曲美他嗪对经皮冠状动脉介入术相关心肌损伤的保护作用

Protective effect of trimetazidine on myocardial injury induced by percutaneous coronary intervention

目的 观察曲美他嗪对经皮冠状动脉介入术（PCI）相关心肌损伤的影响.方法 入选拟行PCI的不稳定型心绞痛患者80例,采用随机数字表法分为曲美他嗪组和对照组,各40例,所有入选患者均服用阿司匹林、氯吡格雷及常规药物治疗,曲美他嗪组PCI术前3d开始口服曲美他嗪,20 mg/次,3次/d,直至采血结束;于PCI术前及术后6、24 h采血测定血清肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、C反应蛋白（CRP）的浓度,另测定术前及术后6h白细胞介素6（IL-6）的浓度.结果 术前2组患者各项指标差异均无统计学意义（P＞0.05）.曲美他嗪组PCI术后在各个测量时点的cTnI、CK-MB、CRP、IL-6均明显低于对照组[术后6 h：cTnI为（0.52 ±0.22） μg/L比（1.96-1.08） μg/L、CK-MB为（52±13） U/L比（89±19）U/L、CRP为（9.6±2.8） mg/L比（12.7±2.5） mg/L、IL-6为（23±6） ng/L比（32±6）ng/L;术后24h：cTnI为（0.44±0.26） μg/L比（1.98±1.12） μg/L、CK-MB为（43±10） U/L比（72±18） U/L、CRP为（14.8±5.6）mg/L比（23.2±7.2） mg/L] （P＜0.05）.结论 曲美他嗪能明显降低PCI术后患者的心肌损伤标志物和炎性因子水平,减轻心肌损伤,对心肌有保护作用.

Objective To observe the protective effect of trimetazidine on myocardial injury induced by percutaneous coronary intervention （PCI）.Methods Eighty patients with unstable angina were randomly divided into control group （n =40） and trimetazidine group （n =40）.All patients were administrated with aspirin,clopidogrel and other medicines;the patients in trimetazidine group were additionally administrated with oral trimetazidine 3 days before PCI （20 mg/time,3 times/d） till the end of venous sampling.The levels of myocardial injury markers troponin I （cTnI）,creatine kinase isoenzyme （CK-MB） and C-reactive protein （CRP） were measured before,6 and 24 h after PCI;the level of interleukin （IL） 6 was detected before and 6 h after PCI.Results There were no significant differences of all indexes between two groups before PCI （all P ＞ 0.05）.The serum levels of cTnI,CK-MB,CRP 6 and 24 h after treatment and the level of IL-6 6 h after treatment in trimetazidine group was significantly decreased compared with those in control group [6 h after PCI：cTnI （0.52 ± 0.22） μg/L vs （1.96 ± 1.08） μg/L,CK-MB （52 ± 13） U/L vs （89 ± 19） U/L,CRP （9.6 ± 2.8） mg/L vs （12.7 ± 2.5） mg/L,IL-6 （23 ± 6） ng/L vs （32 ±6） ng/L;24 h after PCI：cTnI （0.44 ±0.26） μ g/L vs （1.98 ± 1.12） μg/L,CK-MB （43 ± 10） U/L vs （72 ± 18）U/L,CRP （14.8 ±5.6）mg/L vs （23.2 ±7.2）mg/L] （all P ＜0.05）.Conclusion Trimetazidine can reduce the levels of myocardial injury markers and inflammatory cytokines after PCI and has myocardial protective effect.