急性心肌梗死患者介入治疗后还原型谷胱甘肽临床应用研究

Clinical Application of Glutathione in Treatment of Acute Myocardial Infarction After Percutaneous Coronary Intervention

目的探讨还原型谷胱甘肽对急性心肌梗死(AMI)患者介入治疗后的心肌保护作用及其可能的机制。方法选择成功行急诊经皮冠状动脉介入治疗(PCI)的AMI患者50例,随机分为对照组(常规药物治疗)和还原型谷胱甘肽组(GSH组,常规药物加用还原型谷胱甘肽),每组各25例患者,共治疗4周。所有患者再灌注治疗前行超声心动图检查测定左心室舒张末期内径(LVEDD),左室射血分数(LVEF),心脏指数(CI),心输出量(CO)。治疗4周后复查超声心动图。所有患者分别于治疗前,再灌注治疗4周后测定血浆中的超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)。结果 PCI术后4周,两组的LVEDD相比差异无统计学意义(P>0.05),GSH组患者LVEF、CI、CO均高于对照组(P<0.05)。GSH组治疗后SOD和GSH-Px均高于治疗前(P<0.01)。对照组治疗后SOD低于治疗前(P<0.01)。治疗后治疗组SOD和GSH-Px高于对照组,比较差异有统计学意义(P<0.01)。结论还原型谷胱甘肽能有效改善急性心肌梗死PCI术后患者氧化应激状态和心功能,有显著的心肌保护作用。

Objective To explore the protective of reduced glutathione in acute myocardial infarction（ AMI） patients after interventional therapy and its possible mechanism. Methods 50 patients with AMl were treated with Primary PCI. The patients received routine drugs（ control group,n = 25） or routine drugs plus reduced glutathione（ reduced glutathione group,n = 25） for 4 weeks. Echocardiographic examinations were performed before treatment to observe the changes of left ventrieular end- diastolic dimension（ LVEDD）,left ventricular ejection fraction（ LVEF）,cardiac index（ CI） and cardiac output（ CO）. After 4 weeks of treatment review echocardiography,the levels of blood superoxide dismutase（ SOD） and glutathione peroxidase（ GSH- Px） of all patients were measured before treatment and treatment of reperfusion. Results After 4 weeks PCI,LVEDD of GSH group and control group had no significant difference（ P 〉0. 05）. In GSH group,LVEF,CI and CO higher than those in the control group,and the difference was statistically significant（ P 〈0. 05）. In GSH group,after treatment,SOD and GSH- Px were higher than that before treatment（ P〈 0. 01）. In the control group,after treatment,SOD was lower than before treatment（ P〈 0. 01）,After treatment,in GSH group,SOD and GSH- Px were higher in the control group,and the difference was statistically significant（ P〈 0. 01）. Conclusion Reduced glutathione can effectively improve the oxidative stress and cardiac function in patients with acute myocardial infarction after PCI,and reduced glutathione has a significant cardioprotective effect.