评价粒细胞集落刺激因子对一氧化碳中毒患者的心脏保护作用。

Evaluation of the Cardioprotective Effect of Granulocyte Colony Stimulating Factor in Patients with Carbon Monoxide Poisoning.

机构信息

Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

Protein Pept Lett. 2021;28(5):589-601. doi: 10.2174/0929866527666201022112810.

DOI:10.2174/0929866527666201022112810

PMID:33092501

Abstract

BACKGROUND

Carbon monoxide (CO), which is well known as silent killer, has many toxic effects on organs with high rate of metabolism such as heart and brain. CO-induced cardiotoxicity resulted in a wide range of disabilities including electrocardiogram (ECG) abnormalities, elevation in level of cardiac enzymes, arrhythmias, impairment of left ventricular and myocardial infarction (MI). Cardio-protective effects of Granulocyte colony-stimulating factor (G-CSF) on infarcted heart was proved previously in various reports.

OBJECTIVE

In this study, possible effect of G-CSF on cardiac function of patients with moderate to severe acute CO poisoning was investigated.

METHODS

Cardioprotective effects of G-CSF in CO-poisoned patients was evaluated through ECG, Holter monitoring, echocardiography, and biochemical studies. Continuous intravenous infusion of G-CSF (90 μg/kg) and normal saline were administered respectively to treatment and placebo groups.

RESULTS

The results demonstrated that in moderate to severe CO poisoning, myocardial injury is common. ECG changes (e.g., ST-segment and T-wave changes, QTC), cardiac arrhythmias (e.g., heart blocks and ventricular arrhythmias), serum level of Troponin I, left ventricular ejection fraction were determined after G-CSF administration. Frequencies of ST depression, inversion or flatting of T wave and QTC in ECG were significantly reduced after G-CSF treatment. In addition, incidence of cardiac arrhythmias due to CO poisoning were reduced after G-CSF treatment. However, G-CSF did not exert protective effects on TPI level and function of left ventricular in CO-poisoned patients.

CONCLUSION

GCSF could probably reduce CO-induced cardiac ischemia in patients with acute CO poisoning.

CLINICAL TRIAL REGISTRATION

The trial protocol was registered in the Iranian Registry of Clinical Trials (http://www.irct.ir) registry (Irct ID: IRCT201607232083N7).

摘要

背景

一氧化碳（CO）是一种众所周知的“沉默杀手”，对新陈代谢率高的器官如心脏和大脑有许多毒性作用。CO 引起的心脏毒性导致广泛的残疾，包括心电图（ECG）异常、心脏酶水平升高、心律失常、左心室功能障碍和心肌梗死（MI）。以前的研究已经证明，粒细胞集落刺激因子（G-CSF）对梗死心脏有心脏保护作用。

目的

本研究旨在探讨 G-CSF 对中重度急性 CO 中毒患者心脏功能的影响。

方法

通过心电图、动态心电图监测、超声心动图和生化研究评估 G-CSF 对 CO 中毒患者的心脏保护作用。分别给予 G-CSF（90μg/kg）和生理盐水持续静脉滴注至治疗组和安慰剂组。

结果

结果表明，在中重度 CO 中毒中，心肌损伤很常见。心电图改变（如 ST 段和 T 波改变、QTC）、心律失常（如心脏传导阻滞和室性心律失常）、肌钙蛋白 I 血清水平、左心室射血分数在 G-CSF 给药后测定。ECG 中 ST 段压低、T 波倒置或平坦以及 QTC 的频率在 G-CSF 治疗后显著降低。此外，G-CSF 治疗后 CO 中毒引起的心律失常发生率降低。然而，G-CSF 对 CO 中毒患者的 TPI 水平和左心室功能没有保护作用。