曲美他嗪对老年人冠心病的心脏保护作用

Cardioprotective effect of trimetazidine in elderly patients with coronary artery disease

目的评价曲美他嗪对老年冠心病心肌缺血及慢性心力衰竭患者的心脏保护作用。方法选择经冠状动脉造影确诊为冠心病的89例老年患者,随机分为治疗组(45例)及对照组(44例)。治疗组在保持原有治疗不变的情况下,加用曲美他嗪20mg,3次/d,治疗6个月;对照组保持原有治疗方案。结果曲美他嗪治疗组与对照组比较,每周心绞痛发作次数减少〔分别为(3.0±1.7)次/周和(3.9±2.1)次/周,P<0.05〕;硝酸甘油片服用量减少〔(1.6±0.9)mg/周和(2.2±1.2)mg/周,P<0.05〕;心率、心率和血压乘积无明显变化(均为P>0.05);总工作量增加〔分别为(10.2±2.2)METs和(9.3±1.7)METs,P<0.05〕、运动诱发心绞痛时间延长〔分别为(444.0±81.4)s和(404.8±71.6)s,P<0.05〕、运动后ST段下降1mm所需时间增加〔分别为(440.3±75.6)s和(387.3±77.0)s,P<0.05)〕及运动持续时间增加〔分别为(611.6±179.8)s和(506.3±113.4)s,P<0.01〕;左室射血分数增加〔(46.4±5.6)%和(42.5±2.1)%,P<0.05)〕。结论曲美他嗪能够改善老年冠心病患者的心功能及运动诱发的心肌缺血,具有明显的心脏保护作用,且无增加心率与血压乘积的副作用。

Objective To evaluate the cardioprotective effect of trimetazidine in elderly patients with myocardial ischemia and chronic heart failure of coronary artery disease. Methods Eighty nine patients with angiographically proven coronary artery disease were randomized to therapy group (n=45) and controlled group (n=44). The patients in therapy group were given both the routine treatment and trimetazidine 20 mg, 3 times daily, for 6 months. The patients in controlled group were given only the routine treatment. Results After the therapy, the episode of angina pectoris every week was fewer and weekly consumption of nitroglycerin tablets was less in patients of therapy group than those in controlled group: (3.0±1.7 )episodes/w vs (3.9±2.1 )episodes/w,P<0.05;(1.6±0.9) mg/w vs (2.2±1.2) mg/w, P<0.05, respectively. There were no differences in heart rate, systolic pressure and their product between the groups(P>0.05). Work load were increased 〔(10.2± 2.2) vs( 9.3 ±1.7)METs, P<0.05〕. Durations to induce angina, to induce 0.1 mV ST segment depression on electrocardiogram and to reach the maximal tolerance by exercise were prolonged in the therapy group than those in controlled group 〔(444.0 ±81.4) s vs ( 404.8± 71.6) s,P<0.05;( 440.3± 75.6) s vs (387.3 ±77.0) s,P<0.05, and (611.6± 179.8) s vs (506.3± 113.4) s,P<0.01, respectively〕. Left ventricle ejection fraction (LVEF) was obviously increased 〔(46.4±5.6)% vs( 42.5±2.1)%, P<0.05〕. Conclusions Trimetazidine has cardioprotective effect and anti-ischaemic properties in elderly patients with coronary artery disease. It could improve the cardiac function after myocardial ischemia induced by exercise. It has no effect on increment of heart rate and systolic pressure product.