左旋肉碱对一氧化碳中毒后血清心肌损伤标志物水平的影响

The impact of L-carnitine administration on the serum level of myocardium injury markers in patients with acute carbon monoxide poisoning

目的观察血清心肌损伤标志物水平与一氧化碳（CO）中毒程度的关系，并评价左旋肉碱的治疗作用。方法从本院309例急性一氧化碳中毒（ACOP）患者中选择69例入院时血清心肌损伤标志物水平异常增高者，按照入院顺序随机分为对照组34例，观察组35例。在氧疗和对症治疗的基础上，对照组静脉滴注醒脑静20ml／d；观察组静脉滴注醒脑静20ml／d＋左旋肉碱2g／d。于治疗24h、72h和1周后分别检测碳氧血红蛋白（HbCO）浓度和心肌损伤标志物肌红蛋白（Mb）、肌酸激酶同工酶（CK—MB）、心肌肌钙蛋白I（cTnI）水平。分析CO中毒程度（HbCO浓度）与心肌损伤标志物水平异常升高的关系，比较两组患者治疗前后的差异。结果入院时轻度中毒（HbC0浓度10％～19％）、中度中毒（20％～39％）、重度中毒（≥40％）患者中，心肌损伤标志物水平异常的检出率分别为2．5％（5／204）、46．8％（36／77）、100．O％（28／28），与HbCO浓度具有极显著相关性（X2=170．3549，P〈0．0001）。对照组和观察组治疗前HbCO（（31．1±17．6）％、（32．3±16．9）％）]、Mb（μg／L：154．2±51．8、165．4±48．6）、CK—MB（μg／L：8．7±3．3、9．6±3．8）、cTnI（μg／L：2．7±1．2、2．8±1．5）比较差异均无统计学意义（均P〉0．05）。与对照组比较，观察组治疗24h、72h后Mb（24h：74．0±36．5比97．1±35．8，72h：40．1±6．8比69．0±11．2）、cTnI水平（24h：1．9±0．5比2．3±0．7，72h：1．2±0．3比1．8=k0．4）及治疗24h后CK—MB（10．6±4．1比13．0±3．9）显著降低（P〈0．05或P〈0．01）；1周后两组心肌损伤标志物均降至正常水平；治疗过程中HbCO浓度的下降两组间无明显差异。结论c0中毒后心肌损伤标志物水平异常升高的检出率与HbC0浓度呈正相关，左旋肉碱有减轻CO中毒后心肌损伤和横纹肌损伤的治疗作用。

Objective To examine the serum level of myocardial injury markers in patients with carbon monoxide （CO） poisoning, the correlation between these markers and the severity of the disease, and the therapeutic effects of L-carnitine administration. Methods 69 patients, chosen from 309 cases of acute carbon monoxide poisoning （ACOP） for abnormally high level of serum myocardial injury markers （myoglobin, Mb; MB isoenzyme of creatine kinase, CK-MB; cardiac troponin-I, cTnI） at the time of admission, were randomly divided into control group （n= 34） and observation group （n= 35）. The patients in control group were given Xingnaojing （20 ml/d i. v. drip）, and the observation group Xingnaojing （20 ml/d）＋L-carnitine （2 g/d i.v. drip）, in addition to the conventional oxygen supply and symptom- focused therapy. The plasma concentration of carboxyhemoglobin （HbCO, as index for CO poisoning severity）, Mb, CK-MB, and cTnI in these patients were further examined 24 hours, 72 hours and 1 week after the treatment, for difference between the two groups, and the correlation between the serum level of HbCO and the myocardial injury markers. Results At the time of admission, the incidence of abnormal findings in myocardial injury markers were 2. 5% （5/204）, 46.8% （36/77） and 100. 0% （28/28） in patients with mild （HbCO： 10%-19%）, moderate （20%-39%） and severe （≥40%） CO poisoning, respectively. The incidence of abnormal findings in injury markers was significantly correlated to the HbCO concentration （X2= 170. 354 9, P〈0. 000 1）. Before the treatment, no significant difference was found in any of the indexes [HbCO ： （31.1 ± 17.6）%, （32.3±16.9）%, M b （μg/L） ： 154.2 ± 51.8, 165.4 ±48. 6, CK-MB （μg/L） ： 8. 7 ±3.3, 9.6±3.8）, and cTnI （μg/L） ： 2.7±1.2, 2.8 ±1.5, all P〉0.05] between the control and observation group. However, it was found in.. Mb （24 hours： 74. 0±36.5 vs. 97. 1±35.8, 72 hours： 40.1±6.8 vs. 69.0±11.2）, cTnI （24 hours： 1.9±0.5 vs. 2.3±0. 7, 72 hours： 1.2±0.3 vs. 1.8±0. 4） both 24 hours and 72 hours after the treatment, and CK-MB, 24 hours after treatment （10. 6± 4.1 vs. 13.0±3.9） with the values in observation group significantly lower （P〈0. 05 or P〈0. 01） ; 1 week after the treatment, the concentration of all the injury markers returned to the normal levels with no significant difference between the two groups. Meanwhile, no significant difference was found between the two groups in HbCO concentration throughout the due-course of the therapy. Conclusions The incidence of abnormal findings in serum myocardial injury markers was positively correlated with HbCO concentration after CO poisoning. L-carnitine may protect the myoeardium and striated muscles against injury in patients with CO poisoning.