Department of Hand and Microsurgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University; the Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, China.
Department of Post Anaesthesia Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou 325027, China.
Biomed Pharmacother. 2021 Oct;142:111981. doi: 10.1016/j.biopha.2021.111981. Epub 2021 Aug 4.
Arterialized venous flap (AVF) is limited in clinical application because its survival remains inconsistent and its exact survival mechanism is still unclear. Hirudin is an effective thrombin specific inhibitor, which is isolated from the salivary gland secretions of the leech. Our study evaluated the impact of hirudin on the viability of AVFs in rabbits. Thirty-six rabbits were randomly divided into three groups: sham group (physiological perfusion), control group (AVF), and hirudin group (AVF + hirudin). In hirudin group, 20 antithrombin units (ATU) hirudin (2.5 ml) were injected into each flap. In sham group and control group, the same amount of normal saline was injected into each flap. Status of flap survival, water content, vascular perfusion, histopathology, expression of CD34, VEGF, eNOS and HIF-1α were analyzed in each group. Analysis of oxidative stress was performed by measuring the activity of superoxide dismutase (SOD) and malondialdehyde (MDA). Compared with flaps in sham group with physiological perfusion mode, results of survival rate, perfusion status, SOD activity, expression of CD34, VEGF, and eNOS of AVFs in control group were significantly lower, while water content, MDA level and expression of HIF-1α were higher. The flap condition of AVFs injected with hirudin in hirudin group was improved significantly, and the results were similar to sham group. Our findings revealed that hirudin can effectively improve survival of AVF.
动脉化静脉皮瓣（AVF）在临床应用中受到限制，因为其存活率仍然不一致，其确切的存活机制仍不清楚。水蛭素是一种从水蛭唾液腺分泌物中分离出来的有效凝血酶特异性抑制剂。我们的研究评估了水蛭素对兔 AVF 存活的影响。36 只兔子被随机分为三组：假手术组（生理灌注）、对照组（AVF）和水蛭素组（AVF+水蛭素）。在水蛭素组中，每个皮瓣注射 20 抗凝血酶单位（ATU）水蛭素（2.5ml）。在假手术组和对照组中，每个皮瓣注射等量的生理盐水。分析每组皮瓣存活状态、含水量、血管灌注、组织病理学、CD34、VEGF、eNOS 和 HIF-1α 的表达。通过测量超氧化物歧化酶（SOD）和丙二醛（MDA）的活性来分析氧化应激。与具有生理灌注模式的假手术组皮瓣相比，对照组 AVF 的存活率、灌注状态、SOD 活性、CD34、VEGF 和 eNOS 的表达明显降低，而含水量、MDA 水平和 HIF-1α 的表达升高。在水蛭素组中注射水蛭素的 AVF 皮瓣状况得到显著改善，结果与假手术组相似。我们的研究结果表明，水蛭素可以有效提高 AVF 的存活率。
