曲美他嗪对慢性心力衰竭病人心功能、脑钠肽和心肌肌钙蛋白I的影响

The Effects of Trimetazidine on Cardiac Function,Plasma Level of Brain Natriuretic Peptide and Cardiac Troponin I in Patients with Chronic Heart Failure

目的观察曲美他嗪对慢性心力衰竭(CHF)病人心功能、脑钠肽(BNP)和心肌肌钙蛋白I(cTnI)的影响。方法60例病情稳定的CHF病人,随机分为治疗组及对照组,每组30例。对照组病人采用心力衰竭常规药物治疗,治疗组在对照组治疗的基础上加用曲美他嗪20mg,每日3次,两组均连续治疗4周。观察治疗前后两组NYHA分级、心功能、BNP和cTnI等指标的变化。结果与治疗前相比,两组治疗后NYHA分级及心功能均得到显著改善,血浆BNP及cTnI水平显著降低(P<0.05或P<0.01);与对照组治疗后相比,曲美他嗪组显著缩小病人左室舒张末内径(LVEDD,P<0.05),显著减小左室质量指数(LVMI,P<0.05),显著增加左室射血分数(LVEF,P<0.05);血浆BNP(P<0.05)和cTnI(P<0.01)显著降低。结论曲美他嗪能降低血浆BNP及cTnI水平,改善CHF病人的心功能。

Objective To observe the effects of trimetazidine on changes of plasma brain natriuretic peptide （BNP） and cardiac troponin Ⅰ（cTn Ⅰ） and cardiac function in patients with chronic heart failure （CHF）. Methods 60 patients with CHF who had already received conventional therapy were randomly divided into two groups, the trimetazidine group （ n = 30） and the conventional group （ n =30）. Patients in the trimetazidine group were given trimetazidine 20 mg, tid, for 4 weeks. NYHA functional class, plasma BNP and cTn Ⅰ, and echocardiographie indices （LVEDD, LVMI, LVEF） were evaluated before and after 4 weeks＇ therapy. Results After 4 weeks therapy, compared with the patients in the conventional group, trimetazidine significantly decreased LVEDD （ P 〈 0.05 ）, and LVMI（P 〈 0.05）, increased LVEF（P 〈 0.05）, and decreased BNP （ P 〈 0.05） and cTn Ⅰ（P〈 0.01 ）. Meanwhile, changes in BNP level were negatively correlated with those in LVEF （△LVEF： r = -0.90,P〈0.01）,and cTn Ⅰ positively correlated with those in LVEDD and LVMI （ A LVEDD： r =0.87, P 〈 0.05; ALVMI： r = 0.69, P 〈 0.05 ）. Conclusion Trimetazidine maight improve cardiac function in CHF patients, and plasma BNP combined cTn Ⅰ might serve as a good therapeutic indicator for trimetazidine treatment in CHF patients.