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谷胱甘肽钠盐与抗坏血酸联合治疗预防ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗中对比剂相关急性肾损伤:一项有待验证的假说

The Combined Treatment of Glutathione Sodium Salt and Ascorbic Acid for Preventing Contrast-Associated Acute Kidney Injury in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI: A Hypothesis to Be Validated.

作者信息

Arrivi Alessio, Truscelli Giovanni, Pucci Giacomo, Barillà Francesco, Carnevale Roberto, Nocella Cristina, Sordi Martina, Dominici Marcello, Tanzilli Gaetano, Mangieri Enrico

机构信息

Interventional Cardiology Unit, "Santa Maria" University Hospital, 05100 Terni, Italy.

Division of Cardiology, Bios Group, 00197 Rome, Italy.

出版信息

Antioxidants (Basel). 2023 Mar 22;12(3):773. doi: 10.3390/antiox12030773.

Abstract

The occurrence of Contrast-Associated Acute Kidney Injury (CA-AKI) in patients with ST-Elevation Myocardial Infarction (STEMI) has a negative impact on the length of hospital stay and mortality. Reactive Oxygen Species (ROS) release, along with vasoconstriction and hypoperfusion, play a key role in its development. To date, there is still no validated prophylactic therapy for this disease. The use of antioxidants, based on experimental and clinical studies, looks promising. Taking into consideration previous literature, we speculate that an early, combined and prolonged intravenous administration of both Glutathione (GSH) and ascorbic acid in STEMI patients undergoing primary Percutaneous Coronary Intervention (pPCI) may be of value in counteracting the occurrence of CA-AKI. We aimed at evaluating this hypothesis by applying a multicenter research protocol, using a double-blind randomized, placebo-controlled trial design. The primary endpoint will be to test the efficacy of this combined antioxidant therapy in reducing the occurrence of renal damage, in patients with acute myocardial infarction treated with pPCI. Furthermore, we will investigate the effect of the study compounds on changes in oxidative stress markers and platelet activation levels through bio-humoral analyses.

摘要

ST段抬高型心肌梗死(STEMI)患者中对比剂相关急性肾损伤(CA-AKI)的发生对住院时间和死亡率有负面影响。活性氧(ROS)释放以及血管收缩和灌注不足在其发展过程中起关键作用。迄今为止,对于这种疾病仍没有经过验证的预防性治疗方法。基于实验和临床研究,抗氧化剂的使用看起来很有前景。考虑到以往的文献,我们推测在接受直接经皮冠状动脉介入治疗(pPCI)的STEMI患者中,早期、联合且延长静脉输注谷胱甘肽(GSH)和抗坏血酸可能对抵消CA-AKI的发生有价值。我们旨在通过应用多中心研究方案,采用双盲随机、安慰剂对照试验设计来评估这一假设。主要终点将是测试这种联合抗氧化治疗在接受pPCI治疗的急性心肌梗死患者中减少肾损伤发生的疗效。此外,我们将通过生物体液分析研究受试化合物对氧化应激标志物变化和血小板活化水平的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc81/10045886/888f8fa42be1/antioxidants-12-00773-g001.jpg

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