左卡尼汀联合曲美他嗪对维持性血液透析患者左室心肌质量指数的影响

Effect of levocarnitine and trimetazidine on left ventricular mass index in patients with MHD

目的观察左卡尼汀联合曲美他嗪对维持性血液透析（MHD）患者左室心肌质量指数的影响，探讨两药联合使用的有效性及安全性。方法选择48例 MHD 患者随机分为对照组和治疗组，每组24例。在常规治疗基础上，治疗组每次透析结束后，静脉注射左卡尼汀针剂1．0 g，3次／周，同时口服曲美他嗪片剂20 mg，3次／d，对照组仅加用左卡尼汀，疗程12个月。比较治疗前后两组左房内径（LAD）、左室舒张末内径（LVDd）、左室收缩末内径（LVDs）、室间隔厚度（IvST）、左室后壁厚度（LVPWt），左室射血分数（LVEF）、每搏量（SV），计算左室心肌质量指数并比较。结果治疗后，对照组 LAD、LVDd、LVDs、IvST、LVPWt 分别为（40．25±1．73）mm、（51．16±3．17）mm、（32．52±2．86）mm、（11．16±1．23）mm、（10．23±1．19）mm，均较治疗前的（42．63±1．82）mm、（53．71±3．26）mm、（35．83±3．12）mm、（12．51±1．39）mm、（11．76±1．37）mm 下降，治疗后治疗组 LAD、LVDd、LVDs、IvST、LVPWt 分别为（37．61±1．86）mm、（47．53±3．18）mm、（29．71±2．93）mm、（10．46±1．32）mm、（9．14±1．32）mm，均较治疗前的（42．89±1．91）mm、（54．18±3．29）mm、（35．76±3．27）mm、（12．49±1．35）mm、（11．73±1．41）mm 下降（t 对照组＝4．643、2．747、3．831、3．563、4．130，t 治疗组＝9．702、7．120、6．750、5．209、6．569，均 P ＜0．05），且治疗后治疗组各指标均显著低于对照组（t ＝5．091、3．961、3．362、2．901、3．005，均 P ＜0．05）。治疗后对照组、治疗组的 LVMI 为（121．63±7．16）g／m2、（115．49±7．91）g／m2，均较治疗前（127．32±7．51）g／m2、（126．87±7．28）g／m2下降（t ＝2．686、5．186， P ＜0．05），治疗后对照组的 EF、SV 为（58．16±4．35）％、（43．61±4．72）mL，较治疗前的（55．32±4．17）％、（40．52±4．13）mL 提高（t 对照组＝2．309、2．414，P ＜0．05），治疗后治疗组的 EF、SV 为（61．26±4．13）％、（46．25±4．17）mL，较治疗前的（55．28±4．51）％、（40．81±4．96）mL 提高（t ＝4．791，4．113，P ＜0．05）。治疗后治疗组 LVMI 更低于对照组，EF、SV 高于对照组（t ＝2．819、2．532、2．053，P ＜0．05）。结论左卡尼汀联合曲美他嗪较单用左卡尼汀可更好的降低 MHD 患者的左室心肌质量指数，改善心脏结构及心功能，安全有效。

Objective To observe the effect of levocarnitine and trimetazidine on left ventricular mass index in patients with maintenance hemodialysis （MHD）,and to explore the safety and efficacy of the two drugs when used in combination.Methods 48 cases of MHD were randomly divided into control group and treatment group,24 cases in each group.On the basis of routine treatment,treatment group was treated with L -carnitine 1.0g by intravenous, 3 times per week,and trimetazidine tablets 20mg,3 times daily at the end of each dialysis.The control group was only treated with L -carnitine.The course of treatment was 12 months.The left atrial diameter （LAD）,left ventricular end diastolic diameter （LVDD）,left ventricular end diameter （LVDS）,interventricular septal thickness （IvST）,left ventricular posterior wall thickness （LVPWt）,left ventricular ejection fraction （LVEF）,stroke volume （SV）,left ventricular mass index calculation were detected and compared before and after treatment in the two groups.Results After treatment,the LAD,LVDd,LVDs,IvST,LVPWt in the control group were （40.25 ±1.73）mm,（51.16 ± 3.17）mm,（32.52 ±2.86）mm,（11.16 ±1.23）mm,（10.23 ±1.19）mm,which were decreased compared with before treatment [（42.63 ±1.82）mm,（53.71 ±3.26）mm,（35.83 ±3.12）mm,（12.51 ±1.39）mm,（11.76 ± 1.37）mm],and the LAD,LVDd,LVDs,IvST,LVPWt in the treatment group were （37.61 ±1.86）mm,（47.53 ± 3.18）mm,（29.71 ±2.93）mm,（10.46 ±1.32）mm,（9.14 ±1.32）mm,which were decreased compared with beforetreatment [（42.89 ±1.91 ）mm,（54.18 ±3.29）mm,（35.76 ±3.27）mm,（12.49 ±1.35 ）mm,（11.73 ± 1.41）mm]（t control group =4.643,2.747,3.831,3.563,4.130,t treatment group =9.702,7.120,6.750,5.209, 6.569,all P 〈0.05 ）,and each index of the treatment group was significantly lower than the control group （t =5.091,3.961,3.362,2.901,3.005,all P 〈0.05 ）.The LVMI of the control group and treatment group was （121.63 ±7.16）g/m2 ,（115.49 ±7.91）g/m2 after treatment,which were decreased compared with before treatment [（127.32 ±7.51）g/m2,（126.87 ±7.28）g/m2 ]（t =2.686,5.186,all P 〈0.05）.The EF and SV of the control group were （58.16 ±4.35）%,（43.61 ±4.72）mL after treatment,which were increased compared with before treatment[（55.32 ±4.17）%,（40.52 ±4.13）mL]（t =2.686,5.186,all P 〈0.05）.The EF and SV of the treatment group were （61.26 ±4.13）%,（46.25 ±4.17）mL after treatment,which were increased compared with before treat-ment[（55.28 ±4.51）%,（40.81 ±4.96）mL]（t =4.791,4.113,all P 〈0.05）.After treatment,LVMI in the treatment group was lower than that in the control group,SV and EF were higher than those in the control group （t =2.819,2.532,2.053,all P 〈0.05）.Conclusion Compared with single levocarnitine,the therapy of levocarnitine and trimetazidine can better reduce left ventricular mass index in MHD patients and improve the cardiac structure and function,which is safe and effective.