双倍剂量与标准剂量曲美他嗪对不稳定型心绞痛行经皮冠状动脉介入治疗患者围术期心肌保护作用的对比研究

Comparison of double versus standard dose trimetazidine on myocardial protection in patients with unstable angina undergoing percutaneous coronary intervention

目的探讨双倍剂量与标准剂量曲美他嗪对不稳定型心绞痛行经皮冠状动脉介入治疗(PCI)患者心肌保护作用的差异。方法连续纳入2014年9月至2015年6月在航天中心医院行PCI的不稳定型心绞痛患者150例,随机分为试验组(术前24 h给予曲美他嗪40 mg,每日3次口服)和对照组(术前24 h给予曲美他嗪20 mg,每日3次口服),均常规给予冠心病二级预防治疗。对比两组患者在PCI术后心绞痛发作及心电图变化情况,术前及术后12 h心肌肌钙蛋白I(c Tn I)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)水平。结果两组患者年龄、性别、体重指数、家族史、高脂血症、高血压病、吸烟、糖尿病、他汀类药物、硝酸酯类药物、血管紧张素转化酶抑制药/血管紧张素Ⅱ受体拮抗药(ACEI/ARB)、β阻滞药使用情况及药物不良反应比较,差异均无统计学意义(均P>0.05)。两组患者病变部位、病变支数、靶血管置入支架数、平均支架长度及平均支架直径比较,差异均无统计学意义(均P>0.05)。PCI术前两组患者c Tn I、Mb、CK-MB及hs-CRP水平比较,差异均无统计学意义(均P>0.05);PCI术后,试验组c Tn I[(0.49±0.21)ng/ml比(1.50±0.58)ng/ml,P<0.001]及hs-CRP[(16.1±3.7)mg/L比(23.5±4.1)mg/L,P<0.001]水平显著低于对照组,差异均有统计学意义;而CK-MB及Mb有减低趋势,但两组间比较差异无统计学意义(均P>0.05);试验组术后1 d心绞痛及心电图ST-T改变的发生率较对照组有降低趋势,但两组间比较差异亦均无统计学意义(均P>0.05)。结论对拟行PCI的不稳定型心绞痛患者,术前给予双倍剂量的曲美他嗪,能进一步增加心肌保护作用、减少PCI相关心肌损伤。

Objective To compare the protective effect of double dose trimetazidine versus standard dose in patients with unstable angina and received PCI. Methods From September 2014 to June 2015,150 unstable angina pectoris patients who underwent PCI in our hospital were enrolled in this study. All the patients were randomized into two groups： the study group（ patients given trimetazidine 40 mg tid 24 hours before operation） and the control group（ patients given trimetazidine 20 mg tid 24 hours before operation）.All patients received standard secondary prevention therapies of coronary heart disease. Comparison in the rates of angina pectoris attacks,ECG changes after PCI,levels of cardiac troponin I（ c Tn I）,myoglobin（ Mb）,creatine kinase isoenzyme（ CK-MB） and hs-CRP before and 12 hours after PCI was investigated between the 2 groups. Results Baseline data were comparable in the 2 groups. Rates of adverse drug reaction were lower in the control group,but the difference was not statistically significant（ 6. 7% vs.2. 7%,P = 0. 439）. There was no statistical difference between the two groups before PCI in terms of levels of c TNI and hs-CRP but was significantly lowered in the study group after PCI as compared to the control（ both P 〈 0. 05 after PCI）. The levels of CK-MB and Mb in the study group were lower than those in the control group after PCI,but the difference was not statistically significant. The rates of angina pectoris attacks and the changes in ST-T were less in the study group as compared to the control group without statistical significance. Conclusions Unstable angina pectoris patients receiving double dose of trimetazidine before PCI may enhance myocardial protection and reduce PCI related myocardial injury.