接受搭桥手术患者的左心室功能与氧化应激之间的关系。
Relation between left ventricular function and oxidative stress in patients undergoing bypass surgery.
作者信息
De Vecchi E, Pala M G, Di Credico G, Agape V, Paolini G, Bonini P A, Grossi A, Paroni R
机构信息
Department of Laboratory Medicine, IRCCS H San Raffaele, Milan, Italy.
出版信息
Heart. 1998 Mar;79(3):242-7. doi: 10.1136/hrt.79.3.242.
OBJECTIVE
To determine whether preoperative left ventricular ejection fraction (LVEF) is related to the degree of myocardial oxidative stress during bypass surgery in man.
DESIGN
Observational study.
SETTING
Tertiary care centre.
PATIENTS AND INTERVENTIONS
31 patients (LVEF range was 20% to 68%) undergoing elective coronary bypass surgery with blood cardioplegic reperfusion were studied. Arterial and coronary sinus blood was collected before aortic cross clamping (T0) and at 0 (T1), 15 (T2), and 30 (T3) minutes after unclamping. Transmural left ventricular biopsies were also obtained from 15 patients at T0 and at T1.
MAIN OUTCOME MEASURES
Glutathione and adenine nucleotides were measured in myocardial biopsies, while coronary sinus-artery differences for glutathione, nucleotides, and products of lipid peroxidation were calculated from blood specimens. Creatine kinase (myocardial band; CK-MB) was measured in plasma at four and 12 hours after operation.
RESULTS
Myocardial glutathione and adenine nucleotides were correlated (p < 0.02) with preoperative LVEF both at T0 (r = 0.909 and 0.672) and T1 (r = 0.603 and 0.605). Oxidised glutathione released from the heart during reperfusion was inversely correlated with LVEF (r = -0.448, -0.466, and -0461 at T1, T2, and T3, p < 0.01), while reduced glutathione (r = 0.519 and 0.640 at T1 and T2) and glutathione redox ratio (r = 0.647, 0.714, 0.645, and 0.702 at T0, T1, T2, and T3) showed a direct correlation (p < 0.01). Lipid peroxidation at T1 was negatively related to LVEF (r = -0.492). CK-MB was also negatively related to LVEF (r = -0.440 at 4 h and -0.462 at 12 h).
CONCLUSIONS
The capacity to counterbalance oxidative burst following ischaemia and reperfusion appears to be related to the functional ability of the heart.
目的
确定术前左心室射血分数（LVEF）是否与人冠状动脉搭桥手术期间心肌氧化应激程度相关。
设计
观察性研究。
地点
三级医疗中心。
患者及干预措施
对31例行择期冠状动脉搭桥手术并采用血液停搏液再灌注的患者（LVEF范围为20%至68%）进行研究。在主动脉阻断前（T0）以及开放阻断后0（T1）、15（T2）和30（T3）分钟采集动脉血和冠状窦血。还在T0和T1时从15例患者获取透壁左心室活检组织。
主要观察指标
测定心肌活检组织中的谷胱甘肽和腺嘌呤核苷酸，同时根据血标本计算冠状窦 - 动脉之间谷胱甘肽、核苷酸和脂质过氧化产物的差异。术后4小时和12小时测定血浆中的肌酸激酶（心肌带；CK - MB）。
结果
在T0（r = 0.909和0.672）和T1（r = 0.603和0.605）时，心肌谷胱甘肽和腺嘌呤核苷酸均与术前LVEF相关（p < 0.02）。再灌注期间心脏释放的氧化型谷胱甘肽与LVEF呈负相关（T1、T2和T3时r分别为 - 0.448、 - 0.466和 - 0.461，p < 0.01），而还原型谷胱甘肽（T1和T2时r分别为0.519和0.640）和谷胱甘肽氧化还原比（T0、T1、T2和T3时r分别为0.647、0.714、0.645和0.702）呈正相关（p < 0.01）。T1时的脂质过氧化与LVEF呈负相关（r = - 0.492）。CK - MB也与LVEF呈负相关（4小时时r = - 0.440，12小时时r = - 0.462）。
结论
缺血再灌注后对抗氧化爆发的能力似乎与心脏的功能能力有关。
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