Shafiei Ebrahim, Bahtoei Mehrzad, Raj Pema, Ostovar Afshin, Iranpour Daryoush, Akbarzadeh Samad, Shahryari Hooshang, Anvaripour Abdorasoul, Tahmasebi Rahim, Netticadan Thomas, Movahed Ali
Department of Cardiology Department of Internal Medicine, Faculty of Medicine Biochemistry Group, the Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran Physiology and Pathophysiology, University of Manitoba Canadian Center for Agri-food Research in Health and Medicine, Winnipeg, Manitoba, Canada.
Medicine (Baltimore). 2018 Jul;97(30):e11383. doi: 10.1097/MD.0000000000011383.
This study assessed the efficacy of oral consumption of N-acetyl cysteine (NAC) and melatonin (ML) in reducing early reperfusion injury and acute oxidative stress in patients undergoing coronary artery bypass grafting (CABG) with respect to the measurements of cardiac troponin I, lactate, malondealdehyde (MDA), and tumor necrosis factor-α (TNF-α) levels in the blood.
This study was a randomized, open-label, placebo-controlled trial. Eighty eight patients, aged between 39 to 76 years and eligible for CABG, were recruited and randomly assigned into 3 intervention groups through a simple randomization method and underwent CABG surgery. Blood samples were withdrawn from arterial line, before the induction of anesthesia (before the start of surgery), after incision (before aortic cross-clamping), during global ischemia (during aortic cross-clamping), after aortic cross-clamping (on set of reperfusion), 15 minutes after reperfusion, and after recovery at the intense care unit. The blood samples were analyzed for troponin I, lactate, MDA and TNF-α levels.
There was no significant difference in influencing variables among the groups at the baseline. Overall mean troponin I, lactate, and TNF- α levels were significantly different between the intervention groups (all P < .001) at the recovery phase. Post-hoc pairwise comparisons showed that the differences of mean serum levels between ML and control groups were statistically significant for MDA, TNF- α, lactate, and troponin I (P < .001, P = .001, and P = .001, respectively). The differences between NAC and control groups and between ML and NAC groups were only significant for mean lactate level (P < .001).
The current study revealed that ML and NAC are potent antioxidants with similar efficacy in terms of reducing CABG related cardiac injury and oxidative stress with the dosage employed for the intervention.
本研究通过测量血液中心肌肌钙蛋白I、乳酸、丙二醛（MDA）和肿瘤坏死因子-α（TNF-α）水平，评估口服N-乙酰半胱氨酸（NAC）和褪黑素（ML）对接受冠状动脉搭桥术（CABG）患者早期再灌注损伤和急性氧化应激的疗效。
本研究为随机、开放标签、安慰剂对照试验。招募了88名年龄在39至76岁之间且符合CABG条件的患者，通过简单随机化方法将其随机分为3个干预组，并接受CABG手术。在麻醉诱导前（手术开始前）、切口后（主动脉交叉夹闭前）、全心缺血期间（主动脉交叉夹闭期间）、主动脉交叉夹闭后（再灌注开始时）、再灌注15分钟后以及在重症监护病房恢复后，从动脉导管采集血样。对血样进行肌钙蛋白I、乳酸、MDA和TNF-α水平分析。
各组在基线时影响变量无显著差异。在恢复阶段，干预组之间的总体平均肌钙蛋白I、乳酸和TNF-α水平有显著差异（所有P<0.001）。事后两两比较显示，ML组与对照组之间MDA、TNF-α、乳酸和肌钙蛋白I的平均血清水平差异具有统计学意义（分别为P<0.001、P=0.001和P=0.001）。NAC组与对照组之间以及ML组与NAC组之间仅平均乳酸水平差异显著（P<0.001）。
本研究表明，就所采用的干预剂量而言，ML和NAC是有效的抗氧化剂，在减少CABG相关心脏损伤和氧化应激方面具有相似的疗效。
