左卡尼汀对行PCI术的糖尿病患者心肌保护作用的研究

目的探讨冠心病(CHD)合并2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)术前给予左卡尼汀(L-CN)对心肌损伤的保护作用。方法拟诊CHD合并T2DM并计划行冠状动脉造影的60例患者,随机分为两组,治疗组术前在标准治疗的基础上给予静脉滴注L-CN,对照组仅给予标准基础治疗。造影结果不适合行PCI治疗的病人被剔除,最终治疗组入选26例,对照组入选20例。所有患者术前及术后第24小时、1周测定心肌钙蛋白I(cTnI)和高敏CRP(hs-CRP)。结果总共46例患者PCI术后24小时和1周cTnI和hs-CRP均明显上升(P<0.01);但治疗组患者在术后24小时及术后1周血浆cTnI和hs-CRP水平均较对照组为低(P<0.05,P<0.01);直线相关分析显示,PCI术后24小时两组cTnI和hs-CRP水平显著正相关(r=0.75,P<0.01)。结论合并2型糖尿病的冠心病患者PCI治疗术后炎症反应和心肌损伤较为明显,PCI术前给予左卡尼汀可显著降低手术所致的心肌损伤,PCI引起的心肌坏死很可能与其触发的炎症反应有直接关系。

Study of Protective Effect of L-carnitine on Myocardial Injury Following Percutaneous Coronary Intervention in Diabetic and Coronary Heart Disease Patiens

Objective To evaluate the effect of pre-percutaneous coronary intervention(PCI)administration of L-carnitine on myocardial injury in cororary heart disease patients with diabetes.Methods 60 patients with diabetes and suspicious coronary heart disease who were successively recruited and planed to undergo coronary angiography in our hospital from January,2009 to October,2011 were randomly assigned into two groups,which included A group treated with L-carnitine on the basis of standrard therapy prior to intervention and the B group treated with only standrard therapy.Those who hadn’t underwent PCI for some reasons were excluded.Finally,46 patients were enrolled in this study,which included the L-carnitine group(26 patients) and the control group(20 patients).In all of the patients,cTnI and hs-CRP level were messured before PCI and also 24 hours and one week after PCI.Results The cTnI and the hs-CRP level in the total patients were significantly increased 24 hours and 1 week after PCI(P<0.01);The cTnI and the hs-CRP level 24 hours and 1 week after procedural in the therapy group were significantly lower than those in the control group(P<0.05).By using linear correlation analysis,it showed that the cTnI and the hs-CRP levels in both groups 24 hours after PCI were positively correlated significantly(r=0.75,P<0.01).Conclusions The inflammation and myocardial necrocytosis are evident in diabetic with CHD patients after PCI;Pre-procedual L-carnitine administration significantly reduces PCI-induced myocardial injury in diabetic with CHD patients;It may be concluded that one of the reasons of myocardial necrocytosis caused by PCI has much to do with the inflammation.