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目的探讨急性心肌梗死(AMI)再灌注治疗联合高剂量极化液(GIK)持续静脉滴注对心肌损伤和细胞凋亡因子sFas和sFasL血清水平的影响。方法74例AMI患者再灌注后随机分为GIK组(35例)和非GIK组(39例),另设正常对照组(34例)。GIK组在接受再灌注后即刻予以高剂量GIK滴注24h。检测患者入组即刻、24h、3d、7d和14d血清sFas和sFasL水平。结果(1)AMI患者入组即刻血清sFas和sFasL水平明显高于正常对照组(P<0.01);(2)再灌注后GIK组和非GIK组血清sFas水平在24h显著降低(P<0.01),3～7d再次增高(P<0.01);(3)最为重要的发现是在14d时,sFas水平在GIK组明显降低(P<0.01),而非GIK组14d与7d比较差异无统计学意义;(4)血清sFasL水平在14d期间GIK组与非GIK组比较差异无统计学意义(P>0.05)。结论再灌注治疗联合高剂量GIK滴注明显降低AMI患者血清sFas水平,提示高剂量GIK可能通过减少缺血再灌注损伤实现对缺血心肌的保护作用。
Objective To investigate the effects of continuous intravenous infusion of acute myocardial infarction (AMI) reperfusion therapy combined with high-dose polar fluid (GIK) on myocardial injury and serum levels of sFas and sFasL. Methods 74 AMI patients were randomly divided into GIK group (n = 35) and non-GIK group (n = 39) after reperfusion. A normal control group (n = 34) was also established. GIK group received high-dose GIK infusion immediately after reperfusion. The levels of sFas and sFasL in serum were detected immediately, 24h, 3d, 7d and 14d. Results (1) Serum levels of sFas and sFasL in AMI patients were significantly higher than those in normal controls (P <0.01). (2) After reperfusion, serum sFas levels in GIK group and non-GIK group were significantly decreased at 24h (P <0.01). (3) The most important finding was that the level of sFas was significantly decreased in GIK group (P <0.01) on the 14th day, while there was no significant difference between the 14th and 7th day in non-GIK group ; (4) There was no significant difference in the levels of serum sFasL between GIK group and non-GIK group during 14 days (P> 0.05). Conclusion Reperfusion combined with high-dose GIK instillation significantly decreased serum sFas levels in AMI patients, suggesting that high-dose GIK may reduce ischemia-reperfusion injury to achieve the protection of ischemic myocardium.