曲美他嗪治疗缺血性心肌病心力衰竭的疗效及血浆脑钠肽的变化和意义

Therapeutic effect of trimetazidine on patients with ischemic cardiomyopathy heart failure and significance of plasma level of brain natriuretic peptide

目的观察曲美他嗪治疗缺血性心肌病心力衰竭的近期疗效(4周)及血浆脑钠尿肽(BNP)浓度的变化。方法缺血性心肌病心力衰竭患者60例,随机分为常规治疗组(30例)和曲美他嗪组(30例),分别给予常规治疗和加用曲美他嗪治疗4周,治疗前后分别用ELISA法检测血浆BNP浓度,并与同期的超声结果对照,观察血浆BNP与这些指标的关系。结果治疗前两组患者血浆BNP水平无明显差异,但治疗后两组的血浆BNP水平均显著降低(均P<0.05),而曲美他嗪组降低更加明显;两组患者治疗后血浆BNP水平相比有显著性差异(P<0.05)。并且血浆BNP与左室射血分数(LVEF)和左室舒张末期内径(LVEDD)均显著负相关(r分别为-0.481、0.311;均P<0.05)。结论血浆BNP作为曲美他嗪治疗缺血性心肌病心力衰竭的疗效随访指标,其敏感性优于超声心动图;血浆BNP水平与LVEF呈负相关、与LVEDD呈正相关,可以作为心力衰竭的辅助诊断指标并对心力衰竭治疗监控有应用价值。

AIM To assess the 4-week therapeutic effect of cardiomyopathy （TMZ） on patients with ischemic heart failure and the changes of plasma level of brain natriuretic peptide （BNP）. METHODS Sixty patients with ischemic cardiomyopathy heart failure were randomly divided into routine treatment group （30） and TMZ treatment group （30） and the patients were treated for 4 weeks. After treatment, the changes of BNP were observed between the two groups and the correlation between BNP and ultrasound values was explored. RESULTS No statistic difference in the BNP level was found between the two groups before treatment. After the 4-week treatment, the BNP level decreased in both groups, but the decrease was more marked in TMZ group, with significant difference between the two groups （P = 0. 042）. The BNP level was significantly correlated to LVEF and LVEDD （ r = 0. 481, 0. 311 ; P 〈 O. 05）. CONCLUSION TMZ has a positive effect on patients with ischemic cardiomyopathy heart failure, and the plasma BNP level, as follow-up index, has better sensitivity than echocardiography. BNP level is negatively correlated with LVEF and positively correlated with LVEDD.