还原型谷胱甘肽对直接经皮冠脉介入术治疗的急性心肌梗死患者炎症反应的影响

Effects of Reduced Glutathione Infusion on Inflammatory Response in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

目的:探讨行直接经皮冠脉介入术(PPCI)的ST段抬高型心肌梗死(STEMI)患者手术前后给予还原型谷胱甘肽对烟酰胺腺嘌呤二核苷酸磷酸氧化酶(NOX)介导的炎症过程及血管内皮损伤的影响。方法:选取2019年10月至2021年11月于该院治疗的STEMI患者252例,根据随机数字表法分为还原型谷胱甘肽组和对照组,每组126例。还原型谷胱甘肽组患者在PPCI手术当日、术后第1—3日给予还原型谷胱甘肽静脉滴注治疗,剂量2.4 g/d,1日1次。对照组患者给予安慰剂治疗。比较PPCI术前及术后两组患者白细胞及亚型指标、氧化应激指标、炎症和内皮功能障碍指标及超声心动图指标水平。结果:术后5 d,还原型谷胱甘肽组患者中性粒细胞/淋巴细胞比值、超敏C反应蛋白(hs-CRP)、可溶性NOX衍生肽(sNOX-dp)、肿瘤坏死因子α(TNF-α)和心肌肌钙蛋白T水平较对照组显著降低,差异均有统计学意义(P<0.001)。随访第6个月时,还原型谷胱甘肽组患者左心室舒张末期容积、左心室收缩末期容积和左心室重塑较对照组显著降低,左心室射血分数较对照组显著升高,差异均有统计学意义(P<0.001)。sNOX-dp与TNF-α(r=0.052,P<0.001)呈正相关,与hs-CRP(r=-0.623,P=0.005)、一氧化氮(r=-0.316,P<0.001)呈负相关。结论:行PPCI的STEMI患者预防性给予还原型谷胱甘肽,能够保护心肌和内皮细胞免受有害的氧化和炎症环境影响,避免发生不良左心室重塑。

OBJECTIVE:To probe into the effects of reduced glutathione on inflammatory process and vascular endothelial damage mediated by nicotinamide adenine dinucleotide phosphate oxidase(NOX)in patients with ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).METHODS:A total of 252 patients with STEMI addmitted into the hospital from Oct.2019 to Nov.2021 were extracted to be divided into the reduced glutathione group and the control group via the random number table,with 126 cases in each group.The reduced glutathione group was treated with intravenous drip of reduced glutathione at a dose of 2.4 g/d once a day on the day of PPCI and from the 1 st to 3 rd day after PPCI.The control group was given placebo.The white blood cell and subtype indicators,oxidative stress indicators,inflammation and endothelial dysfunction indicators,and echocardiographic indicators were compared between two groups before and after PPCI.RESULTS:After 5 d of surgery,the neutrophil/lymphocyte ratio,high-sensitivity C-reactive protein(hs-CRP),soluble NOXderived peptide(sNOX-dp),tumor necrosis factor-α(TNF-α)and cardiac troponin T levels in the reduced glutathione group were significantly lower than those in the control group,with statistically significant differences(P<0.001).At the 6 th month of follow-up,the left ventricular end diastolic volume,left ventricular end systolic volume and left ventricular remodeling in the reduced glutathione group were significantly lower than those in the control group,and the left ventricular ejection fraction was significantly higher than those in the control group,with statistically significant difference(P<0.001).sNOX-dp was positively correlated with TNF-α(r=0.052,P<0.001),and negatively correlated with hs-CRP(r=-0.623,P=0.005)and nitric oxide(r=-0.316,P<0.001).CONCLUSIONS:Preventive infusion of reduced glutathione in STEMI patients undergoing PPCI can protect important myocardial components and endothelial cells from harmful pro-oxidative and inflammatory environments,and avoid adverse left ventricular remodeling.