左卡尼汀对体外循环下冠状动脉旁路移植术患者hs-CRP和同型半胱氨酸水平的影响  

Effects of L-carnitine on serum high-sensitivity C-reactive protein and homocysteine in patients undergoing coronary artery bypass grafting

作　　者：黎明[1] 刘军辉[2] 闫炀[1] 王海晨[1] 李勇新[1] 易秋月 王锐利[3] 李雯 薛丽[4] LI Ming;LIU Jun-hui;YAN Yang;WANG Hai-chen;LI Yong-xin;YI Qiu-yue;WANG Rui-li;LI Wen;XUE Li(Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China;Department of Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China;Department of Geriatrics Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China;Department of Laboratory, The Second Affiliated Hospital of Xi'an Jiaotong University、Xi'an 710004, China)

机构地区：[1]西安交通大学第一附属医院心血管外科,西安710061 [2]西安交通大学第一附属医院检验科,西安710061 [3]西安交通大学第二附属医院老年神经内科,西安710004 [4]西安交通大学第二附属医院检验科,西安710004

出　　处：《世界临床药物》2019年第4期277-282,共6页World Clinical Drug

基　　金：国家自然科学基金项目(编号:81500219);陕西省社会发展科技攻关项目(编号:2016SF-217)

摘　　要：目的评价围手术期静滴左卡尼汀对体外循环下冠状动脉旁路移植术(coronary artery bypass grafting,GABG)患者血清高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)和同型半胱氨酸(homocysteine,HCY)水平的影响。方法选择在我科接受体外循环下GABG治疗的62例冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAD)患者,按随机数表法均分为两组,各31例。观察组在围手术期静脉滴注左卡尼汀,对照组静滴等量生理盐水。两组患者均于术前1 h,主动脉开放后2 h,6 h,24 h和48 h采静脉血,检测其血清hs-CRP和HCY水平。结果术前及主动脉开放后2 h,两组患者血清hs-CRP水平的差异均无统计学意义(均P> 0.05);且术前两组间血清HCY水平的差异也无统计学意义(P>0.05);主动脉开放后6 h,24 h和48 h时,观察组血清hs-CRP水平较对照组显著降低,且差异均有统计学意义(均P <0.001);主动脉开放后2 h,6 h,24 h和48 h,观察组血清HCY水平也较对照组显著降低,且差异也均有统计学意义(均P <0.01)。且各组血清hs-CRP水平和HCY水平在不同时间点的差异也均有统计学意义(均P <0.001);两组患者术前血清hs-CRP和HCY水平均较低,但在主动脉开放后其血清hs-CRP水平和HCY水平逐渐升高,且血清hs-CRP水平和HCY水平分别于主动脉开放48及24 h时达其峰值(均P <0.001)。结论对体外循环下行GABG的患者围手术期予以左卡尼汀静滴,可明显降低其血清hs-CRP和HCY水平,这可能与其具有心肌保护作用有关。Objective To investigate the effect of intravenous drip of L-carnitine during perioperative period on serum hs-CRP and HCY in patients undergoing coronary artery bypass grafting(CABG) operation. Methods A total of 62 patients undergoing CABG operation under cardiopulmonary bypass(CPB) were recruited in the study. All these patients were randomly divided into the control group and the observation group. The patients were given an intravenous drip of L-carnitine in the observation group while the equal amount of normal saline was given to the patients in the control group during perioperative period. Venous blood was collected from each patient 1 h before the surgery and at 2 h, 6 h, 24 h, and48 h after unclamping the aorta, then serum levels of hs-CRP and HCY were detected. Results There was no significant difference in serum hs-CRP level between the two groups before the operation and at 2 h after unclamping the aorta(P>0.05). No significant difference was also observed in serum HCY level between the two groups before the operation(P>0.05). The level of serum hs-CRP was lower in the observation group than that of the control group at 6 h, 24 h, and 48 h after unclamping the aorta(P<0.001). The level of serum HCY was lower in the observation group than that of the control group at 2 h, 6 h, 24 h, and 48 h after unclamping the aorta(P<0.01). The levels of serum hs-CRP and HCY were relative low in both the two groups before the operation, and after unclamping the aorta serum hs-CRP and HCY were gradually increased in both the two groups. The level of serum hs-CRP reached its peaks at 48 h while serum HCY reached its peaks at 24 h after unclamping the aorta in both the two groups(P<0.001). Conclusion Intravenous drip of L-carnitine during perioperative period could effectively control CPB-induced postoperative inflammatory response and myocardial injury in patients undergoing CABG operation. The myocardial protection of L-carnitine may be associated with its ability to reduce serum levels of hs-CRP and HCY in patient

关 键 词：左卡尼汀 体外循环 冠状动脉旁路移植术 高敏C反应蛋白 同型半胱氨酸 

分 类 号：R541.4[医药卫生—心血管疾病] R977.9[医药卫生—内科学]