大剂量维生素C对脓毒症患者心肌损伤的作用及机制

摘要

目的 探讨大剂量维生素C对脓毒症患者心肌损伤的治疗作用及可能的机制.方法 将40例严重脓毒症后出现心肌损伤的患者随机均分为对照组及观察组,对照组给予常规剂量维生素C(2 g)经稀释后外周静脉输注,观察组给予大剂量维生素C(10 g)经稀释后外周静脉输注,均连用7 d,观察治疗前及治疗7 d后两组患者收缩压及心率的变化,同时比较外周血中肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、B型脑钠尿肽(BNP)、血浆维生素C、丙二醛(MDA)及超氧化物歧化酶(SOD)的浓度差异.结果 两组经治疗7 d后收缩压、血浆维生素C及SOD均较治疗前明显升高,心率、cTnI、BNP及MDA均较治疗前明显降低(P均<0.05),且观察组升高和降低的幅度均显著高于对照组(P均<0.05),观察组在治疗7 d后血浆维生素C值趋于正常水平(50～70μmol/L).CK-MB在两组间及治疗前后差异均无统计学意义(P均>0.05).结论 大剂量维生素C对脓毒症心肌损伤具有治疗作用,这种作用可能与其减轻氧化应激反应有关.%Objective To observe the therapeutic effect of high-dose vitamin C on myocardial injury of patients with sepsis and to explore its possible mechanism .Methods Forty patients with myocardial injury after severe sepsis were di-vided into the observation group and control group , In the observation group , vitamin C (10g) was given intravenously for 7 days.In the control group, vitamin C (2g) was given intravenously for 7 days.The systolic blood pressure and heart rate were monitored on the first day and the eighth day , and we also observed the concentration changes of creatine kinase isoenzyme (CK-MB), troponin I (cTnI), type B urine sodium peptide (BNP), vitamin C, malondialdehyde (MDA), and superoxide dismutase (SOD) in the plasma at the two time points.Results The systolic blood pressure, vitamin C, and SOD significantly increased , while the heart rate , cTnI, BNP, and MDA significantly decreased in both of the two groups after treatment of 7 days as compared with those before treatment (all P<0.05), meanwhile, in the observation group, the increasing and decreasing amplitude was significantly higher than that in the control group (all P<0.05).In the observation group, the concentration of vitamin C tended to normal lever [(50-70) μmol/L] after 7 days.No signifi-cant difference was found in the CK-MB between these two groups before and after treatment (P>0.05).Conclusions High-dose of vitamin C has protective effect on myocardial injury after sepsis by alleviating the oxidative stress .