曲美他嗪对Ⅱ型糖尿病并缺血性心脏病患者的心肌灌注及左心室收缩功能作用的临床研究

Study on the effect of Trimetazidine on Myocardial Perfusion and Left Ventricular Systolic Function in Type 2 Diabetic Patients With Ischemic Cardiomyopathy

目的探讨曲美他嗪(TMZ)改善糖尿病患者并缺血性心脏病的心肌灌注及左心室收缩功能的短期疗效。方法 36例Ⅱ型糖尿病并左心室功能障碍伴有心脏收缩功能下降(左心射血分数38±6%)患者被随机分成两组。治疗组19例接受曲美他嗪治疗3个月,对照组17例接受安慰剂治疗。结果三个月后,治疗组在收缩期室壁增厚指数及左室射血分数上有明显改善,但在心肌灌注缺损无明显改变。差异记分(SDS)越明显的患者收缩期室壁增厚指数(SWTI)及射血分数改善得越明显。总的运动时间在治疗组有改善,而在安慰剂组无变化。结论对糖尿病心脏病,短期的TMZ治疗会改善左室心肌功能和功能性容量,尽管心肌灌注无明显改变。建议对慢性心肌缺血的糖尿病患者进行TMZ治疗以改善左心收缩功能。

Objective To investigate whether short-term treatment with trimetazidine（TMZ） may improve myocardial perfusion and left ventricular systolic function in diabetic patients with ischemic cardiomyopathy.Methods 36 patients with type 2 diabetes mellitus（DM） with depressed systolic function（left ventricular ejection fraction 38±6%） were studied,which contain 30 men and 6 women.Patients were randomized into two groups.The experimental group received TMZ,while the other group received a placebo for 3 months.Results 3 months later,patients in the experimental group had a significant improvement in systolic wall thickening and ejection fraction compared to control patients.These effects were more marked in patients with higher summed difference scores（SDS） on initial evaluation.However,there were no significant changes in myocardial defects between the two groups.Total exercise time was also improved in TMZ-treated patients.Conclusion In diabetic cardiomyopathy,short-term TMZ improved left ventricular systolic function and functional capacity despite no change in myocardial perfusion.So,we suggest that chronic myocardial ischemia is a requirement for the effects of TMZ on left ventricular systolic performance.