Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Drugs R D. 2013 Sep;13(3):199-205. doi: 10.1007/s40268-013-0025-5.
Ischemia following acute myocardial infarction (AMI) increases the level of pro-fibrotic and inflammatory cytokines, including transforming growth factor (TGF)-β and tumor necrosis factor (TNF)-α. N-acetylcysteine (NAC) has therapeutic benefits in the management of patients with AMI. To the best of our knowledge, this is the first study that has evaluated the effect of NAC on TNF-α and TGF-β levels in patients with AMI.
Following confirmation of AMI, 88 patients were randomly administered NAC 600 mg (Fluimucil(®), Zambon, Ticino, Switzerland) or placebo orally twice daily for 3 days. For quantification of TGF-β and TNF-α serum levels after 24 and 72 h of NAC or placebo administration, peripheral venous blood (10 mL) samples were collected at these time points.
Comparisons between levels of TGF-β and TNF-α after 24 and 72 h within the NAC or placebo groups revealed that there was not any significant difference except for TGF-β levels in the placebo group, which increased significantly over time (p = 0.042). Significant relationships existed between patients' ejection fraction (p = 0.005) and TGF-β levels.
Receiving NAC could prevent TGF-β levels from increasing after 72 h as compared with not receiving NAC. As TGF-β had strong correlations with the ejection fraction, its antagonism seems to be important in the prevention of remodeling.
急性心肌梗死（AMI）后缺血会增加促纤维化和炎症细胞因子的水平，包括转化生长因子（TGF）-β和肿瘤坏死因子（TNF）-α。N-乙酰半胱氨酸（NAC）在 AMI 患者的治疗中有获益。据我们所知，这是第一项评估 NAC 对 AMI 患者 TNF-α和TGF-β水平影响的研究。
在确认 AMI 后，88 例患者被随机分为 NAC 组（口服 600mg Fluimucil®，Zambon，Ticino，瑞士）和安慰剂组，每天口服 2 次，连续 3 天。在 NAC 或安慰剂给药后 24 和 72 小时，采集外周静脉血（10mL）样本以定量检测 TGF-β和 TNF-α血清水平。
在 NAC 或安慰剂组中，24 小时和 72 小时时 TGF-β和 TNF-α水平之间的比较显示，除了安慰剂组的 TGF-β水平随时间显著增加（p=0.042）外，没有其他显著差异。患者射血分数（p=0.005）与 TGF-β水平之间存在显著关系。
与未接受 NAC 相比，接受 NAC 可防止 72 小时后 TGF-β水平升高。由于 TGF-β与射血分数有很强的相关性，其拮抗作用似乎对预防重构很重要。
