左卡尼汀对不稳定型心绞痛患者ox-LDL的影响及其抗氧化抗炎作用

王世勋 邱立彬 郝军强 郑佳辉 张新才 邵静波 赵鲁艳

【摘要】 目的：观察左卡尼汀对不稳定型心绞痛患者氧化低密度脂蛋白（ox-LDL）的影响及其抗氧化抗炎中的作用，以明确左卡尼汀在不稳定型心绞痛治疗的作用机制。方法：选取2016年12月-2017年12月在潍坊市人民医院心血管内科住院并符合不稳定型心绞痛诊断标准的患者120例为研究对象，随机分为对照组58例和观察组62例。对照组采取冠心病常规治疗用药，观察组在对照组的基础上加用左卡尼汀口服液治疗，以90 d为一个治疗周期，观察两组患者治疗前后的血清学指标。结果：治疗前，两组患者血清TC、TG、LDL-C、HDL-C、ox-LDL、MDA、GSH-Px、hs-CRP、IL-6、TNF-α水平比较，差异均无统计学意义（P>0.05）。治疗后，两组的血清TC、LDL-C、ox-LDL水平均降低（P<0.05），两组TC、LDL-C比较差异均无统计学意义（P>0.05）;观察组ox-LDL水平低于对照组（P<0.05）。治疗后，观察组HDL-C水平升高（P<0.05）。治疗后，两组的血清MDA均降低、且观察组低于对照组（P<0.05），治疗后两组血清GSH-Px均升高，且观察组高于对照组（P<0.05）。治疗后，两组的血清hs-CRP、IL-6、TNF-α均降低，且观察组均低于对照组（P<0.05）。结论：左卡尼汀可以有效地改善不稳定型心绞痛患者血清ox-LDL，并提高抗氧化酶的活性，从而使得机体的抗氧化能力得到提高、脂质过氧化反应降低，对不稳定型心绞痛治疗起到促进作用。

【關键词】 不稳定型心绞痛 氧化低密度脂蛋白 左卡尼汀 氧化应激

Effect of Levocarnitine on ox-LDL in Patients with Unstable Angina Pectoris and Its Antioxidant and Anti-inflammatory Effects/WANG Shixun， QIU Libin， HAO Junqiang， ZHENG Jiahui， ZHANG Xincai， SHAO Jingbo， ZHAO Luyan. //Medical Innovation of China， 2021， 18（07）： 0-022

[Abstract] Objective： To observe the effect of Levocarnitine on oxidized low density lipoprotein （ox-LDL） and its role in oxidative anti-inflammation in patients with unstable angina， in order to clarify the mechanism of Levocarnitine in the treatment of unstable angina. Method： A total of 120 patients who met the diagnostic criteria of unstable angina pectoris admitted to the Department of Cardiology of Weifang Peoples Hospital from December 2016 to December 2017 were selected as the research subjects， they were randomly divided into observation group of 62 cases and control group of 58 cases. The control group was treated with routine treatment of coronary heart disease. The observation group was treated with Levocarnitine oral solution on the basis of the control group， with 90 days as a treatment week.In the second phase， the levels of ox-LDL， blood lipids and serum GSH-Px， MDA， hs-CRP， IL-6 and TNF-a in the two groups were observed before and after treatment. Result： Before treatment， there were no statistical significance in the levels of serum TC， TG， LDL-C， HDL-C， ox-LDL， MDA， GSH-Px， hs-CRP， IL-6 and TNF-α between two groups （P>0.05）. After treatment， the levels of serum TC， LDL-C and ox-LDL in both groups were decreased （P<0.05）， and there were no statistical significance in TC and LDL-C between the two groups （P>0.05）， the level of ox-LDL in observation group was lower than that in control group （P<0.05）. After treatment， the level of HDL-C in observation group was increased （P<0.05）. After treatment， the serum MDA in both groups decreased， and the observation group was lower than the control group （P<0.05）. After treatment， serum GSH-Px increased in both groups， and the observation group was higher than the control group （P<0.05）. Conclusion： Levocarnitine can effectively improve serum ox-LDL， reduce serum lipid levels， and increase the activity of antioxidant enzymes in patients with unstable angina， so as to improve the bodys antioxidant capacity， reduce lipid peroxidation， and promote the treatment of unstable angina.

[Key words] Unstable angina Ox-LDL Levocarnitine Oxidative stress

First-authors address： Weifang Peoples Hospital， Weifang 261041， China

doi：10.3969/j.issn.1674-4985.2021.07.005

动脉粥样硬化是由于血管内脂质沉积、巨噬细胞浸润、斑块内部出血等原因引发巨噬细胞发生凋亡、细胞发生氧化应激反应从而导致细胞纤维帽变薄、破裂并沉积于动脉壁。其中，冠状动脉粥样硬化性心脏病，简称冠心病，是动脉粥样硬化发生于冠脉血管并引发心脏疾患，有效的抗动脉粥样硬化，对冠心病的治疗息息相关，且可以有效改善动脉粥样硬化所造成的不稳定型心绞痛等临床表现。

伴随对动脉粥样硬化及冠心病发病机制及治疗药物研究的不断深入，近年来研究发现左卡尼汀又称为左旋肉碱，可以促进脂肪酸的β-氧化，从而提高心肌细胞内ATP含量，以达到改善心肌细胞能量代谢、提高心功能的作用，已被应用于抗心力衰竭的治疗中，且治疗效果显著。然而……