Institut für Pathophysiologie, Universitätsklinikum Essen, Hufelandstr. 55, Essen, Germany.
Cardiovasc Res. 2012 May 1;94(2):237-45. doi: 10.1093/cvr/cvr271. Epub 2011 Oct 16.
Cardioprotection, i.e. the reduction in infarct size by pre-, post-, or remote conditioning, has originally been characterized in young and healthy experimental animals. Over the last two decades many signalling steps of cardioprotection have been identified, again in young and healthy animals. Although proof-of-concept studies unequivocally demonstrated the recruitment of all forms of cardioprotection in humans, the translation of cardioprotection to clinical routine has been poor. The apparent lack of translation has been attributed to poor design of clinical trials, but also to the neglect of confounders, such as age, sex, comorbidities, and comedications, in experimental studies. The present opinionated review focuses on the coronary circulation as a major determinant of cardioprotection. Coronary occlusion and the restoration of coronary blood flow are the causes of myocardial ischaemia and reperfusion injury from which protection is sought. On the other hand, brief cycles of coronary occlusion and reperfusion are also the stimulus for protection from myocardial ischaemia/reperfusion injury. The recruitment of collateral blood flow also contributes to protection from infarction. Finally, the coronary microcirculation is also a target of both injury by myocardial ischaemia/reperfusion and protection from it. Different manifestations of coronary artery disease, such as coronary stenosis or coronary microembolization, impact on both injury and protection.
心肌保护，即通过预处理、后处理或远程处理来减少梗死面积，最初在年轻健康的实验动物中得到了描述。在过去的二十年中，已经在年轻健康的动物中确定了许多心肌保护的信号转导步骤。尽管概念验证研究明确证明了所有形式的心肌保护都可以在人体中招募，但心肌保护向临床常规的转化效果不佳。这种明显的转化不足归因于临床试验设计不佳，也归因于在实验研究中忽视了年龄、性别、合并症和合并用药等混杂因素。本观点综述侧重于冠状动脉循环作为心肌保护的主要决定因素。冠状动脉阻塞和恢复冠状动脉血流是引起心肌缺血和再灌注损伤的原因，需要进行保护。另一方面，短暂的冠状动脉闭塞和再灌注循环也是从心肌缺血/再灌注损伤中获得保护的刺激因素。侧支血流的募集也有助于防止梗死。最后，冠状动脉微循环也是心肌缺血/再灌注损伤和保护的靶标。不同的冠状动脉疾病表现，如冠状动脉狭窄或冠状动脉微栓塞，对损伤和保护都有影响。
