摘要
目的 探讨曲美他嗪对经皮冠状动脉介入治疗（PCI）术相关心肌损伤及术后左心室功能的影响。方法本研究为一项单中心前瞻、随机、对照研究，采用随机数字表法将132例拟行择期PCI术的不稳定性心绞痛患者分为曲美他嗪组和对照组。最终纳入106例成功完成PCI术的不稳定性心绞痛患者，曲美他嗪组51例，对照组55例。曲美他嗪组在常规药物的基础上，于PCI术前0．5—1．0h一次性口服60mg曲美他嗪，PCI术后随访期间坚持口服常规剂量曲美他嗪（20mg、3次／d）。分别测定PCI术前和术后16—18h患者血清心肌肌钙蛋白I（cTnI）浓度，通过超声心动图随访、评价两组患者PCI术后心功能，比较主要心血管事件（MACE）的发生情况。结果PCI术后16～18h时，曲美他嗪组患者cTnI水平由术前[0．02（0．01，0．03）]μg／L升至[0．11（0．07，0．13）]μg/L（P〈0．05），对照组患者cTnI水平由术前[0．02（0．01，0．03）]吵晷／L升至[1．31（0．44，2．31）]μg/L（P〈0．05）；曲美他嗪组术后cTnI水平明显低于对照组（P〈0．05），且曲美他嗪组术后cTnI〉0．10μg／L患者的比例明显低于对照组[54．9％（28／51）比94．5％（52／55），P〈0．01]。平均随访12个月后，曲美他嗪组左心室收缩末内径低于对照组[（31．00±4．33）mm比（33．29±2．11）mm，P〈0．05]，左心室射血分数高于对照组[（65．65±3．94）％比（62．29±3．06）％，P〈0．01]，两组MACE发生率差异无统计学意义。结论PCI术前口服负荷剂量曲美他嗪可以减少手术相关心肌损伤，术后长期服用可以改善患者的左心室功能。
Objective To explore the effects of trimetazidine therapy on left ventricular （LV） function after percutaneous coronary intervention （PCI）. Methods A total of 106 patients with unstable angina pectoris underwent successful elective PCI were randomly assigned to standard therapy group （control, n = 55 ） or trimetazidine group （n = 51 , 60 mg trimetazidine loading dose prior to PCI followed by 20 mg Tid after PCI on top of standard therapy）, cTnI level was measured before and at 16 - 18 hours after PCI. LV function was evaluated by echocardiography and major adverse cardiac events （ MACE, including death, re-infarction and target vessel revascularization） at 12 months after PCI was compared between the two groups. Results Post procedural cTnl level increased from [ 0. 02 （0. 01, 0. 03 ） ] p.g/L at baseline to [0. 11 （0. 07, 0. 13）] μg/L （P 〈0. 05） at 16 -18 hours in the trimetazidine group, while [0. 02（0.01, 0. 03 ）μg/L to [ 1.31 （0. 44, 2.31 ） ] μg/L in the control group （ P 〈 0. 05 ）. Post procedural cTnI level was significantly reduced in the trimetazidine group compared to the control group （P 〈 0. 05 ）. At 12 months follow-up, left ventricular ejection fraction in the trimetazidine group was significantly higher than in control group [（65.65±3.94）% vs. （62.29 ±3.06）%, P 〈0.01] while incidence of MACE was similar between the two groups. Conclusion Trimetazidine can reduce the post-PCI cTnI release and improve left ventficular function after PCI in patients with unstable angina pectoris.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第3期205-209,共5页
Chinese Journal of Cardiology
关键词
血管成形术
经腔
经皮冠状动脉
曲美他嗪
肌钙蛋白
心室功能
左
Angioplasty, transluminal, percutaneous coronary
Trimetazidine
Troponin
Ventricular function, left
