曲美他嗪对急性心肌梗死患者肝肾功能及血糖的影响研究

Impact of Trimetazidine on Hepatic and Renal Function, and Blood Glucose of Patients with Acute Myocardial Infarction

目的探讨曲美他嗪对急性心肌梗死(AMI)患者肝肾功能及血糖的影响。方法选取2014年1月—2016年1月在秦皇岛市第一医院CCU住院的AMI患者220例,采用随机数字表法分为对照组和观察组,每组110例。对照组患者给予常规治疗,观察组患者在常规治疗基础上加用曲美他嗪治疗。比较两组患者基础药物使用情况、手术治疗情况,治疗前和治疗2 d后血浆肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平,治疗前和治疗6 d后血浆心肌肌钙蛋白I(c Tn I)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮水平及血糖。结果观察组1例患者自动出院而退出研究。两组患者使用阿司匹林、氯吡格雷、替格瑞洛、低分子肝素钙、β-受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂、他汀类药物及硝酸酯类药物者所占比例比较,差异无统计学意义(P>0.05)。两组患者罪犯血管、置入支架数、行冠状动脉介入治疗者所占比例、TIMI血流分级0~2级者所占比例及行血栓抽吸术者所占比例比较,差异无统计学意义(P>0.05)。治疗前两组患者血浆CK、CK-MB、c Tn I水平比较,差异无统计学意义(P>0.05);治疗2 d后观察组患者血浆CK、CK-MB水平低于对照组,治疗6 d后观察组患者血浆c Tn I水平低于对照组(P<0.05)。治疗前两组患者血浆ALT、AST、Cr、尿素氮水平及血糖比较,差异无统计学意义(P>0.06);治疗6 d后观察组患者血浆ALT、AST水平及血糖低于对照组(P<0.05),而两组患者血浆Cr和尿素氮水平比较,差异无统计学意义(P>0.05)。结论曲美他嗪对AMI患者具有一定的心肌保护作用,并能有效改善患者肝功能及调节血糖,而对肾功能则无明显影响。

Objective To investigate the impact of trimetazidine on hepatic and renal function,and blood glucose of patients with acute myocardial infarction. Methods From January 2014 to January 2016,a total of 220 inpatients with acute myocardial infarction were selected in the Department of Coronary Care Unit（ CCU）,the First Hospital of Qinhuangdao,and they were divided into control group and observation group,each of 110 cases. Patients of control group received conventional treatment,while patients of observation group received extra trimetazidine based on conventional treatment. Usage of essential medicine,surgical treatment,plasma levels of CK and CK-MB before treatment and after 2 days of treatment,plasma levels of cTnI,ALT,AST,Cr,BUN,and blood glucose before treatment and after 6 days of treatment were compared between the two groups. Results One case of observation group withdrew from the study due to against- advice discharge. No statisticallysignificant differences of proportion of patients treated with aspirin, clopidogrel, ticagrelor, low molecular weight heparin calium,beta- blocker, ACEI / ARB, statins or nitrates was found between the two groups（ P 〉 0. 05）. No statistically significant differences of culprit vessels,number of implanted stents,proportion of patients undergoing PCI,with 0 to 2- grade TIMI flow grade or undergoing thrombus aspiration was found between the two groups（ P 〉 0. 05）. No statistically significant differences of CK,CK-MB or cTnI was found between the two groups before treatment（ P 〉 0. 05）; plasma levels of CK and CK-MB of observation group were statistically significantly lower than those of control group after 2 days of treatment,meanwhile plasma cTnI level of observation group was statistically significantly lower than that of control group after 6 days of treatment（ P 〈0. 05）. No statistically significant differences of plasma level of ALT,AST,Cr or BUN,or blood glucose was found between the two groups before treatment,nor was plasma level of Cr or BUN between the two groups after 6 days of treatment（ P 〉 0. 06）,while plasma levels of ALT and AST,and blood glucose of observation group were statistically significantly lower than those of control group after 6 days of treatment（ P 〈 0. 05）. Conclusion Trimetazidine has certain cardioprotective effect in patients with acute myocardial infarction, can effectively improve the hepatic function and adjust the blood glucose, without obvious impact on renal function.