曲美他嗪对老年心力衰竭并贫血患者肾功能及N末端前脑钠肽的影响

Effects of Trimetazidine on Renal Function and Level of NT-Pro BNP in Elderly Patients with Heart Failure Complicating Anemia

目的观察曲美他嗪对老年慢性心力衰竭（CHF）合并贫血患者心功能、肾功能、血红蛋白水平的影响。方法将87例心功能Ⅱ～Ⅳ级（NYHA）的慢性心力衰竭患者随机分为治疗组（44例）及对照组（43例）。在慢性心力衰竭常规治疗基础上,对照组给予口服铁剂,治疗组给予口服铁剂加曲美他嗪片。治疗4周后,观察两组血红蛋白、血肌酐、肌酐清除率、心功能、N末端前脑钠肽（NT-pro BNP）变化。结果与治疗前相比,治疗组治疗后血红蛋白明显升高[（113.2±1.5）g/L比（98.3±4.2）g/L,P〈0.05],血清肌酐水平明显降低[（163.4±38.7）μmol/L比（196.2±40.7）μmol/L,P〈0.05],肌酐清除率增加[（42.8±7.1）mL/min比（38.0±7.8）mL/min,P〈0.05],心功能分级明显改善[（2.1±0.5）比（3.3±0.7）],血浆NT-pro BNP显著下降[（1 233.1±426.7）ng/L比（2 219.3±951.2）ng/L,P〈0.05]。对照组治疗后上述指标均有所改善,但差异无统计学意义。结论老年慢性心力衰竭合并贫血患者应用曲美他嗪和口服铁剂治疗,在改善心功能的基础上,可进一步纠正贫血、改善肾功能,降低血浆NT-pro BNP水平,值得临床推广。

Objective To investigate the effects of trimetazidine on the cardiac and renal functions, and hemoglobin（ Hb） parameters in the elderly patients with chronic heart failure（ CHF） complicating anemia. Methods 87 patients with CHF（ NYHA gradeⅡ- Ⅳ） complicating anemia were randomized to the treatment group（ n = 44） and control group（ n = 43）. All patients received the conventional treatment of heart failure. On this basis the control group was given only oral iron preparation,while the treatment group received oral iron preparation plus trimetazidine. The changes of Hb,serum creatinine,creatinine clearance,plasma NT-pro BNP and cardic function were observed after 4-week treatment in the two groups. Results Compared with before treatment, Hb after treatment in the treatment group was significantly increased [（ 98. 3 ± 4. 2） g / L vs.（ 113. 2 ± 1. 5） g / L, P〈0. 05 ], serum creatinine level was significant decreased[（ 196. 2 ± 40. 7） μmol / L vs.（ 163. 4 ± 38. 7） μmol / L, P〈0. 05 ],the creatinine clearance was increased [（ 38. 0 ± 7. 8） mL / L vs.（ 42. 8 ±7. 1） mL / min, P〈0. 05 ], the NYHA cardiac functional grade was significant improved [（ 3. 3 ± 0. 7） vs.（ 2. 1 ± 0. 5） ], the plasma NT-pro BNP was significant decreased [（ 2 215. 3 ± 950. 2） ng / L vs.（ 1 236. 1 ± 430. 7） ng / L, P〈0. 05 ],the above parameters in the control group were improved to some extent, but the differences between the two groups had no statistical significance. Conclusion Trimetazidine combined with oral iron preparation can improve the cardiac function,on this basis can further correct anemia,improve the renal function and reduce the plasma NT-pro BNP level in treating elderly patients with CHF complicating anemia,which deserves to be clinically promoted.