左卡尼汀对非ST 段抬高型急性冠脉综合征介入术后患者心肌保护作用的探讨

曹媛媛，刘卫涛，梁世宏，汪磊，单金姣，薛玉增

（聊城市人民医院心内科，山东 聊城，252000）

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摘要：

目的 探究不同剂量左卡尼汀（L-CN）注射液对非ST 段抬高型急性冠脉综合征（NSTE-ACS）患者经皮冠脉介入（PCI） 治疗后的心肌保护作用及卡尼汀群在患者体内的代谢变化。方法 选择符合纳入标准并均在入院后第3天行PCI治疗的 NSTE-ACS患者120例，随机分为四组：对照组及不同剂量L-CN治疗组，每组30例。所有患者给予常规治疗，L-CN 治疗各组在常规治疗基础上分别给予2、4 及6 g/d L-CN 连续静脉输注7 d。比较各组术前、术后肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）、血清超氧化物岐化酶（SOD）、丙二醛（MDA）、高敏C-反应蛋白（hs-CRP）的浓度变化，并采用高效液相色谱法（HPLC）检测患者体内卡尼汀群的代谢变化。结果 术后各组血浆CK-MB、cTnI、hs-CRP、MDA 水平均有不同程度升高，治疗各组血浆CK-MB、cTnI、hs-CRP、MDA水平在术后相同时间点均明显低于对照组（P<0.05 或P<0.01）。术后各组SOD水平均有不同程度降低，治疗组SOD水平显著高于同期对照组（P<0.05 或P<0.01）。6 g/d L-CN 治疗组各指标水平均明显优于另外两治疗组（P<0.05 或P<0.01）。治疗7 d 后，治疗组血浆L-CN、ALC、PLC浓度均显著高于治疗前及对照组同期水平（P<0.01）。治疗前各组血浆L-CN 浓度与cTnI水平呈正相关（r=0.8055，P<0.01）。结论 不同剂量L-CN注射液用于NSTE-ACS 患者PCI术后的治疗，可提高患者体内卡尼汀群的血药浓度，明显改善CK-MB、cTnI、hs-CRP、MDA、SOD 等临床指标，对患者心肌具有有效的保护作用，尤以6 g/d L-CN 疗效最佳。

关键词：左卡尼汀（L-CN）；乙酰左卡尼汀（ALC）；丙酰左卡尼汀（PLC）；非ST 段抬高型急性冠脉综合征；介入治疗；高效液相 色谱法

中图分类号：R542 文献标志码：A文章编号：2096-1413(2017)27-0006-04

Exploration the myocardial protection of L-carnitine in patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention
CAO Yuan-yuan, LIU Wei-tao, LIANG Shi-hong, WANG Lei, SHAN Jin-jiao, XUE Yu-zeng


(Department of Cardiology, Liaocheng People``s Hospital, Liaocheng 252000, China)

ABSTRACT: Objective To explore the myocardial protection of different doses of L-carnitine (L-CN) injection in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) and the metabolism of carnitines in patients`` body. Methods According to the inclusion criteria, 120 patients with NSTE -ACS undergoing PCI in the third day after hospitalization were selected, and they were randomly divided into control group and different doses of L-CN therapy groups, with 30 cases in each group. All the patients were given conventional therapy and each therapy group was additionally given intravenous infusion of 2, 4, 6 g/d L-CN for 7 days. The concentration of CK-MB, cTnI, hs-CRP, MDA and SOD were detected before and after PCI, and the metabolic changes of carnitines was measured by high performance liquid chromatography (HPLC). Results The levels of CK-MB, cTnI, hs-CRP and MDA in each group after PCI increased, and the levels of those indexes in the therapy groups were significantly lower than those in the control group (P＜0.05 or P＜0.01). The levels of SOD in each group after PCI decreased, and those in the therapy groups were significantly higher than those in the control group (P＜0.05 or P<0.01). The levels of each clinical indexs in 6 g/d L-CN therapy group were obviously superior to those in the other two therapy groups (P＜0.05 or P＜0.01). The levels of L-CN, ALC and PLC in therapy groups were obviously higher than those before treatment and those in the control group after 7 days of the treatment (P<0.01). There was a positive correlation between the concentration of L-CN and cTnI in each group before treatment (r=0.8055, P＜0.01). Conclusion Different doses of L-CN injection which are given to NSTE-ACS patients undergoing PCI can increase the concentration of carnitines and evidently improve the level of CK-MB, cTnI, hs-CRP, MDA, SOD, especially 6 g/d L-CN therapy is more effective.
KEYWORDS: L-carnitine; acetyl-l-carnitine (ALC); propionyl-l-carnitine (PLC); non-ST-elevation acute coronary syndrome (NSTE-ACS); percutaneous coronary intervention (PCI); high performance liquid chromatography (HPLC)

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