曲美他嗪对急性心肌梗死患者窦性心率震荡干预的配对交叉研究

Pair-matched cross-over study about effects of trimetazidine on heart rate turbulence in acute myocardial infarction patients

目的 研究曲美他嗪对急性心肌梗死（AMI）患者窦性心率震荡（HRT）和心率变异性（HRV）的影响。方法AMI的患者共30对（60例），男22对，女8对；在急性心肌梗死稳定期（6～21天），若患者行血运重建，应在血运重建后，采用病例配对、随机进入交叉、单盲的试验设计；配对主要条件：性别、年龄、梗死部位及常规治疗情况，进入试验的患者，原治疗方案不变。HRT参数为震荡初始（TO），震荡斜率（TS）；HRV参数：24小时全部正常窦性R-R间期标准差（SDNN），24小时内每5分钟时间段窦性R—R间期平均值的标准差（SDANN），24小时全部正常窦性R—R间期差值的均方根（rMSSD），HRV三角指数（HRVTI）。结果分析采用交叉试验的方差分析。结果综合交叉试验结果，曲美他嗪处理组的HRT参数TO、TS得到明显改善（P〈0．05），HRV增加，与对照组比较差异均有统计学意义（P〈0．05），此外，曲美他嗪处理组的心功能也得到明显改善，与对照组比较差异均有统计学意义（P〈0．05）。结论 除常规治疗外，应用曲美他嗪能显著改善急性心肌梗死患者的窦性HRT和HRV，改善自主神经功能，具有不依赖于其他改善血流动力学药物的作用；改善缺血心肌细胞的能量代谢可能是此方面作用的主要基础。

Objective To explore the effects of trimetazidine（TMZ） on the sinus heart rate turbulence（HRT） and heart rate variability（HRV） in acute myocardial infarction（AMI） patients. Methods Totally 60 cases （30 pairs） of AMI patients were studied. In stable stage of AMI （6-21 days）, or after revascularization, the design was randomized, pair-matched,cross-over and single-blinded clinic study, the major matching limitations included sex, age, infarcted position, routine therapy, all patients chosen maintained the original therapy. HRT indices included turbulence onset （TO） ,turbulence slope（TS）, HRV indices including standard deviation of all normal sinus RR intervals over 24 hours （SDNN）;standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours （SDANN） ;root mean square of the successive normal sinus R-R intervals difference over 24 hours（rMSSD） and HRV triangular index（HRVTI）. The statistic analysis of variance/ANOV was used. Results The parameters of HRT and HRV were significantly increased after treatment with trimetazidine （ P 〈 0.05）. Simutaneously, the parameters of cardiac function were also remarkably increased （ P 〈0.05）. Conclusion Besides the routine treatment, trimetazidine may play some important and remarkably positive roles in the improvement of HRT, HRV and autonomic nervous function in the patients of AMI. Trimetazidine is not dependent on the other haemodynamic changes,which is the main cause to improve energy metabolism of isehemic myocardial cells.