School of Medical Sciences, RMIT University, Bundoora. Australia.
Baker IDI Heart & Diabetes Institute, Melbourne. Australia.
Curr Drug Targets. 2017;18(15):1689-1711. doi: 10.2174/1389450116666151001112020.
Early reperfusion of the blocked vessel is critical to restore the blood flow to the ischemic myocardium to salvage myocardial tissue and improve clinical outcome. This reperfusion strategy after a period of ischemia, however, may elicit further myocardial damage named myocardial reperfusion injury. The manifestations of reperfusion injury include arrhythmias, myocardial stunning and micro-vascular dysfunction, in addition to significant cardiomyocyte death. It is suggested that an overproduction of reactive oxygen species, intracellular calcium overload and inflammatory cell infiltration are the most important features of myocardial ischemia-reperfusion injury.
In this review, various pharmacological interventions to treat myocardial reperfusion injury including the antioxidant flavonols, hydrogen sulfide, adenosine, opioids, incretin-based therapies and cyclosporin A which targets the mitochondrial permeability transition pore are discussed.
The processes involved in reperfusion injury might provide targets for improved outcomes after myocardial infarction but thus far that aim has not been met in the clinic.
阻塞血管的早期再灌注对于恢复缺血心肌的血流以挽救心肌组织和改善临床结局至关重要。然而，这种缺血后的再灌注策略可能会引发进一步的心肌损伤，即心肌再灌注损伤。再灌注损伤的表现包括心律失常、心肌顿抑和微血管功能障碍，以及大量心肌细胞死亡。据认为，活性氧过度产生、细胞内钙超载和炎症细胞浸润是心肌缺血再灌注损伤的最重要特征。
在本综述中，讨论了各种治疗心肌再灌注损伤的药理学干预措施，包括抗氧化黄酮类化合物、硫化氢、腺苷、阿片类药物、基于肠促胰岛素的治疗方法和靶向线粒体通透性转换孔的环孢素 A。
再灌注损伤所涉及的过程可能为心肌梗死后改善结局提供靶点，但迄今为止，这一目标在临床上尚未实现。
