通心络联合曲美他嗪对冠心病合并糖尿病患者血脂及心功能影响的临床研究

Clinical research on effects of combined Trimetazidine and Tongxinluo treatment on serum lipid and cardiac function in patients with coronary artery disease and diabetes mellitus

目的研究通心络联合曲美他嗪对冠心病合并糖尿病患者血脂及心功能的影响。方法入选200例冠心病合并糖尿病心功能不全患者。将患者随机分成治疗组和对照组,每组各100例。对照组按照临床需要在常规应用硝酸酯类、β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、利尿剂、他汀类降脂药;治疗组在对照组基础上加用通心络胶囊每次3粒,每日3次,盐酸曲美他嗪20 mg,每日3次,疗程12周。观察两组患者治疗前后血脂及心功能指标变化。结果治疗组与对照组对比心功能明显改善[左室舒张末期容积(LVEDV):(164.26±15.06)mL比(174.34±16.07)mL,P<0.05;左室收缩末期容积(LEVSV):(84.69±13.24)mL比(90.23±15.18)mL,P<0.05;左室射血分数(LVEF):(39.15±11.24)%比(36.83±8.56)%,P<0.05],临床总有效率明显升高(98%比90%,P<0.05),血脂明显改善[总胆固醇(TC):(4.34±0.84)mmol/L比(4.87±0.52)mmol/L,P<0.05;三酰甘油(TG):(1.26±1.05)mmol/L比(1.84±1.42)mmol/L,P<0.05;高密度脂蛋白胆固醇(HDL-C):(1.27±0.78)mmol/L比(1.06±0.37)mmol/L,P<0.05;低密度脂蛋白胆固醇(LDL-C):(1.73±0.56)mmol/L比(1.94±0.54)mmol/L,P<0.05]。结论通心络联合曲美他嗪通过改善微循环、优化心肌能量代谢、降低血脂、稳定斑块来改善患者心功能,提高患者生活质量。

Objective To investigate the effects of combined Trimetazidine and Tongxinluo treatment on serum lipid and cardiac function in patients with coronary artery disease and diabetes mellitus. Methods 200 cardiac insufficient patients who suffered from coronary artery disease and diabetes were included in our study and they were randomly di- vided into treatment group and control group, with 100 cases in each group. Nitrates, β-receptor blockers, ACEI or ARB, diuretics were given to patients in control group as necessary. On the basis of control group, patients in treat- ment group received 3 Tongxinluo capsules and 20 mg Trimetazidine hydrochlofide three times daily. The course of treatment last for 12 weeks. Serum lipid and cardiac function before and after treatment were compared between two groups. Results Compared with control group, patients in treatment group showed significant improvement of cardiac function [LVEDV： （164.26±15.06） mL vs （174.34±16.07） mL, P 〈 0.05; LEVSV： （84.69±13.24） mL vs （90.23±15.18） mL, P 〈 0.05; LVEF： （39.15±11.24）% vs （36.83±8.56）%, P 〈 0.05], decrease of serum lipid [TC： （4.34±0.84） mmol/L vs （4.87±0.52） mmol/L, P 〈 0.05; TG： （1.26±1.05） mmol/L vs （1.84±1.42） mmol/L, P 〈 0.05; HDL-C： （1.27±0.78） mmol/L vs （1.06±0.37） retool/L, P 〈 0.05; LDL-C： （1.73±0.56） mmol/L vs （1.94±0.54） retool/L, P 〈 0.05] and increase of clini- cal total effective rate （98% vs 90%, P 〈 0.05）. Conclusion Tongxinluo combined with Trimetazidine can improve pa- tient cardiac function through improving micro-circulation, optimizing myocardial energy metabolism, decreasing serum lipid and stabilizing of atheromatous plaque.