Exploration Of Myocardial Protection Of L-carnitine In Patients With Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

ObjectiveTo contrast the myocardial protection of different doses of L-carnitine(L-CN)injecttion in patients with Non-ST-elevation acute coronary syndrome(NSTE-ACS)undergoing percutaneous coronary intervention(PCI)and explore the relevance between the changes of plasma concentrations of carnitine and curative effect.Methods? From January 2015 to October 2016,120 standardized patients with NSTE-ACS undergoing PCI in Liaocheng People's Hospital enrolled this study.Among the patients,there were 72 males and 48 females,with average age 65.55±10.91 years old.All of the cases were randomized into control group and different doses of L-CN therapy groups(n=30).All groups were given conventional therapy including aspirin,clopidogrel,fluvastatin,metoprolol,nitrates and several drugs.Each therapy group was additionally given intravenous infusion of 2g,4g,6g L-CN injection,qd,for consecutive seven days;while control group was given 0.9% normal saline,qd,for consecutive seven days.All patients were performed the percutaneous coronary intervention in the third day after hospitalization.? The fasting venous blood of 120 patients were collected when they were on admission,preoperative coronary intervention and 8 hours,12 hours,24 hours after interventional therapy.The plasma concentration of MB isoenzyme of creatine kinase(CK-MB)and cardiac troponin I(cTnI)were measured by means of Chemiluminescence.The fasting venous blood of 120 patients were collected when they were on admission,preoperative coronary intervention and 4 hours,8 hours,12 hours,24 hours after interventional therapy.The plasma concentration of superoxide dismutase(SOD)and malondialdehyde(MDA)were measured by means of spectrophotometry and the plasma concentration of hypersensitive C reactive protein(hs-CRP)was measured by means of immunoturbidimetry.The fasting venous blood of 120 patients were collected when they were on admission and on the eighth day.The content of L-carnitine(LC),Acetyl-L-carnitine(ALC)and Propionyl-L-carnitine(PLC)were measured by high performance liquid chromatography(HPLC).All the datas before and after therapy were analysed by SPSS16.0 statistical software.Results? Compared with preoperative coronary intervention,the concentration of CK-MB,cTnI,hs-CRP and MDA in each group after interventional therapy were raised in different degree(P<0.05 or P<0.01).The CK-MB,cTnI,hs-CRP and MDA levels in plasma of the therapy group at the same point of time after operation were significantly lower than those of the control group and the differences were statistically significant(P<0.05 or P<0.01).? The concentration of SOD in each group was decreased in different degree and the level of SOD in L-CN therapy group was significantly higher than in control group during the same period after PCI(P<0.05 or P<0.01).? Compared with 2g/d L-CN therapy group and 4g/d L-CN therapy group,the level of each clinical index in 6g/d L-CN therapy group was obviously superior to two other therapy groups,meanwhile,the plasma level in 4g/d L-CN therapy group was obviously superior to 2g/d L-CN therapy group(P<0.05 or P<0.01).? There was a positive correlation between the plasma concentration of L-CN and the level of cTnI in each group before treatment and the correlation coefficient was0.8055,P < 0.01.Compared with prior treatment,the concentration of LC,acetyl-LC and propionyl-LC in control group after seven days of treatment were obviously decreased(P<0.05),while the concentration in therapy group were obviously raised(P<0.01).The plasma level of LC,acetyl-LC and propionyl-LC in therapy group were obviously higher than those in control group after seven days of treatment(P<0.01).ConclusionDifferent doses of L-carnitine injection which are given to Non-ST-elevation acute coronary syndrome patients undergoing percutaneous coronary intervention can evidently improve the level of CK-MB,cTnI,hs-CRP,MDA,SOD,especially 6g/d L-CN therapy group is more effective.The therapeutic effect was connected with the improvement of plasma concentration of carnitines,and the higher the blood concentration,the higher thetherapeutic effect.