Regitz V, Bossaller C, Strasser R, Müller M, Shug A L, Fleck E
Clinic for Internal Medicine/Cardiology, German Heart Institute, Berlin.
J Clin Chem Clin Biochem. 1990 Sep;28(9):611-7. doi: 10.1515/cclm.1990.28.9.611.
Severe tissue carnitine deficiency impairs fatty acid oxidation. In explanted hearts from patients with end stage heart failure a 57% carnitine decrease was found in comparison with healthy donor hearts (p less than 0.05). The reduction of myocardial carnitine levels affected all areas of the explanted hearts to a comparable extent. Carnitine decreases in patients with dilated cardiomyopathy or coronary artery disease were similar. Endomyocardial biopsies from patients with less severe heart failure due to cardiomyopathy (n = 28) or other myocardial diseases (n = 8) showed a 42% decrease of total myocardial carnitine (in nmol/mg non-collagen protein) in comparison with biopsies from patients with normal cardiac function (controls) (heart failure: 5.7, confidence interval 4.2-7.0; controls 9.3, confidence interval 7.6-12.0, p less than 0.005). Free myocardial carnitine in heart failure was also different from controls (heart failure: 4.2, confidence interval 3.7-5.3; controls 10.3, confidence interval 7.5-12.2, p less than 0.001). The decrease of free and total myocardial carnitine was comparable in dilated cardiomyopathy and heart failure due to other diseases. Alterations in myocardial carnitine content represent therefore non-specific biochemical markers in heart failure with yet unknown consequences for myocardial function.
严重的组织肉碱缺乏会损害脂肪酸氧化。在终末期心力衰竭患者的离体心脏中，与健康供体心脏相比，肉碱减少了57%（p<0.05）。心肌肉碱水平的降低对离体心脏的所有区域影响程度相当。扩张型心肌病或冠状动脉疾病患者的肉碱减少情况相似。因心肌病（n = 28）或其他心肌疾病（n = 8）导致心力衰竭程度较轻的患者的心肌内膜活检显示，与心功能正常的患者（对照组）的活检相比，总心肌肉碱（以nmol/mg非胶原蛋白计）减少了42%（心力衰竭组：5.7，置信区间4.2 - 7.0；对照组9.3，置信区间7.6 - 12.0，p<0.005）。心力衰竭患者的游离心肌肉碱也与对照组不同（心力衰竭组：4.2，置信区间3.7 - 5.3；对照组10.3，置信区间7.5 - 12.2，p<0.001）。在扩张型心肌病和其他疾病导致的心力衰竭中，游离和总心肌肉碱的降低情况相当。因此，心肌肉碱含量的改变代表了心力衰竭中的非特异性生化标志物，其对心肌功能的影响尚不清楚。
