曲美他嗪治疗扩张型心肌病患者左心功能不全的疗效观察

Efficacy of trimetazidine on left ventricrlar dysfunction of dilated cardiomyopathy patients

目的评价曲美他嗪对扩张型心肌病患者左心功能不全的治疗效果。方法选择冠状动脉造影正常的78例患者,左室射血分数(LVEF)<40%,左室扩大、左心室舒张末期左室内径(LVDD)在(63.61±10.32)mm,心功能Ⅱ～Ⅳ级(NYHA)。随机将患者分为治疗组40例,对照组38例,治疗组在常规治疗基础上加用曲美他嗪20mg3次/d,服用6个月,对照组仅用常规治疗。治疗前、治疗后1个月、6个月观察患者临床情况及多普勒超声指标的变化。结果LVEF由(31.8±6.1)%上升至(41.3±10.3)%,较治疗前明显提高(P<0.01),与对照组比较也有显著提高(P<0.05),运动耐量(NYHA分级)较治疗前明显改善(P<0.001),与对照组比差异显著(P<0.01)。LVDD两组都较治疗前明显下降(P<0.01),组间差异不显著(P>0.05)。结论在常规治疗基础上加用曲美他嗪长期治疗,可明显改善扩张型心肌病患者的左心功能,增加患者运动耐量。

Objective To ewduate the efficacy of trimetazidine on left ventricular dysfunction in dilated cardio myopathy patients, Methods Seventy eight patients with normal coronary arteriography, left ventricular election fraction （LVEF）〈40%, left ventrieular end diastolic dimension （LVDD）（63. 61± 10. 32）mm and stage of NYHA classification Ⅱ -Ⅳ were randomized to therapy group （n= 40） and control group in 38）. The patients in therapy group were given both the routine treatment and trimetazidine 20 mg 3 times daily for 6 months. The patients in con trol group were given only the routine treatment. The patients were followed up for 6 months and assessment included clinical evaluation, cletrocardiography and echocardiography before treatment, one and six months after treatment. Results The LVEF of therapy group was increased from （31.8±6.1）% before treatment to （41.3±10.3）% after treatment （ P 〈0.01）. and was also increased obviously compared with that of control group （P 〈0.05）. Stage of NYHA classification was significantly improved （P 〈0. 001）, and the difference was remarkable compared with that of control group （P 〈0.01）. The LVDD of both groups was obviously decreased （P 〈0.01） ,but there was no signif icant difference between the two groups（P 〉0.05）. Conclusion For patients with dilated cardiomyopathy, long time treatment with trimetazidine in combination with routine therapy can significantly improve the left cardiac func tion and increase the exercise capacity.