生脉注射液对心肌缺血—再灌注损伤的保护作用及其机制的临床研究
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摘要
目的：通过观察生脉注射液对缺血再灌注心肌血清中SOD、MDA、IL-6、TNF-α、NO的影响,探讨生脉注射液对心肌缺血再灌注损伤的作用机制,为临床应用提供理论依据。
方法：2010.5-12月期间的因“急性胸痛”就诊而住院的患者,根据病情需要,在患者知情同意后行CAG,有显著冠脉病变者并行PCI治疗后随机分为对照组、磷酸肌酸钠治疗组、生脉治疗组。各组患者均酌情使用抗凝、抗血小板聚集药物、他汀类药物、β受体阻滞剂、ACEI、硝酸酯类等。空白组：经股/桡动脉路径进行冠状动脉造影,明确严重狭窄或梗死相关动脉,通过球囊扩张或(和)同时支架置入,开通相关血管,恢复TIMIIII级血流。生脉治疗组：在上述治疗的基础上,生脉注射液40ml加入5%葡萄糖或生理盐水250mL中静滴。磷酸肌酸钠治疗组：在上述治疗的基础上,磷酸肌酸钠注射液1g加入5%葡萄糖或生理盐水250mL中静滴。检测血清丙二醛(MDA)值及超氧化物歧化酶(SOD)活性以及NO、IL-6、TNF-α活性,比较各组指标变化是否有显著性差异。
结果：对照组、生脉组、磷酸肌酸钠组术前患者血清中SOD、MDA、IL-6、TNF-α、NO无明显差异(P>0.05),术后对照组中患者SOD活性、NO含量明显降低,MDA、IL-6、TNF-α明显升高。生脉组、磷酸肌酸钠组与空白组组相比,术后血清中SOD活性、NO含量明显升高,MDA、IL-6、TNF-α含量明显降低,有显著差异(P<0.05)。
结论：生脉注射液可通过抑制氧自由基的产生,减轻脂质过氧化反应,减少炎性细胞的浸润,改善内皮功能,改善心肌微循环,对缺血再灌注损伤心肌有保护作用。
Objective:This study is to observe the effects of Shenmai Injection on myocardial with ischemia reperfusion injury and the changes of serum SOD、MDA、IL-6、TNF-a、NO, and to discuss the functional mechanism of SMI, in order to provide theoretical basis for clinical application.
Methods:During 2010.5-12, the patients who were admitted for acute coronary syndrome and were successfully revascularized by PCI were randomized into Shenmai injection group(n=20), Creatine Phospate group(n=20), Blank control group(n=20). The patients in each group were received anticoagulation、antiaggregatory、statins、B-block、ACEI、isosorbide mononitrate et al according their condition. Blank control group:The patients were given coronary angiography, according the results, the lesion coronary were given extension by balloon and/or stent implanted. The related coronary arteries were successfully revascularized and the IR flow≥TIMI 3 grade flow. Shenmai injection group:The patients were given SMI 40ml intravenous guttae on the basis of the patiens in blank control group. Creatine Phospate group:The patients were given Creatine Phospate 1g intravenous guttae on the basis of the patiens in blank control group. The activity of serum superoxide dismutase(SOD)、interleukin-6 (IL-6)、tumor necrosis factor a (TNF-a) and the contentration of malondialdehyde (MDA)、nitric oxide (NO) were assayed. All of them would be compared in order to see whether they had the dramatical difference.
Results:There are no significant differences of the activity of SOD、IL-6、TNF-a and the contention of MDA、NO among these groups preoperative. After operation, The activity of SOD、NO in the Blank control group was lower than preoperative, the contention of MDA、IL-6、TNF-a was higher than preoperative, have significant differences through the statistical analysis(P<0.05). But patients in the Shenmai group and Creatine Phospate group showed the opposite result, compared with the patients in Blank control group, the result show significant differences through the statistical analysis(P<0.05).
Conclusion:SMI can get rid of OFR and prevent cell lipid peroxidation, improve the vascular endotheial cell function, relieve the inflammatory cell infiltrate, improve the myocardium microcirculation, SO SMI have the function of protection of MIRI.
方法：2010.5-12月期间的因“急性胸痛”就诊而住院的患者,根据病情需要,在患者知情同意后行CAG,有显著冠脉病变者并行PCI治疗后随机分为对照组、磷酸肌酸钠治疗组、生脉治疗组。各组患者均酌情使用抗凝、抗血小板聚集药物、他汀类药物、β受体阻滞剂、ACEI、硝酸酯类等。空白组：经股/桡动脉路径进行冠状动脉造影,明确严重狭窄或梗死相关动脉,通过球囊扩张或(和)同时支架置入,开通相关血管,恢复TIMIIII级血流。生脉治疗组：在上述治疗的基础上,生脉注射液40ml加入5%葡萄糖或生理盐水250mL中静滴。磷酸肌酸钠治疗组：在上述治疗的基础上,磷酸肌酸钠注射液1g加入5%葡萄糖或生理盐水250mL中静滴。检测血清丙二醛(MDA)值及超氧化物歧化酶(SOD)活性以及NO、IL-6、TNF-α活性,比较各组指标变化是否有显著性差异。
结果：对照组、生脉组、磷酸肌酸钠组术前患者血清中SOD、MDA、IL-6、TNF-α、NO无明显差异(P>0.05),术后对照组中患者SOD活性、NO含量明显降低,MDA、IL-6、TNF-α明显升高。生脉组、磷酸肌酸钠组与空白组组相比,术后血清中SOD活性、NO含量明显升高,MDA、IL-6、TNF-α含量明显降低,有显著差异(P<0.05)。
结论：生脉注射液可通过抑制氧自由基的产生,减轻脂质过氧化反应,减少炎性细胞的浸润,改善内皮功能,改善心肌微循环,对缺血再灌注损伤心肌有保护作用。
Objective:This study is to observe the effects of Shenmai Injection on myocardial with ischemia reperfusion injury and the changes of serum SOD、MDA、IL-6、TNF-a、NO, and to discuss the functional mechanism of SMI, in order to provide theoretical basis for clinical application.
Methods:During 2010.5-12, the patients who were admitted for acute coronary syndrome and were successfully revascularized by PCI were randomized into Shenmai injection group(n=20), Creatine Phospate group(n=20), Blank control group(n=20). The patients in each group were received anticoagulation、antiaggregatory、statins、B-block、ACEI、isosorbide mononitrate et al according their condition. Blank control group:The patients were given coronary angiography, according the results, the lesion coronary were given extension by balloon and/or stent implanted. The related coronary arteries were successfully revascularized and the IR flow≥TIMI 3 grade flow. Shenmai injection group:The patients were given SMI 40ml intravenous guttae on the basis of the patiens in blank control group. Creatine Phospate group:The patients were given Creatine Phospate 1g intravenous guttae on the basis of the patiens in blank control group. The activity of serum superoxide dismutase(SOD)、interleukin-6 (IL-6)、tumor necrosis factor a (TNF-a) and the contentration of malondialdehyde (MDA)、nitric oxide (NO) were assayed. All of them would be compared in order to see whether they had the dramatical difference.
Results:There are no significant differences of the activity of SOD、IL-6、TNF-a and the contention of MDA、NO among these groups preoperative. After operation, The activity of SOD、NO in the Blank control group was lower than preoperative, the contention of MDA、IL-6、TNF-a was higher than preoperative, have significant differences through the statistical analysis(P<0.05). But patients in the Shenmai group and Creatine Phospate group showed the opposite result, compared with the patients in Blank control group, the result show significant differences through the statistical analysis(P<0.05).
Conclusion:SMI can get rid of OFR and prevent cell lipid peroxidation, improve the vascular endotheial cell function, relieve the inflammatory cell infiltrate, improve the myocardium microcirculation, SO SMI have the function of protection of MIRI.
引文
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