Effect of allopurinol pretreatment on free radical generation after primary coronary angioplasty for acute myocardial infarction
Effect of allopurinol pretreatment on free radical generation after primary coronary angioplasty for acute myocardial infarction
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DOI：
10.1097/00005344-200305000-00005
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发表时间：
2003-05-01
影响因子：
3
通讯作者：
Okumura, K
中科院分区：
文献类型：
--
作者：
Guan, WP;Osanai, T;Okumura, K
别嘌呤醇是一种黄嘌呤氧化酶抑制剂，在动物模型中被证明可以改善冠状动脉闭塞和再灌注后的局部心室功能。研究了口服别嘌呤醇对急性心肌梗死（AMI）患者直接经皮腔内冠状动脉成形术（PTCA）后自由基生成短暂增加及其临床结局的影响。38例AMI患者随机分为对照组（第1组，n=20）和别嘌呤醇治疗组（第2组，n=18）。入院后立即口服别嘌呤醇（400 mg）（再灌注前约60 min）。通过连续测量PTCA后尿中8-表前列腺素F-2 α（PGF（2 α））的排泄来评估自由基的产生。在第1组中，在PTCA后60-90分钟，尿8-epi-PGF（2 α）排泄量与基线值相比增加了两倍。在第2组中，这种增加被完全抑制。第2组再灌注时血浆别嘌呤醇浓度为1，146 +/-55 ng/ml。第2组PTCA术后再通冠状动脉血流缓慢的发生率低于第1组。再灌注后即刻测定的心脏指数和PTCA术后6个月时的左室射血分数在组2中均显著大于组1，尽管两组的肺毛细血管楔压相似。结论：别嘌呤醇预处理可有效抑制再灌注治疗过程中氧自由基的产生，促进人左心室功能的恢复。
Allopurinol, an inhibitor of xanthine oxidase, was shown to improve the regional ventricular function after coronary artery occlusion and reperfusion in animal models. The effects of oral administration of allopurinol on a transient increase in free radical generation after primary percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and on their clinical outcomes were examined. Thirty-eight AMI patients undergoing primary PTCA were randomly assigned to control (group 1, n=20) and allopurinol treatment groups (group 2, n=18). Allopurinol (400 mg) was administered orally just after the admission (approximately 60 min before reperfusion). Free radical production was assessed by successive measurement of urinary excretion of 8-epiprostaglandin F-2alpha (PGF(2alpha)) after PTCA. Urinary 8-epi-PGF(2alpha) excretion was increased by twofold at 60-90 min after PTCA compared with the baseline value in group 1. This increase was completely inhibited in group 2. Plasma allopurinol concentration was 1,146+/-55 ng/ml in group 2 when reperfusion was achieved. Slow flow in the recanalized coronary artery after PTCA occurred less frequently in group 2 than in group 1. Cardiac index determined just after reperfusion and left ventricular ejection fraction at 6 months after PTCA were both significantly greater in group 2 than in group 1 although pulmonary capillary wedge pressure was similar in the two groups. In conclusion, allopurinol pretreatment is effective in inhibiting generation of oxygen-derived radicals during reperfusion therapy and the recovery of left ventricular function in humans.