卡维地洛对AMI再灌注患者NOS-NO系统活性的影响

Effect of Carvedilol on NOS-NO System in Patients of Acute Myocardial Infarction with Reperfusion

目的:探讨卡维地洛对急性心肌梗死(AMI)再灌注患者一氧化氮合酶-一氧化氮(NOS-NO)系统活性的影响。方法:回顾性分析216例AMI且经冠脉造影检查证实其梗死相关冠状动脉(IRCA)再通患者,分为干预组(102例,AMI前已口服卡维地洛)及对照组(114例)。采集两组患者入院后0、4、8、12、24、48、72h静脉血,检测血清总一氧化氮合酶(NOS)、诱导型一氧化氮合酶(iNOS)、内皮型一氧化氮合酶(eNOS)活性及NO水平。结果:两组患者所有观察指标基线水平比较P>0.05;干预组NO含量及NOS活性4、8、48、72h时间点高于对照组,而12、24h时间点低于对照组,除4h时间点外两组NO含量相比P<0.05,4、8、12、24、48、72h时间点NOS活性干预组与对照组相比P<0.01;干预组iNOS活性再灌注后各时间点均低于对照组,8、12、24、48h时间点相比P<0.01;iNOS活性于再灌注后4h即开始升高24h达峰值, NO及NOS除24h时间点升高外其它时间点均呈下降趋势。结论:卡维地洛可以减少AMI患者再灌注后NO的失活及iNOS的活化,使NOS-NO系统活性维持在有利于心肌理想再灌注水平,从而减少AMI再灌注后心肌缺血再灌注损伤。

Objective： To explore the effect of carvedilol on Nitric oxide synthase -Nitric oxide （NOS-NO）system in patients of acute myocardial infarction （AMI） with repeffusion. Methods：216 patients with AMI were divided into 2 groups. Control group （l 14 cases）：The blood flow of infarct-related coronary acteD＇ （IRCA） has been reverted to TIMI Ⅲ level; Treated group：The blood flow of IRCA has been reverted to TIMI Ⅲ level and gavaged with carvedilol before AMI（102 casesh The concentratmn of NO and activity of NOS were assayed at pre-reperfusion （baseline） and post-repeffusion period （4-hour, 8-hour, 12-hour, 24-hour. 48-hour and 72-hour after repeffusion）.Results： There were no statistical significant differences between two groups in general features（P〉0.05L The levels of NO, NOS and iNOS showed no significant change between two groups at baseline. The concentration of NO and the activity of NOS in treated group were higher than those in control group at 4- hour, 8-trout, 48hour and 72-hour time points, but they were low at 12-hour and 24-hour time points; The difference of NO content between treated group and control group was noted at 8-hour,12-hour,24-hour. 48hour and 72-hour time points （P〈0.01）; The activity of NOS between treated group and cantrol group at 4-hour, 8-hour,12-haur,24-hour,48-hour and 72-hour time points had statistic significant difference （P〈 0.01）; The activities of iNOS in treated group were lower than those, in control group. The activities of iNOS between treated group and control group at 8-hour,12-hour,24-hour and 48-hour time points had statistic significant difference（P〈0.01）; The activity of iNOS began to increase m 4-hcur and reached the peak level at 24-hour after repeffusion. The levels of NO and NOS showed a downward trend except 24-hour time point. Conelusions：Carvedilol could reduce inactivation of NO and activation of iNOS in patients of AMI with repeffusion. It can maintain NOS-N0 system activity to the ideal level for myocardial reperfusion.