1，6－二磷酸果糖对冠脉搭桥病人有心肌保护的作用（附原文）
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（Anesth Analg 2004;98:20-29）报道最新研究发现，对于进行冠脉搭桥的患者，在缺血前给予FDP可以明显改善其心脏功能，减轻围手术期的缺血性损伤。
英国学者Riedel BJ博士指出，以往研究表明，作为一种葡萄糖代谢的中间产物，1，6－FDP（FDP）能通过提高高能磷酸水平来改善缺血组织的损伤。因此，研究人员推测其可能对体外循环冠脉搭桥术的患者有心肌保护作用。
为此，研究人员探讨了5种不同剂量FDP对CABG患者的作用。
结果发现，5种浓度的FDP中，3种无效，1种改善了心功能，1种因为产生代谢性酸中毒而需要调整剂量。患者在术前静脉注射250mg∕kg，术中追加2.5mM（n＝15），这些患者再灌注后2，4，6小时，血浆肌酐浓度低（p<0.05），很少发生术后心梗（p<0.05），术后心功能得到改善，表现为再灌注6，12和16小时后（p<0.01）更高的左心室收缩指数（LVSWI），和再灌注12和16小时后更高的CI（p<0.05）。
统计分析的结果表明，FDP处理组的CI和 LVSWI明显升高，而CK-MB水平明显降低。综合分析表明FDP对CABG手术患者有心肌保护作用，并且支持以往的实验室和临床关于FDP对缺血性心脏病作用的研究结果。
Riedel博士认为， FDP可以在乏氧的情况下升高高能磷酸的水平，因此能够减轻缺血损伤。他指出，对于冠状动脉搭桥术病人，在缺血前给予FDP可以明显的改善心脏功能，减弱围手术期的缺血性损伤，而且，这种保护作用可以改善病人的预后。
Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial
In vitro and in vivo studies suggest that fructose-1,6-diphosphate (FDP), an intermediary glycolytic pathway metabolite, ameliorates ischemic tissue injury through increased high-energy phosphate levels and may therefore have cardioprotective properties in patients undergoing coronary artery bypass graft (CABG) surgery. We designed a randomized, placebo-controlled, double-blinded, sequential-cohort, dose-ranging safety study to test 5 FDP dosage regimens in patients (n = 120; 60 FDP, 60 control) undergoing CABG surgery. Of these dosage regimens, 3 produced no benefit, 1 produced improved cardiac function, and 1 required adjustment as a result of metabolic acidosis. This suggests that we achieved the intended effect of a dose-ranging study. The expected response was observed in patients treated with 250 mg/kg FDP IV before surgery and 2.5 mM FDP as a cardioplegic additive (n = 15). These patients had lower serum creatine kinase-MB levels 2, 4, and 6 h after reper fusion (P < 0.05), fewer perioperative myocardial infarctions (P < 0.05), and improved postoperative cardiac function, as evidenced by higher left ventricular stroke work index (LVSWI) 6, 12, and 16 h (P < 0.01) and cardiac index (CI) at 12 and 16 h (P < 0.05) after reperfusion. Overall efficacy of FDP was tested across all regimens that included IV FDP (n = 88; 44 FDP, 44 control) using 2 (FDP versus placebo) x 3 (dose size) factorial analyses. Area-under-curve (AUC) analysis demonstrated a significant increase in CI (AUC-16h, P = 0.013) and LVSWI (AUC-16h, P = 0.003) and reduction in CK-MB levels (AUC-16h, P < 0.05) in FDP-treated patients. The internal consistency of this dataset suggests that FDP may provide myocardial protection in CABG surgery and supports previous laboratory and clinical studies of FDP in ischemic heart disease.
IMPLICATIONS: Fructose-1,6-diphosphate (FDP) may increase high-energy phosphate levels under anaerobic conditions and therefore ameliorate ischemic injury. A dose-ranging safety study for FDP was conducted in patients undergoing coronary artery surgery. Preischemic provision of FDP significantly improved cardiac function and reduced perioperative ischemic injury. These myocardial protective effects may improve patient outcome after cardiac surgery.
Anesth Analg 2004;98:20-29
并给战友们提供原文以参考！详见原文！！
英国学者Riedel BJ博士指出，以往研究表明，作为一种葡萄糖代谢的中间产物，1，6－FDP（FDP）能通过提高高能磷酸水平来改善缺血组织的损伤。因此，研究人员推测其可能对体外循环冠脉搭桥术的患者有心肌保护作用。
为此，研究人员探讨了5种不同剂量FDP对CABG患者的作用。
结果发现，5种浓度的FDP中，3种无效，1种改善了心功能，1种因为产生代谢性酸中毒而需要调整剂量。患者在术前静脉注射250mg∕kg，术中追加2.5mM（n＝15），这些患者再灌注后2，4，6小时，血浆肌酐浓度低（p<0.05），很少发生术后心梗（p<0.05），术后心功能得到改善，表现为再灌注6，12和16小时后（p<0.01）更高的左心室收缩指数（LVSWI），和再灌注12和16小时后更高的CI（p<0.05）。
统计分析的结果表明，FDP处理组的CI和 LVSWI明显升高，而CK-MB水平明显降低。综合分析表明FDP对CABG手术患者有心肌保护作用，并且支持以往的实验室和临床关于FDP对缺血性心脏病作用的研究结果。
Riedel博士认为， FDP可以在乏氧的情况下升高高能磷酸的水平，因此能够减轻缺血损伤。他指出，对于冠状动脉搭桥术病人，在缺血前给予FDP可以明显的改善心脏功能，减弱围手术期的缺血性损伤，而且，这种保护作用可以改善病人的预后。
Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial
In vitro and in vivo studies suggest that fructose-1,6-diphosphate (FDP), an intermediary glycolytic pathway metabolite, ameliorates ischemic tissue injury through increased high-energy phosphate levels and may therefore have cardioprotective properties in patients undergoing coronary artery bypass graft (CABG) surgery. We designed a randomized, placebo-controlled, double-blinded, sequential-cohort, dose-ranging safety study to test 5 FDP dosage regimens in patients (n = 120; 60 FDP, 60 control) undergoing CABG surgery. Of these dosage regimens, 3 produced no benefit, 1 produced improved cardiac function, and 1 required adjustment as a result of metabolic acidosis. This suggests that we achieved the intended effect of a dose-ranging study. The expected response was observed in patients treated with 250 mg/kg FDP IV before surgery and 2.5 mM FDP as a cardioplegic additive (n = 15). These patients had lower serum creatine kinase-MB levels 2, 4, and 6 h after reper fusion (P < 0.05), fewer perioperative myocardial infarctions (P < 0.05), and improved postoperative cardiac function, as evidenced by higher left ventricular stroke work index (LVSWI) 6, 12, and 16 h (P < 0.01) and cardiac index (CI) at 12 and 16 h (P < 0.05) after reperfusion. Overall efficacy of FDP was tested across all regimens that included IV FDP (n = 88; 44 FDP, 44 control) using 2 (FDP versus placebo) x 3 (dose size) factorial analyses. Area-under-curve (AUC) analysis demonstrated a significant increase in CI (AUC-16h, P = 0.013) and LVSWI (AUC-16h, P = 0.003) and reduction in CK-MB levels (AUC-16h, P < 0.05) in FDP-treated patients. The internal consistency of this dataset suggests that FDP may provide myocardial protection in CABG surgery and supports previous laboratory and clinical studies of FDP in ischemic heart disease.
IMPLICATIONS: Fructose-1,6-diphosphate (FDP) may increase high-energy phosphate levels under anaerobic conditions and therefore ameliorate ischemic injury. A dose-ranging safety study for FDP was conducted in patients undergoing coronary artery surgery. Preischemic provision of FDP significantly improved cardiac function and reduced perioperative ischemic injury. These myocardial protective effects may improve patient outcome after cardiac surgery.
Anesth Analg 2004;98:20-29
并给战友们提供原文以参考！详见原文！！
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