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再灌注时给予吗啡不能改善缺血后心脏功能,但可能通过热休克蛋白27磷酸化限制心肌损伤。

Morphine administration at reperfusion fails to improve postischaemic cardiac function but limits myocardial injury probably via heat-shock protein 27 phosphorylation.

作者信息

Mourouzis Iordanis, Saranteas Theodosios, Perimenis Philippos, Tesseromatis Christina, Kostopanagiotou Georgia, Pantos Constantinos, Cokkinos Dennis V

机构信息

Department of Pharmacology, Attikon Hospital, University of Athens School of Medicine, Athens, Greece.

出版信息

Eur J Anaesthesiol. 2009 Jul;26(7):572-81. doi: 10.1097/EJA.0b013e32832a225a.

Abstract

BACKGROUND AND OBJECTIVES

We explored the effects of morphine administration during reperfusion period after an index ischaemia as well as potential molecular mechanisms underlying this response. This is of important clinical value, as morphine is used routinely in cardiovascular anaesthesia and in the emergency management of cardiac infarction.

METHODS

Male Wistar rat hearts, mounted on constant flow isolated Langendorff preparation, were subjected to stabilization, 30 min of zero-flow global ischaemia and 45 min of reperfusion (CONT; n = 10). Morphine (10(-6) mol l(-1)) was administered only at reperfusion (MORPH; n = 10). Postischaemic recoveries of left ventricular developed pressure were expressed as percentage of the initial value. At the end of the experimental protocol, lactate dehydrogenase release in the perfusate was measured and the left ventricle was isolated and used for determination of oxidized actin, mitogen-activated protein kinase activation and heat-shock protein 27 phosphorylation.

RESULTS

Left ventricular developed pressure percentage did not differ between groups, whereas lactate dehydrogenase release was significantly reduced in MORPH compared with CONT hearts. Left ventricular developed pressure percentage was negatively correlated with lactate dehydrogenase release in CONT hearts (r = -0.8, P = 0.006), whereas in MORPH hearts no correlation was found (r = -0.2, P = 0.57). Phosphorylated p38 mitogen-activated protein kinase, c-jun N-terminal protein kinases, extracellular signal-regulated kinases and Akt at 45 min of reperfusion were similar between groups. However, a 1.5-fold increase in phospho-heat-shock protein 27 was found in MORPH hearts compared with CONT hearts (P < 0.05). Additionally, the ratio of oxidized actin to total actin was found to be 1.9-fold more in MORPH compared with CONT hearts (P < 0.05).

CONCLUSION

Morphine administration at reperfusion does not affect cardiac function but limits the extent of myocardial injury, possibly through increased heat-shock protein 27 phosphorylation.

摘要

背景与目的

我们探究了在首次缺血后的再灌注期给予吗啡的效果以及这种反应潜在的分子机制。这具有重要的临床价值,因为吗啡常用于心血管麻醉和心肌梗死的急救处理。

方法

将雄性Wistar大鼠心脏安装在恒流离体Langendorff装置上,先进行稳定处理,然后经历30分钟的零流量全心缺血和45分钟的再灌注(对照组;n = 10)。仅在再灌注时给予吗啡(10⁻⁶ mol·l⁻¹;吗啡组;n = 10)。缺血后左心室舒张末压的恢复以初始值的百分比表示。在实验方案结束时,测量灌注液中乳酸脱氢酶的释放量,并分离左心室用于测定氧化型肌动蛋白、丝裂原活化蛋白激酶的激活情况以及热休克蛋白27的磷酸化水平。

结果

两组之间左心室舒张末压百分比无差异,而与对照组心脏相比,吗啡组心脏的乳酸脱氢酶释放量显著降低。对照组心脏中左心室舒张末压百分比与乳酸脱氢酶释放量呈负相关(r = -0.8,P = 0.006),而在吗啡组心脏中未发现相关性(r = -0.2,P = 0.57)。再灌注45分钟时,两组之间磷酸化的p38丝裂原活化蛋白激酶、c-jun氨基末端蛋白激酶、细胞外信号调节激酶和Akt相似。然而,与对照组心脏相比,吗啡组心脏中磷酸化热休克蛋白27增加了1.5倍(P < 0.05)。此外,与对照组心脏相比,吗啡组心脏中氧化型肌动蛋白与总肌动蛋白的比率高1.9倍(P < 0.05)。

结论

再灌注时给予吗啡不影响心脏功能,但可能通过增加热休克蛋白27的磷酸化来限制心肌损伤的程度。

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