Yellon D M, Downey J M
Department of Cardiology, University College Hospital, London, UK.
Cardioscience. 1990 Jun;1(2):89-98.
This article discusses the types of reperfusion injury, some of the causes of the injury and the possible role of the radical scavengers in protecting against it. The methodological problems that have plagued this field are explored and some answers put forward, although we are sure that further questions will have been raised. There are now reasons to question the use of the tetrazolium staining procedure which has become the "gold standard" for measurements of infarct size. It seems likely that it is adequate only as a screening procedure, and even then will be associated with a troublesome number of false positives. Collateral flow is an important determinant of infarct size and simultaneous measurements of collateral flow are essential in the interpretation of the effects of drugs on infarct size. The limitations of the various animal models are important when relating experimental findings to the clinical condition. After a decade of research, reperfusion injury is itself still under question, and there remains confusion as to the role that oxygen-derived free radicals may play in the ischemic/reperfused myocardium. However, we believe that, from the experimental data available, oxygen derived free radicals are involved in the overall pathophysiology of ischemia and reperfusion, although the full extent remains to be clarified and the therapeutic implications explored.
本文讨论了再灌注损伤的类型、损伤的一些原因以及自由基清除剂在预防再灌注损伤中可能发挥的作用。文中探讨了困扰该领域的方法学问题，并给出了一些答案，尽管我们确信还会引发更多问题。目前有理由质疑已成为测量梗死面积“金标准”的四氮唑染色法。它似乎仅适用于筛查，即便如此，也会出现大量令人头疼的假阳性结果。侧支血流是梗死面积的重要决定因素，在解释药物对梗死面积的影响时，同时测量侧支血流至关重要。在将实验结果与临床情况相关联时，各种动物模型的局限性很重要。经过十年的研究，再灌注损伤本身仍存在疑问，关于氧自由基在缺血/再灌注心肌中可能发挥的作用也仍存在困惑。然而，我们认为，从现有实验数据来看，氧自由基参与了缺血和再灌注的整体病理生理学过程，尽管其全部影响仍有待阐明，治疗意义也有待探索。
