Meng X, Ao L, Brown J M, Fullerton D A, Banerjee A, Harken A H
Department of Surgery, University of Colorado Health Sciences Center, Denver 80262, USA.
Shock. 1997 Feb;7(2):111-8. doi: 10.1097/00024382-199702000-00007.
Endotoxin and proinflammatory cytokines induce nitric oxide synthase (NOS), and nitric oxide (NO) plays an important role in promoting endotoxin shock. However, the role of NOS in endotoxemic cardiac contractile dysfunction is not defined. To determine whether endotoxemic cardiac contractile dysfunction involves NOS, the present study used a rat model of endotoxemia without shock and examined the effects of glucocorticoids (dexamethasone, a potent inhibitor of inducible NOS, iNOS, expression), isoform nonselective NOS inhibitor (NG-monomethyl-L-arginine, L-NMA) and iNOS selective inhibitor (S-methylisothiourea sulfate, SMT) on cardiac contractile dysfunction. A sublethal dose of endotoxin (from Salmonella typhimurium, .5 mg/kg, i.p.) was given to adult rats, and left ventricular developed pressure (LVDP) examined by Langendorff technique was attenuated in hearts isolated at 4 or 6 h (66.7 +/- 3.4 and 60.3 +/- 5.5 mmHg, respectively, p < .05 vs. 102 +/- 2.4 mmHg in saline control) after endotoxin treatment. Pretreatment of rats with dexamethasone (4.0 mg/kg, i.v., -30 min) partially abolished endotoxin-induced contractile dysfunction at 6 h (LVDP 87.6 +/- 6.8 mmHg, p < .05 vs. endotoxin alone at 6 h). However, pretreatment with L-NMA (30 mg/kg, i.v., -5 min) or SMT (5.0 mg/kg, i.v., -1 min) failed to prevent the contractile dysfunction. Moreover, infusion of L-NMA or SMT in vitro could not restore contractile function in hearts isolated at 6 h after endotoxin treatment. In contrast, inhibition of NOS with L-NMA or SMT in vitro further attenuated coronary flow in endotoxin-treated hearts. Thus, endotoxemic cardiac contractile dysfunction in this non-shock rat model may not involve NOS, and inhibition of NOS may deteriorate coronary perfusion in endotoxemic heart.
内毒素和促炎细胞因子可诱导一氧化氮合酶(NOS),一氧化氮(NO)在促进内毒素休克中起重要作用。然而,NOS在内毒素血症性心脏收缩功能障碍中的作用尚未明确。为了确定内毒素血症性心脏收缩功能障碍是否涉及NOS,本研究使用了无休克的内毒素血症大鼠模型,并研究了糖皮质激素(地塞米松,一种诱导型NOS即iNOS表达的强效抑制剂)、同工型非选择性NOS抑制剂(NG-单甲基-L-精氨酸,L-NMA)和iNOS选择性抑制剂(硫酸S-甲基异硫脲,SMT)对心脏收缩功能障碍的影响。给成年大鼠注射亚致死剂量的内毒素(来自鼠伤寒沙门氏菌,0.5mg/kg,腹腔注射),在内毒素处理后4或6小时分离的心脏中,通过Langendorff技术检测的左心室舒张末压(LVDP)降低(分别为66.7±3.4和60.3±5.5mmHg,与生理盐水对照组的102±2.4mmHg相比,p<.05)。用糖皮质激素(4.0mg/kg,静脉注射,-30分钟)预处理大鼠,可部分消除6小时时内毒素诱导的收缩功能障碍(LVDP为87.6±6.8mmHg,与6小时时单独使用内毒素相比,p<.05)。然而,用L-NMA(30mg/kg,静脉注射,-5分钟)或SMT(5.0mg/kg,静脉注射,-1分钟)预处理未能预防收缩功能障碍。此外,在内毒素处理后6小时分离的心脏中,体外输注L-NMA或SMT不能恢复收缩功能。相反,体外使用L-NMA或SMT抑制NOS会进一步降低内毒素处理心脏的冠状动脉血流量。因此,在这种无休克大鼠模型中,内毒素血症性心脏收缩功能障碍可能不涉及NOS,抑制NOS可能会使内毒素血症心脏的冠状动脉灌注恶化。