维生素C对冠状动脉介入治疗患者近期预后的影响

目的 探讨术前静脉滴注抗氧化剂维生素C对接受择期经皮冠状动脉介入治疗(PCI)的冠状动脉粥样硬化性心脏病(CAD)患者围手术期心肌损伤和对比剂诱导的急性肾损伤(I-AKI)的影响。方法 532例接受PCI治疗的CAD患者按入院先后顺序随机分为2组：研究组（265例）于介入术前6h内开始维生索C3g入250 ml生理盐水中持续静脉点滴4～6h；对照组（267例）给予静脉滴注250 ml空白生理盐水。主要临床观察终点为PCI相关心肌梗死，次要观察终点为CI-AKI和血浆氧化物8-羟基-2-脱氧鸟苷水平。结果 研究组磷酸肌酸激酶同工酶(CK-MB)和肌钙蛋白(IcTnI)的最高水平都明显高于对照组。如以CK-MB为诊断标准，2组患者围手术期心肌梗死的发生率分别为6.8％比12.7％(P=0.021)；如以cTnI为诊断标准，2组患者围手术期心肌梗死的发生率分别为20.1％比28.8％ (P =0.020)。研究组均明显低于对照组。研究组CI-AKI的发生率也明显低于对照组（6.8％比12.4％，P=0.029）。研究组血浆中8-羟基-2-脱氧鸟苷的含量和浓度均明显低于对照组。Logistic多因素回归分析的结果显示，维生素C是围手术期心肌梗死（OR值0.66，95％可信区间0.38～0.91，P=0.017）和CI-AKI( OR值0.64，95％可信区间0.27～0.89，P=0.024）的独立保护因素。结论 择期PCI术前静脉滴注维生素C可以降低血浆中氧化物的氧化应激反应，明显减少PCI相关心肌梗死和术后CI-AKI的风险。

The effect of intravenous vitamin C infusion on short-term prognosis for patients undergoing elective percutanous coronary intervention

Objective To explore whether antioxidant vitamin C infusion before procedure is able to affect the incidences of periprocedural myocardial injury or contrast-induced acute kidney injury(CI-AKI) in patients undergoing percutaneous coronary intervention(PCI) for cardiovascular disease. Methods In this prospective, singlecenter, randomized study, 532 patients were randomized into two groups: the study group, which received 3 g Vitamin C infusion over 6 h before PCI; control group received normal saline. The primary endpoint was PCI related myocardial infarction (MI). The secondary endpoint was CI-AKI and the post-procedure level of 8-hydroxy-2-deoxyguanosine (8-OHdG). Results After PCI, the peak levels of CK-MB and cTnI in study group were both significantly lower than those of control group. The incidence of procedure-related MI was reduced based on CM-MB or cTnI compared with control group (CM-MB: 6.8％ vs 12.7％, P=0. 021; cTnI: 20. 1％ vs 28.8％, P =0.020).The CI-AKI was also significantly lower in study group compared with control group(6.8％ vs 12.4％, P =0.029).The post-procedure plasma value of 8-OHdG was significantly lower than that of control group. Logistic multivariate analysis showed that pre-procedure use of vitamin C was independent protective factor for both procedure-related MI and CI-AKI ( MI: OR 0. 66, 95％ CI 0. 38-0. 91, P = 0.017; CI-AKI: OR 0. 64, 95％ CI 0. 27-0.89, P =0.024). Conclusion In patients undergoing elective PCI, pre-procedure intravenous treatment of Vitamin C can reduce the oxidation reaction in the plasma, the injury of myocardium and the incidence of CI-AKI.