曲美他嗪对冠心病慢性心力衰竭患者心功能及心率震荡的影响

Effects of Trimetazidine on Cardiac Function and Heart Rate Turbulence in Coronary Heart Disease and Chronic Heart Failure

目的：观察曲美他嗪对冠心病慢性心力衰竭患者心功能及窦性心率震荡（HRT）的影响。方法2009年10月~2012年6月经冠脉造影和/或CT血管造影（CTA）证实的73例冠心病慢性心力衰竭患者，随机分成对照组（n=35）和曲美他嗪组（n=38）。对照组采用常规强心、利尿、扩血管等抗心力衰竭治疗；曲美他嗪组在此基础上给予口服曲美他嗪片。两组分别于服药前和服药3个月后检查心脏彩色多普勒超声心动图、24 h动态心电图，测算左心室射血分数（LVEF）、左室舒张末期内径（LVd）以及反映HRT的两个量化指标震荡初始（TO）和震荡斜率（TS）。结果经3个月治疗，两组LVEF提高，LVd缩小（P＜0.01）。曲美他嗪组LVEF改善显著优于对照组（P＜0.001）。曲美他嗪组TO和TS均改善（P＜0.05），对照组仅TO改善（P＜0.05）。曲美他嗪组TO和TS改善均优于对照组（P＜0.05）。结论曲美他嗪有助于改善冠心病慢性心力衰竭患者的心功能，改善HRT现象。

Objective To evaluate the effects of trimetazidine on cardiac function and autonomic function in patients with coronary heart disease and chronic heart failure. Methods 73 patients with coronary heart disease and chronic heart failure were randomly divided into con-trol group （conventional therapy, n=35） and trimetazidine group （conventional therapy plus oral trimetazidine, n=38）. All the patients under-went echocardiography for left ventricular ejection fraction （LVEF） and left ventricular end-diastolic diameter （LVd）, and 24-hour Holter electrocardiogram for heart rate turbulence （HRT） indexes, turbulence onset （TO） and turbulence slope （TS） were calculated before and 3 months after treatment. Results 3 months after treatment, LVEF increased, and LVd shrank in both groups （P〈0.01）. LVEF improved better in the trimetazidine group than in the control group （P〈0.001）. TO decreased and TS increased in the trimetazidine group （P〈0.05）. Only TO decreased in the trimetazidine group （P〈0.05）. TO and TS improved better in the trimetazidine group than in the control group （P〈0.05）. Conclusion Trimetazidine could improve cardiac function and autonomic function in patients with coronary heart disease and chronic heart failure.