Clinical application of angiogenic therapy for ischemic heart disease

血管生成治疗是治疗缺血性心脏病的一种新疗法，由于应用血管生成生长因子后继发于侧支循环，从而增加了流向缺血心肌的血流量。虽然这种治疗的有效性在几个犬实验中得到了报道，但德国和美国已经开始临床应用。我们发现，将碱性成纤维细胞生长因子浸渍的酸性明胶水凝胶微球植入犬急性冠脉闭塞的梗塞心肌中，可以诱导显著的冠脉侧支循环形成。治疗后局部室壁运动异常减轻，有利于缺血心肌的保护。作为未来的临床应用，我们计划使用碱性成纤维细胞生长因子浸渍的酸性明胶水凝胶微球进行血管生成治疗，用于内科治疗无效且不适合经皮或外科血管重建术的患者。EECP(增强型体外反搏)以及IABP(主动脉内球囊泵)可增加主动脉舒张压，降低主动脉收缩压，从而增加冠脉血流量和心输出量。我们报告了35小时的体外反搏和5,000 U的肝素预处理可以减轻劳力性心绞痛患者的心绞痛发作。可以想象，体外反搏联合肝素预处理作为心绞痛患者的非侵入性治疗具有很大的潜力。

Angiogenic therapy is noticed as a new treatment for ischemic heart disease, which increases blood flow to the ischemic myocardium as a result of collateral development secondary to the administration of angiogenic growth factors. While the effectiveness of this treatment is reported in several canine experiments, clinical applications have been launched out in Germany and U.S.A..We found that significant coronary collateral development is induced by the implantation of bFGF-impregnated acidic gelatin hydrogel microspheres into the infarct myocardium of dogs with acute coronary occlusion. We also found that regional wall motion abnormality is attenuated by the treatment and this treatment is useful for the preservation of ischemic myocardium. As a future clinical application, we have a plan of angiogenic therapy with use of bFGF-impregnated acidic gelatin hydrogel microspheres for patients who are refractory to medical therapy and are not a candidate for percutaneous or surgical revascularization.EECP (enhanced external counterpulsation) as well as IABP (intra-aortic balloon pumping) increases the aortic diastolic pressure, and decreases the aortic systolic pressure resulting in the augmentation of coronary blood flow and cardiac output. We reported that 35 hours of EECP with the 5,000 U of heparin pretreatment alleviated anginal attack in a patient with effort angina. It is conceivable that EECP combined with heparin pretreatment has great potential as noninvasive treatment of angina patients.