左-卡尼汀对心瓣膜替换术患者血浆基质金属蛋白酶的影响

Effects of L-carnitine on plasma matrix metalloproteinases in patients undergoing heart valve replacement operation

目的 研究风湿性心脏病心瓣膜替换术患者 ,围术期静脉滴注不同剂量的左 卡尼汀以及术中应用左 卡尼汀作为心麻痹液的组成成分进行冠状动脉顺行灌注对血浆基质金属蛋白酶(MMPs)的影响及与心功能的关系。方法 96例风湿性心脏病体外循环 (CPB)下心瓣膜替换术患者随机分为 3组 ,每组 3 2例 (即治疗Ⅰ组、治疗Ⅱ组和对照组 )。治疗Ⅰ组术前 7d和术后 7d每日静脉滴注左 卡尼汀 6g ,术中于ST .ThomasⅡ号冷晶体心麻痹液中按 12 g/L加入左 卡尼汀 ,治疗Ⅱ组术前 7d和术后 7d每日静脉滴注左 卡尼汀 3 g ,术中于ST .ThomasⅡ号冷晶体心麻痹液中按6g/L加入左 卡尼汀 ,对照组围术期不用左 卡尼汀 ,术中仅以ST .ThomasⅡ号冷晶体液作为心麻痹液 ,3组其他治疗条件相同。结果 (1)治疗Ⅰ组患者血浆MMP 2从转流 2 0min到术后 1d明显低于对照组 (P <0 .0 5或P <0 .0 1) ,其中从转流毕到术后 1d明显低于治疗Ⅱ组 (P <0 .0 5或P <0 .0 1) ;治疗Ⅰ组患者血浆MMP 9从转流 2 0min到转流毕明显低于对照组 (P <0 .0 5或P <0 .0 1) ,两治疗组之间比较差异无显著性 (P >0 .0 5 )。 (2 )血浆心肌肌钙蛋白Ⅰ (cTnI)从转流毕到术后 3d明显低于对照组 (P <0 .0 5或P <0 .0 1) ,其中治疗Ⅰ组明显低于治疗Ⅱ组 (P <0 .0 5 )。

Objective To investigate the effects of L-carnitine,used as an ingredient of cardiac aresting solution,on the plasma matrix metalloproteinases (MMPs) in the process of heart valve replacement operation.Methods 96 cases undergoing heart valve replacement with cardiopulmonary bypass (CPB) were divided into test group Ⅰ,test group Ⅱ and control group ( n =32 in each group).L-carnitine was put in the ST.Thomas II cold crystal cardiac arresting liquid in test group I (12 g/L) and in test group II (6 g/L) for antegrade coronary artery perfusion,and administered for intravenous drip one dose a day in test group I (6 g/day) and in test group II (3 g/day) perioperatively.Other experimental conditions were the same among the three groups.Results From the end of CPB to 3 days after operation,the serum level of cardial tropnin I in test group I were significantly lower than in test group Ⅱ ( P <0.05) and control group [(6.21±1.22) μg/L vs (12.34±2.29) μg/L,P <0.01] 8 h postoperatively;and [(5.75±1.33) μg/L vs (11.12±2.16) μg/L,P <0.01] 3 days postoperatively.Twenty min after the initiation of CPB to 1 day after operation,plasma level of MMP-2 in test group I was significantly lower than in control group [(116.1±22.3) μg/L vs (288.7±51.4) μg/L,P <0.05] end of CPB;and [(41.6±9.5) μg/L vs (248.6±52.7) μg/L,P <0.01] 1 day postoperatively.Twenty min after the beginning of shunt to the termination of CPB,plasma level of MMP-9 in test group I was significantly lower than in control group [(59.5±7.5) μg/L vs (122.3±25.8) μg/L,P <0.01] 20 min after the beginning of shunt,and [(179.3±33.5) μg/L vs (312.3±68.9) μg/L,P <0.05] end of CPB.Conclusion Antegrade coronary perfusion of L-carnitine as an ingredient of cardiac arresting solution in the process of operation and administration of high dose L-carni-tine for intravenous drip during perioperation can reduce plasma levels of MMPs and shows good protective effect on myocardium for heart valve replacement patients under cardiopulmonary bypass.