曲美他嗪治疗急性心肌梗死的临床研究

Clinical study of trimetazidine for myocardial protection in acute myocardial infarction

目的评价在急性心肌梗死(AMI)再灌注治疗前开始应用曲美他嗪(TMZ)对再灌注治疗的影响。方法 60例接受再灌注治疗的 AMI 患者随机分为 TMZ 组和对照组。经冠状动脉造影证实血管再通。TMZ 组患者在确诊 AMI 后即刻服用 TMZ 60 mg,随后给予20 mg,3次/d。比较两组患者再灌注治疗前后的心电图 ST 段降幅以及血浆丙二醛(MDA)、内皮素(ET-1)水平的变化。记录住院期间和发病3个月内的主要临床事件。结果 TMZ 组患者再灌注治疗后 ST 段下降幅值显著高于对照组[(7.14±3.50)mm比(3.79±1.32)mm,P=0.041];ST 段下降幅度>70%者显著多于对照组(68.8%比42.9%,P=0.043)。TMZ 组的血 MDA 水平于再灌注4 h后各个时间段内均显著低于对照组。TMZ 组的血 ET-1水平于再灌注后8 h和第7天显著低于对照组。结论 AMI 患者于再灌注治疗前即开始应用 TMZ 可增加 ST 段降低的幅值,减少 MDA 的生成及 ET-1的释放,具有心肌细胞保护作用。

Objective To assess the effect of trimetazidine as an adjunctive treatment to reperfusion therapy in acute myocardial infarction. Methods Sixty patients with acute myocardial infarction were randomized to receive trimetazidine （a loading dose of 60 mg followed by 20 mg 3 times daily） for 2 weeks （n = 32） or to be controls （n = 28 ）. The loading dose was started early before the reperfusion therapy. Patients received intermittent ST-segment monitoring to assess the resolution of ST-segment deviation one hour after reperfusion therapy. Venous blood samples for measurement of malondialdehyde （MDA） and endothelin （ET-1） were taken immediately on admission and 1,4,8,24 and 48 hours as well as 7 days after reperfusion. In-hospital and 3-months major adverse cardiac events were recorded. Results Blinded ST- segment analysis showed that there was a more marked return towards baseline one hour after reperfusion therapy in the trimetazidine group, than in the control group [ change （7. 14 ± 3.50 ） mm vs （ 3.79 ± 1.32 ） mm, P =0. 041 ]. The measurement of plasma MDA showed that, there was a significantly lower level in the trimetazidine group 4, 8, 24, 48 hours and 7 days after reperfasion（P 〈0. 05） . The level of plasma ET-1 was significantly lower in the trimetazidine group 8 hours and 7 days after reperfasion （P 〈 0.05 ）. There was no side effect due to trimetazidine. Clinical outcomes were similar between the two groups. Conclusions Trimetazidine is effective for the resolution of ST-segmentelevation. The effect of trimetazidine against malondialdehyde and ET-1 formation suggested that it might be the mechanism of the myocardial protection.