乙酰半胱氨酸(NAC)对急性心衰中心肌细胞凋亡的影响作用探讨

Effect of N acetylcysteine on cardiomyocyte apoptosis in acute heart failure

目的针对乙酰半胱氨酸对急性心衰中心肌细胞凋亡的影响作用进行分析,为乙酰半胱氨酸在临床上的进一步合理应用提供参考依据。方法于2017年3月-2018年2月采用定群抽样法选取青海省心脑血管病专科医院心血管内科确诊的急性心衰患者,在征得所有入选受试者同意的基础上,采用不记名调查方式收集患者的基本人口学资料及流行病学特征资料,按照临床流行病学随机对照试验的设计原则设置实验组(A组)和安慰剂组(B组)。两组均给予强心药、血管扩张剂,同时行镇静、吸氧,并配合常规护理方案;A组前述干预手段的基础.上添加乙酰半胱氨酸;B组则采用安慰剂疗法(于预的所有形式与A组相同,但乙酰半胱氨酸替换为纯生理盐水,用法和用量同A组);于干预后直接抽血获得受试者血液样本,并提取相应DNA;采用lipofactamine3000将DNA转染至H9c2细胞中,显微镜下观察Hoechest染料染色细胞核形态,评估细胞凋亡情况;Logistic回归方法分析影响乙酰半胱氨酸作用心肌细胞凋亡的因素。结果本研究有效观察对象81例。实验组40例,安慰剂组41例,两组患者临床基线数据对比,差异无统计学意义(P>0.05):实验组中>20%细胞凋亡率患者比例低于安慰剂组,经卡方检验分析,差异有统计学意义(P<0.05);是否首次发病(OR=2.15,95%CI:1.25~4.99)、家族史.(OR=3.69,95%Cl:2.68~4.84)、高血糖(OR=4.72,95%CI:3.23~5.70)是乙酰半胱氨酸对急性心衰发生时细胞凋亡作用的影响因素。结论在常规急性心衰治疗方案的基础上添加乙酰半胱氨酸,可以对该疗法在改善细胞凋亡层面的疗效进行进一步提升,但若患者有急性心衰家族史、高血糖或为首次发病可能降低乙酰半胱氨酸在改善细胞凋亡层面的疗效。

Objective To analyze the effect of N-acetylcysteine(NAC)on cardiomyocyte apoptosis in acute heart failure.Methods 81 patients with heart failure underwent conventional treatment,such as cardictonic drug,vasodilators,oxygen uptake,sedation,etc.and were randomly divided into 2 demographically and epidemiologically not significantly differ-ent groups.Group A(n=40)underwent aerosol inhalation of 10%NAC sodium chloride solution 2~3 ml per 4~6 hours daily;and Group B(n=41)were given saline(placebo).One month later,blood samples were collected from their coro-nary arteri ies so as to extract the DNA to transfect H9c2 calls by Lipofectamine3000 reagent.Hoechest staining kit was used to analyze the apoptosis of the H9c2 calls.Results 0nly 12.5%of the Group A patients showed an H9c2 cell apop-tosis rate>20%,a percentage significantly lower than that of the Group B patients(34.14%,P<0.05).Conclusion Add-ing NAC into the treatment protoccl of conventional acute heart failure help increase the effect.Whether first onset(OR=2.15,95%CI:1.25~4.99),family history of acute heart failure(OR=3.69,95%CI:2.68~4.84)and hyperglycemia(OR=4.72,95%CI:3.23~5.70)were influencing factors on the effect of NAC on cardiomyocytes apoptosis.Conclusion Adding NAC into the treatment protocol for acute heart failure helps increase the clinical effect by lowering the level of apopto-sis.However,whether the first onset,family history of acute heart failure,and hyperglycemia may reduce the effect.