大剂量维生素C对脓毒症患者心肌损伤的作用及机制

Effect of high-dose vitamin C on myocardial injury of patients with sepsis

目的探讨大剂量维生素C对脓毒症患者心肌损伤的治疗作用及可能的机制。方法将40例严重脓毒症后出现心肌损伤的患者随机均分为对照组及观察组,对照组给予常规剂量维生素C(2 g)经稀释后外周静脉输注,观察组给予大剂量维生素C(10 g)经稀释后外周静脉输注,均连用7 d,观察治疗前及治疗7 d后两组患者收缩压及心率的变化,同时比较外周血中肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)、B型脑钠尿肽(BNP)、血浆维生素C、丙二醛(MDA)及超氧化物歧化酶(SOD)的浓度差异。结果两组经治疗7 d后收缩压、血浆维生素C及SOD均较治疗前明显升高,心率、c Tn I、BNP及MDA均较治疗前明显降低(P均<0.05),且观察组升高和降低的幅度均显著高于对照组(P均<0.05),观察组在治疗7 d后血浆维生素C值趋于正常水平(50~70μmol/L)。CK-MB在两组间及治疗前后差异均无统计学意义(P均>0.05)。结论大剂量维生素C对脓毒症心肌损伤具有治疗作用,这种作用可能与其减轻氧化应激反应有关。

Objective To observe the therapeutic effect of high-dose vitamin C on myocardial injury of patients with sepsis and to explore its possible mechanism. Methods Forty patients with myocardial injury after severe sepsis were divided into the observation group and control group,In the observation group,vitamin C（ 10 g） was given intravenously for7 days. In the control group,vitamin C（ 2 g） was given intravenously for 7 days. The systolic blood pressure and heart rate were monitored on the first day and the eighth day,and we also observed the concentration changes of creatine kinase isoenzyme（ CK-MB）,troponin I（ c Tn I）,type B urine sodium peptide（ BNP）,vitamin C,malondialdehyde（ MDA）,and superoxide dismutase（ SOD） in the plasma at the two time points. Results The systolic blood pressure,vitamin C,and SOD significantly increased,while the heart rate,c Tn I,BNP,and MDA significantly decreased in both of the two groups after treatment of 7 days as compared with those before treatment（ all P〈0. 05）,meanwhile,in the observation group,the increasing and decreasing amplitude was significantly higher than that in the control group（ all P〈0. 05）. In the observation group,the concentration of vitamin C tended to normal lever [（ 50-70） μmol/L] after 7 days. No significant difference was found in the CK-MB between these two groups before and after treatment（ P〉0. 05）. Conclusions High-dose of vitamin C has protective effect on myocardial injury after sepsis by alleviating the oxidative stress.