曲美他嗪与尼可地尔对经皮冠状动脉介入治疗相关心肌损伤干预作用的比较

Comparative Study for Trimetazidine and Nicorandil in Patients With PCI Related Myocardial Injure

目的:比较口服常规剂量曲美他嗪或尼可地尔对经皮冠状动脉介入治疗(PCI)相关心肌损伤的干预作用。方法:147例行择期PCI的急性心肌梗死或不稳定型心绞痛患者于术前72 h,随机分为四组,即曲美他嗪+尼可地尔组(41例)、曲美他嗪组(n=34例)、尼可地尔组(n=40例)和对照组(n=32例)。对照组接受阿司匹林、β受体阻滞剂、他汀类药物等冠心病常规药物治疗,前三组在上述治疗基础上于术前72 h开始口服常规剂量的曲美他嗪和(或)尼可地尔。四组分别于术前、术后12 h、18 h、24 h抽血检测心肌酶、肌钙蛋白I(cTnI)、血小板平均体积(MPV)水平。结果:对照组术后各时间点的肌酸激酶MB同工酶(CK-MB)与cTnI水平均较术前增高,其中CK-MB水平在术后18 h增高最明显(P=0.049),差异具有统计学意义。而曲美他嗪+尼可地尔组、曲美他嗪组和尼可地尔组术后CKMB、cTnI水平较各组术前相比差异均无统计学意义(P>0.05),且低于对照组同时间点数值。曲美他嗪组各时间点的CK-MB及cTnI水平与尼可地尔组相应时间的数值相比均无统计学差异(P>0.05)。曲美他嗪+尼可地尔组、曲美他嗪组与尼可地尔组术后各时间点的MPV水平较各组术前均有下降,其中曲美他嗪+尼可地尔组与尼可地尔组术后12 h、24 h的MPV水平明显下降(P<0.001),差异具有统计学意义。结论:口服常规剂量曲美他嗪或尼可地尔均可减少PCI引起的心肌损伤,发挥心肌保护作用,两药对PCI心肌损伤的干预作用无显著性差异,且尚未发现两药联用对PCI心肌损伤有更强大的保护作用。本研究还发现,曲美他嗪和尼可地尔均可以减少炎症反应,其中又以尼可地尔作用更明显,这可能是曲美他嗪和尼可地尔能够减少PCI心肌损伤的原因之一。

Objective： To compare the effect of trimetazidine and nicorandil in patients with percutaneous coronary intervention （PCI） related myocardial injure. Methods： A total of 147 patients of acute myocardial infarction （AMI） or unstable angina pectoris with elective PCI were randomly divided into 4 groups. Trimetazidine plus nicorandil group, n=41, Trimetazidine group, n=34, Nicorandil group, n=40 and Control group, n=32 patients received the conventional treatment including aspirin, [3 receptor blocker, statin, etc. In addition to conventional treatment, the first 3 groups received their medication at 72 hours prior to PCI. The levels of myocardial enzymes, cTnl and mean platelet volume （MPV） were examined and compared at before and 12,18 and 24 hours after PCI among different groups. Results： In control group, the post-operative levels of CK-MB and cTnI were increased at each time point, especially for CK-MB, it reached the highest level at 18 h after the operation, P=0.049. In the other 3 groups, the levels of CK-MBand cTnI were similar at before and post-operation, P〉0.05, and they were all lower than that in Control group at the same time point. CK-MB and cTnI were similar between Trimetazidine group and Nicorandil group at each time point, P〉0.05. In those 3 groups, the post-operative MPV level decreased at each time point, in Trimetazidine plus nicorandil group and Nicorandil group, MPV significantly decreased at 12 and 24 h after the operation, P〈0.001. Conclusion： The conventional dose of trimetazidine or nicorandil may reduce myocardial injury after PCI and the combined medication had no special effect. Furthermore, either trimetazidine or nicorandil may reduce the inflammatory response, and nicorandil was stronger, which might be one of the mechanisms for reducing the PCI related myocardial injure.