels of micro-embolism were significantly lower than those before micro-embolization. The level of ET-1 was changed to “two-phase” at 50 000 microspheres and peaked at 100,000 doses Decreased and continued to 150000 micro-ball dose. CFR negatively correlated with ET-1 (r = -0.31, P = 0.02). Conclusion: The degree of destruction of microvessel integrity is closely related to the changes of myocardial ET-1, but both are not proportional to the degree of coronary micro-embolism.