DOSE-DEPENDENT EFFECTS OF SHORT-TERM METHYLPREDNISOLONE ON MYOCARDIAL INFARCT EXTENT, SCAR FORMATION, AND VENTRICULAR-FUNCTION
DOSE-DEPENDENT EFFECTS OF SHORT-TERM METHYLPREDNISOLONE ON MYOCARDIAL INFARCT EXTENT, SCAR FORMATION, AND VENTRICULAR-FUNCTION
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DOI：
10.1161/01.cir.68.2.446
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发表时间：
1983-01-01
期刊：
影响因子：
37.8
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
--
作者：
HAMMERMAN, H;KLONER, RA;BRAUNWALD, E
用甲基强的松龙（MP）治疗急性心肌梗死患者仍然是一个有争议的话题;尽管一些研究表明MP可以减少梗死面积，但其他研究表明它会改变愈合过程。为了确定短期MP是否限制梗死面积以及是否改变愈合过程或功能，研究了不同剂量的MP对梗死面积、瘢痕形成和心脏功能的影响。23只麻醉开胸犬，结扎冠状动脉左前降支近端，造成实验性心肌梗塞。第1组犬（n = 8）在闭塞后15 min和3、24和48 h（高MP）静脉注射MP 50 mg/kg;第2组（n = 7）在闭塞后15 min（低MP）静脉注射MP 30 mg/kg。第3组（n = 8）接受生理盐水（对照）。结扎犬冠状动脉6周后，进行二维超声心动图检查，处死犬，检查心脏。用短轴2D超声心动图计算的左心室腔面积变化百分比表示的局部功能在高MP组中显著降低，面积变化百分比为23.3 ± 0.1%。4.9%，而38.4 .+-。对照组为3.9%（P < 0.05），对照组为40.5 ± 0.05。低MP组为4.4%（P < 0.05）。用梗塞厚度除以非梗塞壁厚度得到的比值在高MP组中较低（0.42 ± 0.001）。0.04平均值+-。SEM [平均值的标准误差]）与低MP组（0.95 ± 0.95. 0.05）和对照组（0.88 . ±. 0.07; P < 0.01）。低MP组的梗死范围较小，梗死内皮细胞周长百分比为19.0 ± 0.1%。1.9%相对于高MP组（30.0 ±. 3.5%; P < 0.05）。对照组中梗塞内皮细胞周长的百分比为25.0 ± 0.5%。1.8%（P = NS）。治疗组和对照组的瘢痕组织学和羟脯氨酸含量相似。因此，高MP，而不是低MP，导致与局部功能降低相关的明显瘢痕变薄，而胶原蛋白含量没有变化。
Treatment with methylprednisolone (MP) of patients with acute myocardial infarcts remains a controversial topic; although some studies have shown that MP reduces infarct size, others have shown that it alters the healing process. To determine whether short-term MP limits infarct size and whether it alters the healing process or function, the effects of different doses of MP on infarct size, scar formation and cardiac function were investigated. Experimental infarction was produced in 23 anesthetized open-chest dogs by ligation of the proximal left anterior descending coronary artery. Group 1 dogs (n = 8) received MP 50 mg/kg i.v. 15 min and 3, 24 and 48 h after occlusion (high MP); group 2 (n = 7) received MP 30 mg/kg i.v. 15 min after occlusion (low MP). Group 3 (n = 8) received saline (control). After 6 wk of coronary occlusion, 2 dimensional (2D) echocardiograms were performed, dogs were killed and their hearts were examined. Regional function, expressed as percent of change in the area of the left ventricular cavity calculated from short-axis 2D echocardiograms, was markedly reduced in the high MP group with the percent of change in the area of 23.3 .+-. 4.9% compared with 38.4 .+-. 3.9% in the control group (P < 0.05) and with 40.5 .+-. 4.4% in the low MP group (P < 0.05). A ratio obtained by dividing infarct thickness by noninfarcted wall thickness was lower in the high MP group (0.42 .+-. 0.04 mean .+-. SEM [standard error of the mean]) vs. both the low MP group (0.95 .+-. 0.05) and the control group (0.88 .+-. 0.07; P < 0.01). Infarct extent was smaller in the low MP group, with the percent of infarcted endocardial circumference of 19.0 .+-. 1.9% vs. the high MP group (30.0 .+-. 3.5%; P < 0.05). The percent of infarcted endocardial circumference in the control group was 25.0 .+-. 1.8% (P = NS). Scars in the treated and control groups were similar histologically and by hydroxyproline content. Therefore, high MP, but not low MP, caused marked scar thinning associated with reduction in regional function, without a change in collagen content.