Кардиопротекторный эффект пептидных и непептидных агонистов опиоидных рецепторов при реперфузии сердца: возможность клинического применения экспериментальных данных

Летальность у пациентов с острым инфарктом миокарда составляет 5–8 % и не снижается в последние годы. Одной из причин смерти является реперфузионное повреждение сердца. Совершенно очевидно, что существует острая необходимость в разработке принципиально новых препаратов, которые могут эффективно снижать летальность при ОИМ. Такими препаратами могут стать опиоиды. Активация периферических µ2-, δ2-, κ1- опиоидных рецепторов уменьшает размер инфаркта и улучшает сократимость при реперфузии. Периферические µ1-, δ1-, κ2-рецепторы не участвуют в регуляции толерантности сердца к реперфузионному повреждению сердца. Опиоидное посткондиционирование ограничивает воспалительный процесс в миокарде, уменьшает микрососудистую обструкцию, подавляет апоптоз кардиомиоцитов и уменьшает неблагоприятное постинфарктное ремоделирование. Опиоиды могут снижать избыточную продукцию активных форм кислорода в реперфузируемом миокарде. Наиболее перспективными препаратами могут оказаться опиоидные пептиды, которые не проникают через гематоэнцефалический барьер и поэтому, в отличие от других опиоидов, не вызывают тошноту, рвоту и угнетение дыхания.

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