Cavalcante Leonardo Pessoa, Ferreira Sueli Gomes, Pereira Daniel Romano, Moraes Sergio Rodrigues de, Simas Rafael, Sannomiya Paulina, Breithaupt-Faloppa Ana Cristina, Moreira Luiz Felipe Pinho
Laboratory of Cardiovascular Surgery and Circulation Pathophysiology (LIM-11), Heart Institute (Incor), Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Interact Cardiovasc Thorac Surg. 2018 Feb 1;26(2):196-201. doi: 10.1093/icvts/ivx314.
Despite research into protective pharmacological adjuncts, paraplegia persists as a dreaded complication after thoracic and thoracoabdominal aortic interventions. Reports on gender-related neurological outcomes after ischaemic and traumatic brain injuries have led to increased interest in hormonal neuroprotective effects and have generated other studies seeking to prove the neuroprotective effects of the therapeutic administration of 17β-oestradiol and of progesterone. We hypothesised that acute administration of oestradiol or progesterone would prevent or attenuate spinal cord ischaemic injury induced by occlusion of the descending thoracic aorta.
Male rats were divided into groups receiving 280 µg/kg of 17β-oestradiol or 4 mg/kg of progesterone or vehicle 30 min before transitory endovascular occlusion of the proximal descending thoracic aorta for 12 min. Hindlimb motor function was assessed by a functional grading scale (that of Basso, Beattie and Bresnahan) for 14 days after reperfusion. On the 14th day, a segment of the thoracolumbar spinal cord was harvested and prepared for histological and immunohistochemical analyses.
There was significant impairment of the motor function of the hindlimb in the 3 study groups, with partial improvement noticed over time, but no difference was detected between the groups. On Day 1 of assessment, the 17β-oestradiol group had a functional score of 9.8 (0.0-16.5); the progesterone group, a score of 0.0 (0-17.1) and the control group, a score of 6.5 (0-16.9); on the 14th day, the 17β-oestradiol group had a functional score of 18.0 (4.4-19.4); the progesterone group had a score of 7.5 (0-18.5) and the control group had a score of 17.0 (0-19.9). Analysis of the grey matter showed that the number of viable neurons per section was not different between the study groups on the 14th day. Immunostaining of the spinal cord grey matter was also similar among the 3 groups.
Acute administration of oestradiol or of progesterone 30 min before transitory occlusion of the proximal descending thoracic aorta of male rats could not prevent or attenuate spinal cord ischaemic injury based on an analysis of functional and histological outcomes.
尽管对保护性药物辅助治疗进行了研究，但截瘫仍是胸主动脉和胸腹主动脉干预术后令人恐惧的并发症。关于缺血性和创伤性脑损伤后性别相关神经学结果的报告引发了人们对激素神经保护作用的更多关注，并催生了其他旨在证明治疗性给予17β - 雌二醇和孕酮具有神经保护作用的研究。我们假设急性给予雌二醇或孕酮可预防或减轻降主动脉闭塞所致的脊髓缺血性损伤。
将雄性大鼠分为几组，在短暂性血管内闭塞胸降主动脉近端12分钟前30分钟，分别给予280μg/kg的17β - 雌二醇、4mg/kg的孕酮或赋形剂。再灌注后14天，通过功能分级量表（Basso、Beattie和Bresnahan量表）评估后肢运动功能。在第14天，采集胸腰段脊髓的一段进行组织学和免疫组织化学分析。
3个研究组的后肢运动功能均有显著损害，随着时间推移有部分改善，但各研究组之间未检测到差异。在评估的第1天，17β - 雌二醇组的功能评分为9.8（0.0 - 16.5）；孕酮组为0.0（0 - 17.1）；对照组为6.5（0 - 16.9）；在第14天，17β - 雌二醇组的功能评分为18.0（4.4 - 19.4）；孕酮组为7.5（0 - 18.5）；对照组为17.0（0 - 19.9）。灰质分析显示，第14天时各研究组每切片存活神经元数量无差异。3组脊髓灰质的免疫染色也相似。
基于功能和组织学结果分析，在雄性大鼠短暂性闭塞胸降主动脉近端前30分钟急性给予雌二醇或孕酮，不能预防或减轻脊髓缺血性损伤。
