Przyklenk K, Ovize M, Bauer B, Kloner R A
Heart Institute, Hospital of the Good Samaritan, Los Angeles, CA 90017, USA.
Am Heart J. 1995 Jun;129(6):1108-13. doi: 10.1016/0002-8703(95)90390-9.
Mechanisms responsible for the well-documented "protection" against myocardial ischemia and infarction in young women and subsequent loss of protection after menopause remain speculative. One possibility is that gender-related variables (such as endogenous hormone levels or regular loss of stored iron) alter the susceptibility of the heart to ischemia: if so, then premenopausal women when compared with men may manifest endogenous protection against acute myocardial ischemic injury. Using the canine model we therefore sought to determine whether gender influences acute myocardial ischemia and infarction. Retrospective analysis was performed on data compiled from 60 mature adult dogs subjected to 1 hour of coronary artery occlusion and > or = 4 hours of reperfusion. We first compared the incidence of lethal ventricular fibrillation in the male and female cohorts and then for survivors compared collateral blood flow during coronary occlusion (by injection of radioactive microspheres), infarct size (assessed by tetrazolium staining and expressed as a percentage of the myocardium at risk), and regional wall motion (by somomicrometry) in the infarct-related area. The incidence of lethal ventricular fibrillation was 23% in the male dogs and 19% in the female dogs (p = 0.70, difference not significant). For survivors, the area at risk of infarction was comparable in males and females (23 +/- 2% and 22% +/- 1% of the total left ventricular weight), and the groups were equally ischemic during coronary occlusion, with collateral blood flow to the ischemic subendocardium averaging 0.05 +/- 0.02 and 0.07 +/- 0.01 ml/min/g tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
年轻女性中充分记录的对心肌缺血和梗死的“保护作用”以及绝经后这种保护作用的丧失,其机制仍存在推测。一种可能性是与性别相关的变量(如内源性激素水平或储存铁的定期流失)改变了心脏对缺血的易感性:如果是这样,那么绝经前女性与男性相比,可能表现出对急性心肌缺血损伤的内源性保护。因此,我们使用犬类模型来确定性别是否会影响急性心肌缺血和梗死。对60只成年犬进行1小时冠状动脉闭塞和≥4小时再灌注后收集的数据进行回顾性分析。我们首先比较了雄性和雌性队列中致命性室颤的发生率,然后对存活者比较了冠状动脉闭塞期间的侧支血流(通过注射放射性微球)、梗死面积(通过四氮唑染色评估并表示为危险心肌的百分比)以及梗死相关区域的局部室壁运动(通过体视显微镜测量)。雄性犬中致命性室颤的发生率为23%,雌性犬为19%(p = 0.70,差异不显著)。对于存活者,男性和女性的梗死危险面积相当(分别为左心室总重量的23±2%和22%±1%),并且在冠状动脉闭塞期间两组的缺血程度相同,缺血性心内膜下的侧支血流平均分别为0.05±0.02和0.07±0.01 ml/min/g组织。(摘要截断于250字)