高剂量极化液对心肌梗死患者细胞凋亡因子的影响

目的探讨急性心肌梗死(AMI)再灌注治疗联合高剂量极化液(GIK)持续静脉滴注对心肌损伤和细胞凋亡因子sFas和sFasL血清水平的影响。方法74例AMI患者再灌注后随机分为GIK组(35例)和非GIK组(39例),另设正常对照组(34例)。GIK组在接受再灌注后即刻予以高剂量GIK滴注24h。检测患者入组即刻、24h、3d、7d和14d血清sFas和sFasL水平。结果(1)AMI患者入组即刻血清sFas和sFasL水平明显高于正常对照组(P<0.01);(2)再灌注后GIK组和非GIK组血清sFas水平在24h显著降低(P<0.01),3～7d再次增高(P<0.01);(3)最为重要的发现是在14d时,sFas水平在GIK组明显降低(P<0.01),而非GIK组14d与7d比较差异无统计学意义;(4)血清sFasL水平在14d期间GIK组与非GIK组比较差异无统计学意义(P>0.05)。结论再灌注治疗联合高剂量GIK滴注明显降低AMI患者血清sFas水平,提示高剂量GIK可能通过减少缺血再灌注损伤实现对缺血心肌的保护作用。

Effects of high dose glucose-insulin-potassium infusion on myocardial injury and serum sFas/ sFasL concentration in acute myocardial infarction

Objective This study was designed to evaluate reperfusion therapy, co-administered with high dose glucose-insulin-potassium(GIK) treatment on serum soluble Fas/APO-1 (sFas) and Fas ligand (sFasL) concentration in Acute Myocardial Infarction(AMI) patients. Methods Seventy-four patients with AMI underwent reperfusion therapy were randomized into GIK group (n=35) receiving high-dose GIK for 24 hours or a vehicle group (n=39). Thirty-four control subjects (NC) were also enrolled in the present study. Strepavidin-biotin ELISA was used to determine the serum sFas and sFasL concentration at baseline and different time point (24 h, 3 d, 7 d and 14 d) after reperfusion. Results (1)The serum concentration of sFas and sFas-L ([sFas] and [sFas-L]) of AMI patients were significantly elevated at baseline as compared with NC (P<0.01). (2) The [sFas] in GIK and non-GIK group decreased 24 h after reperfusion (P<0.01 vs. baseline) and then increased during 3-7 d period (P<0.01 vs. 24 h). (3) The GIK group demonstrated reduced [sFas] at 14 d (P<0.01 vs. 7 d), with no concomitant changes in the non-GIK group.(4) The [sFasL] in the GIK and non-GIK group were no significant difference during (3-14 d) period. Conclusion Owing to cardioprotective effects reported here and by others, a high-dose GIK infusion co-administered with the timely establishment of perfusion should be strongly considered as a treatment of choice for AMI.