<International Circulation>: So what is the relationship between ischemia reperfusion injury and the time interval between the infarct and the interventions?
Prof. Heusch: Well formally， even textbook knowledge even in some older textbooks is that once you occlude a coronary artery you will have the start of necrosis within twenty to forty minutes. But we have now learned that this is not necessarily true. It can be true but in some instances viable myocardium， even with a coronary artery occlusion can be maintained for hours， up to twelve， or even longer hours if there is a slight amount of residual blood flow. As such， slight amount of residual blood flow in a patient is often present because a patient who develops a coronary artery diseases over a prolonged period of time develops a sub collateral blood flow sub-passing the actual site of the lesion such that distal to the occlusion a little blood flow is maintained， and that little blood flow can go a long way to sustain some sort of residual viability in the myocardium and it is therefore that even after ten hours that it maybe worth it to reopen the artery to rescue some of the myocardium， maybe not all of it， but at least a significant portion of it.
《国际循环》：缺血再灌注损伤和梗死发病和干预时间间隔之间的关系是什么？
Heusch教授：通常来讲，即使是一些经典的教科书也指出，冠脉闭塞后20~40分钟心肌开始发生坏死。但是现在我们知道这不一定是正确的。可能是正确的。但是在某些情况下，即使冠脉闭塞了，如果有少量残存血流的话，心肌在几个小时内仍然是存活的，最长可达12小时。实际上，患者通常是有少量残存心肌，因为经过很长时间发生冠心病的患者有侧支血流供应梗死灶的实际部位，使得闭塞部位远端有少量血流供应，这些血流可以维持残留心肌存活。因此，即使是梗死后10个小时，也值得再通动脉以挽救心肌，也许不会全部挽救，但是至少是一大部分心肌。
<International Circulation>: Is this happening through angiogenesis?
Prof. Heusch:Yes. Basically collateral growth like stenosis of the lesion is a process of angiogenesis. Some people are more specific about it， they call it arteriogenesis because it not capillary growth but it is growth but basically it is vessel growth， let us say it this way.
《国际循环》：侧支是通过血管生成产生的吗？
Heusch教授：是的，侧支的生长就像狭窄的病灶一样是血管生成的过程。某些学者对此有特定的叫法，称之为动脉生成，因为并不是毛细血管生长而是血管生长。
<International Circulation>: Are people targeting and are there ways to stimulate this arterial genesis?
Prof. Heusch:Yes. VEGF was used， growth factor has been used. Actually there has been clinical trials， unfortunately they failed and for two reasons. One is VEGF is mostly promoting capillaries and they are of no use.
《国际循环》：人们是否针对血管生长进行治疗？有什么方法能够促进血管增长？
Heusch教授：是的。人们应用了血管内皮生长因子（VEGF）。实际上有相关临床试验，不幸的是临床试验失败了，原因有两个。一个原因是VEGF主要是促进毛细血管生长，对患者没有用处。
<International Circulation>: So it is a totally different kinds of muscle tissue?
Prof. Heusch:Exactly， and this is why the terminology has something to do with it but we need arterial genesis. We want the growth of larger conduit vessels rather than small microvessels. That was one failure， and the other thing possibly also a serious concern is that if you have a spill over of the VEGF you will not only have vascular growth in that myocardium but also maybe in aside effect of prostate cancer where you do not want vascularization so the side effects of vascular growth are very difficult. Basically to attenuate vascular growth is the main treatment target for all anticancer therapies so you are just in a ying and yang situation here. So therefore angiogenesis， is a very dangerous target， potentially very effective but also very dangerous.
《国际循环》：因此是完全不同的肌肉组织？
Heusch教授：没错，这就是需要术语的原因，我们需要的是动脉生成。我们需要大血管的生长而不是微血管生长。这是VEGF的问题之一。另一个问题同样是个严重的问题，就是应用VEGF时不仅心肌的血管会生长，同时如果有前列腺癌的话对其也有影响，你可能不希望前列腺癌发生血运重建，因此血管生长的不良反应是区别很大的。基本上来讲，抑制血管生长是所有抗肿瘤治疗的主要治疗目标，因此你现在面临的问题就像硬币的两面。因此，血管生成是一个非常危险的靶点，可能非常有效但是同样非常危险。
<International Circulation>: Do a lot of your patients with cardiovascular problems also have cancer?
Prof. Heusch: It is the population， it is just because they are old and the longer they survive the treatments for cardiovascular disease the more they develop cancer. They all eventually die， you have to die from something.
《国际循环》：很多心血管疾病患者有癌症的问题吗？
Heusch教授：是人群的问题，只是因为该人群年龄更大，他们接受心血管疾病治疗后存活的时间越长，他们发生癌症的风险越大。最后患者都面临死亡，会有一定的死因。
上一页 [1] [2] [3]