负荷剂量曲美他嗪对不稳定型心绞痛介入治疗术后肌钙蛋白I的影响

The impact of loading dose of trimetazidine on troponin I after interventional treatment in patients with unstable angina pectoris

目的评价口服负荷剂量曲美他嗪在不稳定型心绞痛经皮冠状动脉介入术(PCI)治疗中对心肌损伤的保护作用。方法 291例不稳定型心绞痛患者,选择经冠脉造影后只需单支血管接受PCI,且球囊预扩张1次者,排除多支血管病变、行1次以上球囊预扩张、术前肌钙蛋白I(cTnI)增高、术前曾口服曲美他嗪治疗及药物禁忌证后,最后共136例患者入选,随机分成两组:曲美他嗪组(术前一次性口服曲美他嗪60 mg)70例及对照组(未服用曲美他嗪)66例。测定PCI前及PCI后6、12、18、24 h的cTnI水平。结果两组cTnI水平均升高,升高率曲美他嗪组与对照组比较差异无统计学意义(21.4%vs 19.7%,P>0.05),但曲美他嗪组cTnI水平在介入术后6、12、18、24 h均低于对照组(P均<0.01)。结论负荷剂量曲美他嗪预处理后能明显减轻不稳定型心绞痛PCI治疗所致的心肌损伤。

Objective To evaluate the protective effect of pre-procedural oral administration of trimetazidine（TMZ） on percutaneous coronary intervention（PCI）-induced myocardial injury in patients with unstable angina pectoris. Methods A total of 291 patients with unstable angina pectoris were collected. After screening according to predefined excluding standards including multi-vessel lesion,balloon pre-dilation for more than one time,elevated cardiac troponin I（cTnI） before operation,oral TMZ before operation and drug contraindication,136 cases were enrolled in this study at last. The 136 patients were randomized to two groups： TMZ group（n=70,oral TMZ 60mg before procedure） and control group（n=66,no treatment with TMZ）. The cTnI levels were measured before PCI and 6,12,18,24 h after PCI. Results Although there was no significant statistical difference in cTnI increase rate between the two groups（21.4%vs19.7%,P0.05）,post-procedural cTnI levels were significantly reduced in TMZ group at all time points compared with control group（ all P0.01）. Conclusions Pre-treatment with loading dose of TMZ before PCI can significantly reduce PCI-induced myocardial injury in patients with unstable angina pectoris.