曲美他嗪联合氯吡格雷治疗缺血性心肌病的临床疗效

Clinical efficacy of trimetazidine combined with clopidogrel on ischemic cardiomyopathy

目的探讨曲美他嗪联合氯吡格雷治疗缺血性心肌病(ICM)的疗效及对心功能和血浆N端-脑钠肽前体(NT-proBNP)水平的影响。方法选取2013年5月至2015年5月于我院接受治疗的ICM患者150例,随机分为对照组和观察组,每组各75例。对照组患者接受常规治疗,观察组患者在常规治疗的基础上接受曲美他嗪(一日2次,每次35 mg)联合氯吡格雷治疗(维持剂量一日75 mg),两组均持续治疗3个月。对比分析两组患者治疗前后左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室短轴缩短率(LVFS)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)及每博输出量(SV)等心功能指标;测定两组患者治疗前后血浆NT-proBNP水平;对比两组患者的治疗总有效率。结果治疗1个月和治疗3个月,两组患者LVESV、LVEDD和LVESD均较治疗前明显缩小(P<0.05或P<0.01),与对照组相比,治疗3个月后观察组缩小更为显著(P<0.05);治疗后两组LVEF、LVFS和SV均较治疗前明显升高(P<0.05或P<0.01),与对照组相比,观察组升高更显著(P<0.05);治疗1个月和治疗3个月,两组血浆NT-proBNP水平均较治疗前明显下降(P<0.05或P<0.01),与对照组相比,观察组下降更为显著(P<0.05);观察组患者治疗总有效率为90.7%,明显高于对照组的77.3%,差异具有统计学意义(P<0.05)。结论在常规抗心衰治疗基础上联用曲美他嗪和氯吡格雷能有效改善ICM患者的心功能,降低血浆NT-proBNP水平。

Objective To explore the efficacy of trimetazidine combined with clopidogrel in ischemic cardiomyopathy （ICM） patients and to observe their effect on heart function and the plasma level of N-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods A total of 150 cases of ICM patients treated in our hospital from May 2013 to May 2015 were selected and divided into two groups randomly （75 patients per group）. The control group received conventional anti- ischemic cardiomyopathy therapy, while the observation group additionally received the treatment of trimetazidine （35 mg once, twice one day） plus clopidogrel （75 mg one day）. Both groups were treated for 3 months. The cardiac function index of two groups, including left ventricular ejection fraction （LVEF）, left ventricular end systolic volume （LVESV）, left ventricular fractional shortening （LVFS）, left ventricular end systolic diameter （LVESD）, left ventricular end diastolic diameter （LVEDD） and stroke volume （SV） were compared. The plasma levels of NT-proBNP were measured before and after treatment in both groups, and the total effective rates of treatment in two groups were also compared. Results Compared with control group, the LVESV, LVESD and LVEDD of observation group in the 1st and 3ra month after treatment were significantly decreased （P〈0.05 or P〈0.01）, while the LVEF, LVFS and SV were significantly higher （P〈0.05 or P〈0.01）. 1st and 3rd month after treatment, the plasma level of NT-proBNP in two groups were significantly decreased compared with those before treatment （P〈0.05 or P〈0.01）. However, compared with the control group, those of the observation group were decreased more significantly （P〈0.05）. The total effective rate of observation group was 90.7%, which was significantly higher than that of control group （77.3%）, the difference was statistically significant （P〈0.05）. Conclusion On the basis of conventional anti-ischemic cardiomyopathy therapy, the additional using of trimetazidine combined with clopidogrel can effectively improve heart function. This treatment can decrease NT-proBNP plasma level of ICM patients.