α-硫辛酸对合并2型糖尿病的急性冠状动脉综合征患者心脏的保护作用

Cardioprotective effects of α-lipoic acid in patients with acute coronary syndrome complicated with type 2 diabetes mellitus

目的探讨α-硫辛酸对合并2型糖尿病的急性冠状动脉综合征患者的心脏保护作用及可能的机制。方法选择2014年5月1日至2017年4月30日在首都医科大学附属北京世纪坛医院心内科住院的急性冠状动脉综合征伴2型糖尿病的患者220例,按随机数字表法分为对照组和研究组。研究组在对照组的基础上给予硫辛酸静脉注射1周。比较两组患者不同时间点的氧化损伤指标超氧化物歧化酶(superoxide dismutase,SOD)、高敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)及氧化型低密度脂蛋白(oxidized low-den-sity lipoprotein,OX-LDL)、空腹血糖浓度及胰岛素抵抗水平(homeostatic model assessment for insulin resistance,HOMA-IR)、心肌损伤程度(肌钙蛋白I)和心功能[左心室射血分数(left ventricular ejection fraction,LVEF)]情况。结果经过7 d的α-硫辛酸干预,与对照组比较,研究组SOD浓度更高、hs-CRP浓度更低、HOMA-IR更低、LVEF更高,且两组比较差异均有统计学意义(P<0.01);但治疗后两组患者空腹血糖、OX-LDL和肌钙蛋白I浓度比较,差异无统计学意义(P>0.05)。结论α-硫辛酸可下调急性冠状动脉综合征合并2型糖尿病的患者急性期的氧化损伤,改善HOMA-IR,减轻心肌损伤,保护心功能。

Objectives To investigate the protective effect of α-lipoic acid on heart in patients with acute coronary syndromes （ACS） complicated with type 2 diabetes mellitus and its possible mechanism. Methods Totally 220 patients with ACS complicated type 2 diabetes were selected. All the patients were randomly divided into control group and study group. Patients in study group were given α-lipoic acid intravenous infusion for 1 week on the basic treatment of control group. Concentrations of superoxide dismutase （SOD） , high-sensitivity C-reactive protein （hs-CRP） , oxidized low-density lipoprotein （OX-LDL） SOD, fasting blood glucose and homeostatic model assessment for insulin resistance （ HOMA- IR）, myocardial injury [ cardiac troponin I （ cTnI ） ] and cardiac function [ left ventricular ejection fraction （LVEF） ] were compared between the two groups at different time points. Results Concentration of SOD, LVEF in study group were higher, concentration of hs-CRP, HOMA-IR were lower than those in control group （P〈 0.01）. There were no significant differences in fasting blood glucose, OX-LDL and cTnI between the two groups （P〉 0.05）. Conclusions α-Lipoic acid reduces oxidative level in patients with ACS complicated with type 2 diabetes mellitus, improves insulin resistance, and reduces myocardial damage.