左旋卡尼汀对冠心病介入术后患者的心肌保护
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摘要
目的在冠心病接受经皮冠状动脉介入治疗(primary percutaneous coronaryintervention,PCI)的患者中,评价左旋卡尼汀(L-carnitine,L-CN)对PCI术后心肌损伤的保护作用。方法(一)静脉治疗组:连续入选冠心病非ST段抬高急性冠脉综合征(NSTE-ACS)患者96例,均在入院后48h内进行PCI,术前口服阿司匹林300mg/d;氯吡格雷300mg顿服后75mg/d;根据入院顺序随机分为(1)治疗组:48例,在PCI术前30min给予L-CN 5g静脉推注,继以LC5g静脉输注,术后以L-CN10g静脉输注,共3d;(2)对照组:48例,以同等剂量生理盐水代替L-CN静脉输注,其他用药两组相同。(二)口服治疗组:连续入选拟接受PCI的冠心病住院患者110例,随机分为L-CN治疗组55例和对照组55例。两组患者均在入院7d后进行PCI,对照组给予常规治疗,并常规处理其他并发症。L-CN治疗组在常规治疗的基础上,加用口服L-CN 3g/d,术前7d开始应用,术后继续应用7d。分别用化学发光法定量测定PCI术前、术后肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白I(TnI)等指标变化,并观察住院期间和出院后30d联合心脏事件(CCE,含复发心肌缺血、心肌梗死、死亡)发生情况。结果入选患者年龄、性别、高血压、糖尿病及相关用药、冠状动脉造影显示的病变特点、术前TIMI血流分级等在两组间差异均无统计学意义(P＞0.05);两组患者PCI前CK-MB、TnI的水平差异无显著性(P＞0.05);L-CN治疗组术后12h、24h的CK-MB水平与对照组相比明显降低(P＜0.01,P＜0.05);L-CN治疗组术后8h、12h及24h的TnI水平与对照组比较明显下降(P＜0.05);术后L-CN治疗组TIMI3级高于对照组、术后48h及30d联合心脏事件发生率低于对照组,但差异无显著性(P＞0.05)。静脉或口服L-CN均未见与用药有关的不良反应。
结论L-CN静脉治疗非ST段抬高急性冠脉综合征(NSTE-ACS)及口服治疗冠心病拟行PCI术后患者,具有明显减少心肌坏死标志物CK-MB、TnI的释放,从而减轻PCI术引起的心肌损伤作用,同时未发现明显不良反应。
OBJECTIVE To evaluate the myocardial protection effects of L-carnitine in patients with coronary heart disease undergoing primary percutaneous coronary intervention(PCI) . METHODS vein treatment group: 96 consecutive patients with NSTE-ACS undergoing primary PCI were randomized to two groups in 48h were randomized to two groups ,the L-CN treated group(n=48) and control group(n=48). L-CN 5g was infused into vein 30min previous PCI and L-CN10g was infused into vein after PCI in the L-CN treated group in three days. Normal saline replace L-CN was infused into vein in control group, oral administration treatment group: 110 consecutive patients with coronary heart disease undergoing primary PCI were randomized to two groups ,the L-CN treated group(n=55) and control group(n=55) .The peak value of CK-MB and TnI before and after PCI were observed .The combined cardiovascular events(a combination of cardiac death,nonfatal myocardial infarction and the re-hospital admission due to recurrent ischemia angina) within 30 days after PCI were analyzed. RESULTS In L-CN treated group,the peak value of CK-MB was significantly lower than the control group at 12h and 24h after PCI(P<0.01).The peak value of TnI in the treatment group were also significantly lower than the control group at 8h(P<0.01),12h and 24h(P<0.05) after PCI. The combined cardiovascular events during or 30d after PCI was markedly reduced in the L-CN treated group. CONCLUSION L-CN adjunct therapy appears to be associated with a reduced level of cardiac markers in patients with CHD. These results support a larger clinical trial to investigate the effect of L-carntine on cardiac events following PCI.
结论L-CN静脉治疗非ST段抬高急性冠脉综合征(NSTE-ACS)及口服治疗冠心病拟行PCI术后患者,具有明显减少心肌坏死标志物CK-MB、TnI的释放,从而减轻PCI术引起的心肌损伤作用,同时未发现明显不良反应。
OBJECTIVE To evaluate the myocardial protection effects of L-carnitine in patients with coronary heart disease undergoing primary percutaneous coronary intervention(PCI) . METHODS vein treatment group: 96 consecutive patients with NSTE-ACS undergoing primary PCI were randomized to two groups in 48h were randomized to two groups ,the L-CN treated group(n=48) and control group(n=48). L-CN 5g was infused into vein 30min previous PCI and L-CN10g was infused into vein after PCI in the L-CN treated group in three days. Normal saline replace L-CN was infused into vein in control group, oral administration treatment group: 110 consecutive patients with coronary heart disease undergoing primary PCI were randomized to two groups ,the L-CN treated group(n=55) and control group(n=55) .The peak value of CK-MB and TnI before and after PCI were observed .The combined cardiovascular events(a combination of cardiac death,nonfatal myocardial infarction and the re-hospital admission due to recurrent ischemia angina) within 30 days after PCI were analyzed. RESULTS In L-CN treated group,the peak value of CK-MB was significantly lower than the control group at 12h and 24h after PCI(P<0.01).The peak value of TnI in the treatment group were also significantly lower than the control group at 8h(P<0.01),12h and 24h(P<0.05) after PCI. The combined cardiovascular events during or 30d after PCI was markedly reduced in the L-CN treated group. CONCLUSION L-CN adjunct therapy appears to be associated with a reduced level of cardiac markers in patients with CHD. These results support a larger clinical trial to investigate the effect of L-carntine on cardiac events following PCI.
引文
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