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Objective: To explore the peri-operative application of GLP-1 analogue and insulin on myocardial perfusion and clinical prognosis in patients of acute ST segment elevation myocardial infarction (STEMI) with stress-induced hyperglycemia. Methods: Our research was a prospective single center randomized control study. A total of 114 consecutive STEMI patients received percutaneous coronary intervention (PCI) within 12h of onset were enrolled, the patients had no diabetes while blood glucose ≥11.1mmol/L at immediate admission. Based on random number table, the patients were divided into 2 groups: Observation group, the patients received GLP-1 analogue, n=59 and Control group, the patients received insulin, n=55. The post-operative myocardial perfusion, indicators of myocardial damage and cardiac function, myocardial infarct area (MIA) and myocardial salvage index (MSI) were compared between 2 groups. The patients were followed-up for 6 months to record the incidence of major adverse cardiovascular events (MACE). Results: At peri-operative period, compared with Control group, Observation group had decreased peak values of creatine kinase isoenzyme (CK-MB) and troponin T (cTnT), P<0.05. At 6 months post-operation, compared with Control group, Observation group showed increased myocardial perfusion and left ventricular ejection fraction (LVEF), P<0.05, reduced MIA (15±12) g vs (20±14) g, P<0.05 and 12% elevated MSI as (0.64±0.13) vs (0.56±0.12), P<0.001. The MACE incidence was similar between 2 groups, P=0.217. Conclusion: In STEMI patients with stress-induced hyperglycemia, peri-operative application of GLP-1 analogue may safely regulate blood glucose, improve cardiac perfusion and function, reduce MIA; while it had no influence on myocardial perfusion at peri-operative period and no impact on MACE occurrence at 6 months post-operation.
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Objective To systematically review the efficacy of glutamine enriched nutrition support for patients with severe acute pancreatitis (SAP).Methods Database including PubMed,Embase,HighWire,Cochrane Central Register of Controlled Trials,Wanfang Database,CJFD and CBM were searched with glutamine,severe acute pancreatitis,SAP,谷氨酰胺,重症急性胰腺炎.Literatures published before March 2014 were searched.Randomized controlled trials containing the comparison of conventional treatment and glutamine enriched nutrition support were enrolled in the study,and then the literatures were screened and the data were extracted by 2 independent reviewers.The quality of the literatures was assessed,and the data were analyzed using the RevMan 5.2 software.SAP was diagnosed according to The revised Atlanta classificantion for acute pancreatitis or guideline for the diagnosis and treatment of SAP which was composed by the pancreatic surgery Branch of Chinese Medical Association.The count data were analyzed using the relative risk (RR) and 95％ confidence interval (95％ CI),and the measurement data were analyzed using standard mean difference (SMD) and 95 ％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Ten literatures including 433 cases were enrolled in the study,and all of them were prospective randomized controlled studies.There were 218 patients treated by conventional methods (control group) and 215 patients received glutamine enriched nutrition support (experimental group).Compared with the control group,glutamine enriched nutrition support could elevate the albumin level,decrease the C-reaction protein level and shorten the hospital stay in the experimental group (SMD=1.00,-0.93,-0.71,95％CI:0.50-1.50,-1.25--0.61,-1.10--0.32,P＜0.05),glutamine enriched nutrition support could decrease the morbidity and mortality (RR =0.56,0.34,95％ CI:0.41-0.77,0.15-0.76,P ＜ 0.05) without increasing the expenses (SMD =0.03,95％ CI:-0.88-0.95,P ＞ 0.05).Conclusion Glutamine enriched nutrition support is superior to conventional methods for the treatment of SAP.
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@#Objective To observe the effect of ischemic postconditioning on myocyte apoptosis in hyperlipemia rats with myocardial ischemic reperfusion.Methods Total forty-eight hyperlipemia SD rats were randomly divided into the sham-operation group, ischemic reperfusion group and ischemic postconditioning group with 16 rats in each group. The myocardial ischemic reperfusion model of rat was made. Rats in the ischemic reperfusion group were ligated for 40 min ischemia, and then reperfused for 240 min. Rats in the ischemic postconditioning group were treated for 40 min ischemia, reperfused for 10 s and 10 s ischemia for three cycles, and then reperfused for 240 min. Rats in the sham-operation group were opened the chest to braid for ringer without deligation. The presence of apoptotic myocytes was detected by the method of terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL). Meanwhile, the serum creatine kinase activity and myocardial infarct size were measured.Results The creatine kinase activity was 734.86±25.48 U/L in the ischemic postconditioning group and 967.64±28.16 U/L in the ischemic reperfusion group after reperfusion, all significantly higher than that (274.28±16.94 U/L) in the sham-operation group ( P<0.05), and it was significantly lower in the ischemic postconditioning group than that in the ischemic reperfusion group ( P<0.05). There was no significant difference in ratio of myocardial ischemic size and left ventricle after reperfusion between the ischemic postconditioning group and the ischemic reperfusion group. But the ratio of myocardial necrotic size and ischemic size of the ischemic postconditioning group was 24.8%±6.7% and significantly lower than that (38.2%±7.1%) of the ischemic reperfusion group ( P<0.05). No apoptotic myocardial cells were found after the reperfusion in the sham-operation group. The apoptotic rate in the ischemic postconditioning group (12.7%±2.8%) was significantly lower than that (20.9%±3.7%) in the ischemic reperfusion group ( P<0.05).Conclusion Ischemic postconditioning can relieve the ischemic reperfusion injury in hyperlipemia rats, the mechanism of which may be related with decreased myocardial apoptosis.