曲美他嗪对不稳定型心绞痛合并糖尿病患者经皮冠状动脉介入治疗后心肌损伤及再发心绞痛的影响

Effect of trimetazidine on myocardial injury and recurrence angina pectoris after percutaneous coronary intervention in unstable angina pectoris patients with diabetes

目的 评价曲美他嗪对不稳定型心绞痛（UAP）合并糖尿病患者经皮冠状动脉介入（PCI）治疗后心肌损伤、再发心绞痛症状及心功能的影响。方法 选取2013年1月至2015年12月首都医科大学附属北京安贞医院收治的192例UAP合并糖尿病拟行PCI手术的患者，按照随机数字表法分为常规治疗组和曲美他嗪组，各96例。常规治疗组采用常规治疗；曲美他嗪组在常规治疗组基础上于PCI前3 d开始口服曲美他嗪20 mg/次、3次/d至术后6个月。分别测定PCI前及PCI后16、24 h患者血清心肌肌钙蛋白I（cTnI）水平。电话随访患者PCI后6个月内有无再发心绞痛，并于PCI后6个月时复查超声心动图，测定左心室射血分数（LVEF）。结果 PCI后16、24 h 2组cTnI水平较PCI前逐渐升高，曲美他嗪组升高幅度小于常规治疗组，cTnI水平组间比较差异有统计学意义［（0.150±0.050）μg/L比（0.450±0.200）μg/L、（0.220±0.110）μg/L比（0.670±0.110）μg/L］（P〈0.01）。PCI后6个月内曲美他嗪组心绞痛再发率明显低于常规治疗组［8.3%（8/96）比22.9%（21/96）］，PCI后6个月时曲美他嗪组LVEF明显高于常规治疗组［（56.1±2.2）%比（50.8±2.4）%］，差异均有统计学意义（均P〈0.05）。结论 PCI治疗前后口服曲美他嗪可以减少心肌损伤，降低心绞痛再发率，改善左心室功能。

Objective To evaluate the effect of trimetazidine on myocardial injury and recurrence angina pectoris in unstable angina pectoris（UAP） patients with diabetes after percutaneous coronary intervention（PCI）. Methods A totally of 192 UAP patients with diabetes undergoing PCI were divided into trimetazidine group and conventional treatment group according to the random number table method, with 96 cases in each group. The conventional treatment group was treated with routine treatment; the trimetazidine group had trimetazidine 20 mg/time, 3 times/d before PCI and maintain the same dose after PCI for 6 months. The level of serum cardiac troponin I（cTnI） was tested before PCI and at 16, 24 h after PCI. Recurrent angina pectoris was observed through 6 months of telephone follow-up; echocardiography was reexamined at 6 months after PCI and left ventricular ejection fraction（LVEF） was determined. Results The cTnI levels were gradually increased after PCI in both groups, the increasing range in trimetazidine group was smaller than that in conventional treatment group; cTnI levels at 16, 24 h after PCI had significant differences between groups[（0.15±0.05）μg/L vs （0.45±0.20）μg/L, （0.22±0.11）μg/L vs （0.67±0.11）μg/L]（P〈0.01）. The recurrent angina pectoris rate during 6 months after PCI in trimetazidine group was lower than that in conventional treatment group[8.3%（8/96） vs 22.9%（21/96）]; the LVEF at 6 months after PCI in trimetazidine group was higher than that in conventional treatment group[（56.1±2.2）% vs （50.8±2.4）%], the differences were statistically significant（P〈0.05）. Conclusions Trimetazidine can ameliorate PCI-induced myocardial injury, reduce the incidence of recurrent angina pectoris and improve left ventricular function.