曲美他嗪治疗缺血性心肌病慢性心力衰竭合并糖尿病患者的疗效观察

Effects of trimetazidine in the treatment of ischemic cardiomyopathy patients with chronic heart failure and diabetes mellitus

目的 探讨曲美他嗪治疗缺血性心肌病慢性心力衰竭合并糖尿病患者的疗效。方法 选择2013-01~2014-06在驻马店市中心医院心内科住院的,诊断为缺血性心肌病慢性心力衰竭合并糖尿病患者,按纽约心脏病协会（NYHA）心功能分级标准在Ⅲ~Ⅳ级患者共60例（男42例,女18例）,随机分为治疗组和对照组各30例。在给予血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体拮抗剂（ARB）、β受体阻滞剂、洋地黄、利尿剂等常规抗心衰药物治疗的同时,治疗组加用曲美他嗪,对照组给予谷维素治疗。随访6个月,比较两组患者心脏彩色超声各指标改善情况及运动耐量情况。结果 治疗组心脏超声指标左室收缩末径（LVESD）、左室舒张末径（LVEDD）、左室射血分数（LVEF）、6 min步行试验改善均明显好于对照组（P〈0.05）,服药期间无明显不良反应发生。结论 曲美他嗪可明显改善缺血性心肌病慢性心力衰竭合并糖尿病患者心功能,提高生活质量。

Objective To observe the effects of trimetazidine in the treatment of ischemie cardioinyopathy （ICM） patients with chronic heart failure（CHF） and diabetes mellitus. Methods Sixty ICM patients （42 males and 18 females） were collected from the Central Hospital of Zhumadian City from January 2013 to June 2014, and were diagnosed as New York Heart Association（NYHA） Class Ⅲ- Ⅳ heart failure. All included patients were randomly divided into the control group and the treatment group. Tile treatment group was given the standard therapy including the angiotensin converting enzyme inhibitors （ACEI）/angiotensin receptor blockers （ ARB）, beta blockers, digitalis, diuretics and other medicines combined with trimetazidine 20 mg/TID（ three times a day） to cure the heart failure for 6 months. The control group was given the same standard treatment combined with oryzanol for 6 months. Left ventricular end-diastolic diameter（LVEDD） , left ventricular ejection fraction （LVEF） , left ventricular end-systolic dimension（LVESD） , and 6-minute walking test（6MWT） were measured and compared between the two groups 6 months after the treatment. Results LVESD, LVEDD, LVEF and 6MWT in the treatment group improved better than those in the control group （ P 〈 0. 05 ）. No adverse reactions were found in both of the two groups. Conclusion Trimetazidine obviously improves the cardiac function of ICM patients with CHF and diabetes mellitus, and improves the quality of their lives.