内皮祖细胞治疗心肌梗死后心力衰竭患者心肌酶及能量代谢的改变

目的应用粒细胞集落刺激因子（granulocyte colony-stimulating factor,G-CSF）动员内皮祖细胞（endo-thelial progenitor cells,EPCs）治疗心肌梗死后心力衰竭患者,研究其对心肌组织中超氧化物歧化酶（superoxide dis-mutase,SOD）活性、脂质过氧化物（lipid peroxidation,LPO）、丙二醛（malondialdehyde,MDA）及心肌能量代谢的影响。方法选取38例心肌梗死患者,入院后均接受心肌梗死的常规治疗,随机分成治疗组和对照组。治疗组除常规治疗外还给予动员剂G-CSF（450μg/d）皮下注射,连续注射5天。检测两组治疗前、治疗后第3、7、14、28天外周血EPCs数量;于治疗前、治疗后1个月检测两组SOD、LPO、MDA含量,并行心脏超声检测左心室射血分数（left ventricular ejectionfraction,LVEF）等左心室心功能指标,应用相关公式计算左心室收缩末圆周室壁应力（circumferential end-systolic wallstress,cESS）、心肌能量消耗（myocardial energy expenditure,MEE）。结果治疗组的EPCs数量较治疗前及对照组增加明显,于第7天达到峰值,增加有统计学意义（P〈0.01）;两组患者治疗后心肌能量代谢均好转,心肌组织中SOD活性提高,LPO、MDA生成减少,LVEF升高,cESS下降,MEE水平降低,心功能得到改善,治疗组改善优于对照组,差异有统计学意义（P〈0.05）。结论应用G-CSF动员EPCs治疗心肌梗死后心力衰竭患者,EPCs具有保护缺血心肌,增强SOD活性,抑制LPO、MDA的生成,降低心肌耗氧,有效改善心脏功能的作用。

Impact of Endothelial Progenitor Cells on Myocardial Enzyme and Energy Metabolism of Patients with Heart Failure after Myocardial Infarction

Objective To study the changes of myocardial enzyme and energy metabolism in patients with heart failure after myocardial infarction treated by granulocyte colony stimulating factor. Methods A total of 38 patients with myocardial infarction were randomly divided into treatment group and control group.All patients received conventional treatment(medication and interventional therapy),and treatment group underwent additional G-CSF mobilization injection(450 μg/day) for 5 days.Plasma EPC number in the peripheral blood was detected before treatment and 3,7,14 and 28 days after treatment.Cardiac function was evaluated by ultrasonic imaging before treatment and 1 month after treatment.Left ventricular circumferential end systolic wall stress(cESS) and myocardial energy expenditure(MEE) were calculated by the corresponding formula. Results The EPC number in the treatment group increased more than that in the control group,especially at 7 days after treatment(P<0.01).After treatment the myocardial energy metabolism level was improved,SOD activity was increased,LPO,MDA formation decreased,left ventricular ejection fraction(LVEF) increased,cESS and MEE decreased in both groups.The improvement of treatment group was better than that in the control group(P<0.05). Conclusion EPCs mobilized by G-CSF can protect ischemic myocardium,increase SOD activity,inhibit the formation of LPO and MDA,reduce the myocardial consumption of oxygen,and effectively improve the heart function of patients with heart failure after myocardial infarction.