丙氨酰谷氨酰胺对急性ST段抬高型心肌梗死患者PCI术后心功能的影响分析  

Influence of alanyl-glutamine on heart function in patients with acute ST-segment elevation myocardial infarction after PCI

作　　者：鲍宏刚 赵冰 左惠荣[3] 徐志勇[1] 苏芳菊 张玲玲[1] Bao Honggang;Zhao Bing;Zuo Huirong;Xu Zhiyong;Su Fangju;Zhang Lingling(Department of Cardiovascular Medicine,Air Force Hospital,Chinese PLA Central Theater,Datong 037000,China;不详)

机构地区：[1]中国人民解放军中部战区空军医院心血管内科,大同037000 [2]中国人民解放军总医院第七医学中心心内科,北京100000 [3]中国人民解放军陆军厦门特勤疗养中心,厦门361005 [4]中国人民解放军联勤保障部队940医院心内科,兰州4730000

出　　处：《中国循证心血管医学杂志》2021年第3期354-357,361,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨丙氨酰谷氨酰胺对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心功能的影响及可能机制分析。方法纳入2015年10月至2018年10月于中部战区空军医院心内科行急诊PCI的STEMI患者60例为研究对象,按随机数字表法分为对照组(n=30)和观察组(n=30)。对照组患者采用STEMI常规治疗药物,观察组在对照组的基础上于术前及术后按0.5 g/kg体重静滴注射用丙氨酰谷氨酰胺,1/d,持续14 d。两组患者于术前、术后7 d、术后14 d抽血运用全自动生化分析仪检测N末端B型脑钠肽前体(NT-proBNP)水平;双抗体夹心ELISA法检测血清热休克蛋白70(HSP70)浓度;采用比色法测血清中丙二醛(MDA)、超氧化物歧化酶(SOD)含量。HD15型彩色多普勒超声诊断仪检查左心室射血分数(LVEF)及二尖瓣舒张早期血流峰值(E)/二尖瓣舒张晚期血流峰值(A)变化。分析比较两组患者术前、术后7 d、术后14d NT-proBNP水平、HSP70浓度、SOD、MDA含量、LVEF、E/A比值变化情况。结果术前,两组患者LVEF、E/A、血浆NT-proBNP、血清HSP70、SOD、MDA比较,差异均无统计学意义(P>0.05)。与术前相比,两组患者PCI术后7 d、14 d LVEF、E/A升高,而血浆NTproBNP下降,差异均有统计学意义(P<0.05);与术前相比,对照组PCI术后7 d、14 d,血清HSP70浓度较术前下降,差异有统计学意义(P<0.05),观察组血清HSP70浓度较术前升高,差异有统计学意义(P<0.05);与术前相比,两组患者PCI术后7 d、14 d血清SOD含量较术前均升高,差异有统计学意义(P<0.01),而血清MDA含量下降,差异有统计学意义(P<0.05)。与对照组相比,观察组PCI术后7 d、14 d LVEF、E/A升高,而血浆NT-proBNP降低,差异均有统计学意义(P<0.05);与对照组相比,观察组PCI术后7 d、14 d血清HSP70、SOD浓度升高,而血清MDA含量下降,差异均有统计学意义(P<0.05)。相关性分析结果表明:血清HSP70、SOD浓度与LVEF、E/A呈正相关(P<0.01),与�Objective To investigate the influence of alanyl-glutamine(Ala-Gln)on heart function in patients with acute ST-segment elevation myocardial infarction(STEMI)after PCI,and analyze possible mechanism.Methods STEMI patients undergone PCI(n=60)were chosen from Department of Cardiovascular Medicine in Air Force Hospital of Chinese PLA Central Theater from Oct.2015 to Oct.2018,and divided randomly into control group and observation group(each n=30).The control group was treated with routine drugs for STEMI,and observation group was additionally treated with intravenous drip of Ala-Gln(0.5 g/kg)once a day for 14 d before and after PCI.Before PCI and after PCI for 7 d and 14 d,the level of plasma NT-proBNP was detected by using automatic biochemical analyzer,concentration of heat shock protein 70(HSP70)was detected by using double antibody sandwich ELISA,content of MDA and SOD were detected by using chromatoptometry,and changes of LVEF and mitral early diastolic peak(E)/late diastolic peak(A,E/A)were detected by using color Doppler ultrasonic diagnostic apparatus HD15 in 2 groups.The level of NT-proBNP,HSP70 concentration,SOD and MDA content and changes of LVEF and E/A were analyzed and compared in 2 groups before PCI and after PCI for 7 d and 14 d.Results Before PCI,LVEF,E/A,NT-proBNP,HSP70,SOD and MDA had no statistical significance between 2 groups (P>0.05). After PCI for 7 d and 14 d, LVEF and E/A increased and NT-proBNP decreased in 2 groups(P<0.05). The concentration of serum HSP70 decreased in control group (P<0.05) and increased in observationgroup (P<0.05) after PCI for 7 d and 14 d. After PCI for 7 d and 14 d, SOD increased (P<0.01) and MDA decreased(P<0.05) in 2 groups. After PCI for 7 d and 14 d, LVEF and E/A increased and NT-proBNP decreased inobservation group compared with control group (P<0.05). After PCI for 7 d and 14 d, HSP70 and SOD increased andMDA decreased in in observation group compared with control group (P<0.05). The results of correlation analysisshowed that HSP70 and SOD were positively corre

关 键 词：急性ST段抬高性心肌梗死 心肌缺血再灌注 丙氨酰谷氨酰胺 自由基 

分 类 号：R544.22[医药卫生—心血管疾病]