曲美他嗪短期治疗原发性扩张型心肌病心力衰竭的疗效分析

Effect of trimetazidine in the short-term treatment for dilated cardiomyopathy patients with heart failure

目的 观察曲美他嗪短期治疗扩张型心肌病（DCM）心力衰竭的疗效.方法 将67例DCM患者随机分为对照组33例,治疗组34例.2组均给予常规抗心力衰竭治疗,治疗组在常规抗心力衰竭基础上加用曲美他嗪20 mg,3 次/d口服,3个月为1个疗程.结果 2组心功能均明显好转,治疗组总有效率为88.2%（30/34）,对照组为69.7%（23/33）,2组比较差异有统计学意义（P＜0.05）.治疗组治疗前左心室射血分数（LVEF）、每搏量（SV）、每分排血量（CO）、6 min步行距离,分别为（28.7±13.6）%、（31.0±8.7）ml、（3.10±0.49）L/min、（138.0±30.4）m,治疗后分别为（38.5±9.7）%、（48.5±6.8）ml、（4.90±0.98）L/win、（350.0±20.4）m,治疗后明显增加（P均＜0.05）;治疗组治疗前左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）及脑钠肽（BNP）分别为（68.0±8.0）、（70.0±7.8）mm、（669.0±71.4）μg/L,治疗后分别为（59.0±6.7）、（68.0±7.9）mnn,（340.0±56.0）μg/L,治疗后明显减小（P均＜0.05）;对照组治疗前LVEF、SV、CO、6 min步行距离分别为（28.5±13.9）%、（30.0±9.9）ml、（3.00±0.48）L/min、（130.0±28.6）m,治疗后分别为（34.0±8.5）%、（34.0±11.0）ml、（3.90±0.56）L/min、（254.0±30.0）m,治疗后明显增加（P均＜0.05）;对照组治疗前LVESD、LVEDD及BNP分别为（67.0±9.0）、（70.0±8.0）mm,（666.0±70.8）μg/L,治疗后分别为（60.0±5.5）、（66.0±5.7）mm,（350.0±55.3）μg/L,治疗后明显减小（P均＜0.05）.且治疗组优于对照组（P均＜0.05）.结论 常规抗心力衰竭基础上加用曲美他嗪可提高疗效,改善心肌的收缩功能.

Objective To analyze the clinical efficacy of trimetazidine in short-term treatment for dilated cardiomyopathy accompanied by heart failure. Methods Sixty seven cases of dilated cardiomyopathy patients with heart failure were recruited and divided into two groups randomly,the control group（n = 33） had conventional therapy and the treatment group （n = 34） had conventional therapy plus oral tid 20 mg trimetazidine administration for 3 months. Results The heart function improved significantly in both groups. The overall effective rate was significantly lower in the control group than the treatment group（69. 7% vs. 88.2%,P 〈 0. 05）. In the treatment group, before treating the left ventricular ejection fraction（LVEF）, stroke volume （SV）, cardiac output per minute （CO）, 6 min walk test（6-MWT）, were（28.7 ± 13. 6） %,（31.0 ± 8. 7） ml,（3. 10 ± 0. 49） L/min,（138.0 ± 30. 4） m respectively, and after treazing these indices were（38. 5 ± 9. 7） %,（48. 5 ± 6. 8） ml, （4. 90 ± 0. 98） L/min,（350. 0 ± 20. 4） m respectively, which increased significantly after treatment（Ps 〈0. 05）. However,in the treatment group ,before treatment left ventricular. End-systolic dimension （LVESD）, left ventricular end-diastolic dimension （LVEDD） and brain natriuretic peptide （BNP） were （68. 0 ± 8. 0）mm,（70. 0 ± 7. 8） mm,（669. 0 ± 71.4） μg/L respectively, whereas after treatment these indices were（59. 0 ± 6. 7） mm,（68.0 ± 7. 9） μg/L,（340. 0 ± 56. 0） μg/L respectively, which decreased significantly after treatment（Ps 〈 0. 05）. In the control group, before treatment LVEF, SV, CO, 6-M WT were（28. 5 ±13.9） %,（30. 0 ± 9. 9） ml,（3.00 ± 0. 48） L/min,（130. 0 ± 28. 6） m respectively, whereas after treating these indices were（34. 0 ± 8. 5） %,（34. 0±11.0） ml,（3. 90 ± 0. 56） L/min,（254. 0 ± 30. 0） m, respectively,which increased significantly after treatment（Ps 〈 0. 05）. While in the control group, before treatment LVESD,LVEDD and BNP were （67.0 ± 9. 0） mm, （70. 0 ± 8.0） mm,（666. 0 ± 70. 8） μg/L respectively, whereas after treatment these indices were（60. 0 ± 5. 5） mm,（66. 0 ± 5.7） mm,（350. 0 ± 55.3） μg/L respectively, which decreased significantly after treatment （Ps 〈 0. 05）. Moreever, the improvement of these indices in the treatment group were significantly higher than those in the control group （Ps 〈 0. 05）. Conclusion The additional administration of trimetazidine to conventional anti-failure treatment can significantly improve the heart function in patients with dilated cardiomyopathy,which is worth to be generalized clinically.