Davies S W, Ranjadayalan K, Wickens D G, Dormandy T L, Umachandran V, Timmis A D
Cardiac Department, London Chest Hospital.
Br Heart J. 1993 Feb;69(2):114-20. doi: 10.1136/hrt.69.2.114.
Experimental data suggest that reperfusion injury involving free radicals contributes to the impairment of left ventricular function after successful thrombolysis.
In 72 patients presenting with acute myocardial infarction, markers of free radical activity were measured before streptokinase and two hours later. Thiobarbituric acid reactive material (TBA-RM) reflects lipid peroxidation by free radicals, and the concentration of plasma total thiols (34 patients) reflects oxidative stress. Coronary arteriography was performed at 18-72 hours after thrombolysis to determine coronary patency, and left ventricular function was assessed by ventriculography and from QRS scoring of the electrocardiogram.
The infarct related artery was patent (Thrombolysis In Myocardial Infarction Trial grade 2 or better) in 60 (83%) and occluded in 12. In the 60 with a patent artery, the concentration of TBA-RM increased after streptokinase by (mean (SD)) 9.2 (14.0) nmol/g albumin, whereas in the 12 with an occluded artery TBA-RM decreased by 7.0 (11.3) nmol/g albumin (p < 0.01 between groups). In those with a patent artery the rise in TBA-RM associated with thrombolysis correlated with left ventricular ejection fraction (R = -0.41, p < 0.002), and with the QRS score (R = +0.38, p = 0.003). Plasma total thiol concentrations decreased by 12.7 (31.1) mumol/l in those with a patent artery, and this decrease associated with thrombolysis correlated with left ventricular ejection fraction (R = +0.39, p < 0.02) but not with the QRS score (R = -0.2, NS).
These findings suggest that reperfusion injury mediated by free radicals may be of clinical importance in humans.
实验数据表明，涉及自由基的再灌注损伤会导致溶栓成功后左心室功能受损。
对72例急性心肌梗死患者，在使用链激酶前及两小时后测量自由基活性标志物。硫代巴比妥酸反应物质（TBA-RM）反映自由基引起的脂质过氧化，血浆总硫醇浓度（34例患者）反映氧化应激。溶栓后18至72小时进行冠状动脉造影以确定冠状动脉通畅情况，并通过心室造影和心电图QRS评分评估左心室功能。
梗死相关动脉通畅（心肌梗死溶栓试验2级或更好）的有60例（83%），闭塞的有12例。在60例动脉通畅的患者中，链激酶治疗后TBA-RM浓度平均（标准差）增加9.2（14.0）nmol/g白蛋白，而在12例动脉闭塞的患者中，TBA-RM浓度下降7.0（11.3）nmol/g白蛋白（两组间p<0.01）。在动脉通畅的患者中，与溶栓相关的TBA-RM升高与左心室射血分数相关（R=-0.41，p<0.002），与QRS评分相关（R=+0.38，p=0.003）。动脉通畅患者的血浆总硫醇浓度下降12.7（31.1）μmol/l，与溶栓相关的这种下降与左心室射血分数相关（R=+0.39，p<0.02），但与QRS评分无关（R=-0.2，无显著性差异）。
这些发现表明，自由基介导的再灌注损伤在人类中可能具有临床重要性。
