Akut ST Segment Elevasyonlu Miyokard İnfarktüsü Geçiren N-asetil sistein uygulanan hastalarda oksidatif stres ve QT dispersiyonu ilişkisi
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Date
2006-08-04
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Uludağ Üniversitesi
Abstract
Çalışmanın amacı, miyokard infarktüsünde ek tedavi olarak, N-asetil sisteinin (NAS) oksidatif stres, infarkt büyüklüğü ve QT dispersiyonu üzerine olan etkisinin değerlendirilmesidir. Akut miyokard infarktüsü (Mİ) geçiren hastalar, streptokinaz ile birlikte 24 saat süreyle intravenöz infüzyon şeklinde 15 gram N-asetil sistein alanlar (n=15) ve almayanlar (n=15) şeklinde iki gruba ayrıldı. Oksidatif stresin değerlendirilmesi için kabulde, 4 saatte ve 24. saatte plazma malondialdehid (MDA) düzeyleri ölçüldü. Tüm hastaların başlangıçta, 4. ve 24. saatte 50 mm/sn ile 12 derivasyonlu elektrokardiyografileri çekilerek QT dispersiyonları ve “Bazett” formülü ile hıza göre düzeltilmiş QT dispersiyonları hesaplandı. Reperfüzyonun değerlendirilmesi için koroner anjiyografi yapıldı. Kabulde her iki grup arasında plazma MDA düzeyleri arasında farklılık yoktu. N-asetil sistein ile tedavi edilen hastalarda, plazma MDA düzeyleri azalırken, NAS ile tedavi edilmeyen hastalarda, plazma MDA düzeyleri 4. saat ve 24. saatte artış gösterdi (sırasıyla p=0.001 ve p=0.0001). 24. saatte NAS alan hastalarda, NAS almayan hastalara göre, QT dispersiyonu (p=0,04) ve hıza göre düzeltilmiş QT dispersiyonunun yüzde değişiminde (p=0.03) anlamlı olarak azalma izlendi. NAS tedavisi, iskemi reperfüzyon sırasında lipid peroksidasyonunu ve sonucunda QT dispersiyonunu anlamlı olarak azaltabilmektedir
The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment, as an adjunct therapy in myocardial infarction on oxidative stress, infarct size and dispersion of QT. Patients with acute myocardial infarction received either 15 mgc of NAC infused intravenously over 24 hours (n=15) or no NAC (n=15), combined along with streptokinase. In order to assess the oxidative stres, plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 hours. For all patients, QT dispersion (QTd) and Bazett rate corrected QTc dispersion (QTcd) were measured from a high quality 12 lead ECG recorded at 50 mm/s on admission, at 4 and 24 hours. Coronary angiography were performed to assess reperfusion. At admission, plasma MDA levels were not different between the groups. In the NAC treated patients percent plasma MDA changes according to the baseline decreased whereas in the NAC non-treated patients percent MDA changes increased at 4 and 24 hours (p=0.001 and p=0.0001, respectively). Significant decreases in the percent QTd (p=0,04) and QTcd (p=0.03) period changes were observed in patients treated with NAC compaired to patients treated without NAC at 24 hours. N-acetylcysteine treatment reduces lipid peroxidation during ischemia and reperfusion and decreases QT dispersion.
The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment, as an adjunct therapy in myocardial infarction on oxidative stress, infarct size and dispersion of QT. Patients with acute myocardial infarction received either 15 mgc of NAC infused intravenously over 24 hours (n=15) or no NAC (n=15), combined along with streptokinase. In order to assess the oxidative stres, plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 hours. For all patients, QT dispersion (QTd) and Bazett rate corrected QTc dispersion (QTcd) were measured from a high quality 12 lead ECG recorded at 50 mm/s on admission, at 4 and 24 hours. Coronary angiography were performed to assess reperfusion. At admission, plasma MDA levels were not different between the groups. In the NAC treated patients percent plasma MDA changes according to the baseline decreased whereas in the NAC non-treated patients percent MDA changes increased at 4 and 24 hours (p=0.001 and p=0.0001, respectively). Significant decreases in the percent QTd (p=0,04) and QTcd (p=0.03) period changes were observed in patients treated with NAC compaired to patients treated without NAC at 24 hours. N-acetylcysteine treatment reduces lipid peroxidation during ischemia and reperfusion and decreases QT dispersion.
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Keywords
N-asetil sistein, QT dispersiyonu, Miyokard infarktüsü, Malondialdehid, N-acetylcysteine, Dispersion of QT, Myocardial infarction, Malondialdehyde
Citation
Şentürk, T. vd. (2006). "Akut ST Segment Elevasyonlu Miyokard İnfarktüsü Geçiren N-asetil sistein uygulanan hastalarda oksidatif stres ve QT dispersiyonu ilişkisi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 32(1), 29-34.