Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China.
Department of Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China.
Oxid Med Cell Longev. 2020 Jun 26;2020:1241065. doi: 10.1155/2020/1241065. eCollection 2020.
Myocardial reperfusion damage after severe ischemia was an important issue during a clinical practice. However, the exacted pathogenesis involved remained unclear and also lacks effective interventions. Melatonin was identified to exert protective effects for alleviating the myocardial I/R injury. This meta-analysis was determined to evaluate the efficacy of melatonin treatment against reperfusion insult and further summarize potential molecular and cellular mechanisms.
15 eligible studies with 211 animals (108 received melatonin and 103 received vehicle) were included after searching the databases of PubMed, MEDLINE, Embase, and Cochrane. Pretreatment with melatonin was associated with a significant lower infarct size in comparison with vehicle in myocardial I/R damage (WMD: -20.45, 95% CI: -25.43 to -15.47, < 0.001; = 91.4%, < 0.001). Evidence from subgroup analyses and sensitivity analysis indicated the robust and consistent cardioprotective effect of melatonin, while the metaregression also did not unmask any significant interactions between the pooled estimates and covariates (i.e., sample size, state, species, study type, route of administration, and duration of reperfusion, along with timing regimen of pretreatment). Accordingly, melatonin evidently increased EF (WMD: 17.19, 95% CI: 11.08 to 23.29, < 0.001; = 77.0%, < 0.001) and FS (WMD: 14.18, 95% CI: 11.22 to 17.15, < 0.001; = 3.5%, = 0.387) in the setting of reperfusion damage.
Melatonin preadministration conferred a profound cardioprotection against myocardial I/R injury in preclinical studies.
严重缺血后的心肌再灌注损伤是临床实践中的一个重要问题。然而，其确切的发病机制仍不清楚，也缺乏有效的干预措施。褪黑素已被证明具有保护作用，可以减轻心肌 I/R 损伤。本荟萃分析旨在评估褪黑素治疗对抗再灌注损伤的疗效，并进一步总结潜在的分子和细胞机制。
通过搜索 PubMed、MEDLINE、Embase 和 Cochrane 数据库，共纳入了 15 项符合条件的研究，涉及 211 只动物（108 只接受褪黑素治疗，103 只接受载体治疗）。与载体相比，褪黑素预处理与心肌 I/R 损伤时的梗死面积显著减小（WMD：-20.45，95%CI：-25.43 至-15.47，<0.001； = 91.4%，<0.001）。亚组分析和敏感性分析的证据表明，褪黑素具有稳健一致的心脏保护作用，而荟萃回归也没有揭示出汇总估计值和协变量之间存在任何显著的相互作用（即样本量、状态、物种、研究类型、给药途径和再灌注持续时间，以及预处理的时间方案）。因此，褪黑素明显增加了 EF（WMD：17.19，95%CI：11.08 至 23.29，<0.001； = 77.0%，<0.001）和 FS（WMD：14.18，95%CI：11.22 至 17.15，<0.001； = 3.5%， = 0.387）在再灌注损伤的情况下。
在临床前研究中，褪黑素预处理对心肌 I/R 损伤具有显著的心脏保护作用。
