高剂量曲美他嗪对扩张型心肌病心衰患者预后影响

High dose of trimetazidine on the prognosis of patients with dilated cardiomyopathy and heart failure

目的分析高剂量曲美他嗪(120 mg/d)对扩张型心肌病(DCM)心衰患者预后的影响。方法选取西京医院心内科及沈阳军区总医院心内科2014年出院的DCM心衰患者150例,随访1~2年,失访14例,最终纳入136例患者。按曲美他嗪使用剂量将患者分为高剂量组(40 mg,每天3次,n=13)、常规剂量组(20 mg,每天3次,n=99)及对照组(未服用,n=24),比较3组患者用药前后心功能、影像学改变及代谢相关指标的差异。结果高剂量组患者年龄、射血分数(EF)值均偏低(P<0.05);左心室收缩内径(LVESD)、CO、缩短分数(FS)、每搏输出量(SV)值均偏高(P<0.05);主要合并用药包括血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂(100%)、利尿剂(76.92%)及洋地黄(76.92%)。服用药物1~2年后,高剂量组患者脑钠肽、FS值、EF值均较常规剂量组明显减小,LVESD值较常规剂量组明显增大。高剂量与常规剂量的曲美他嗪均可降低CO值,且SV值改变均较对照组大。结论高剂量曲美他嗪常被用于病情偏重患者,但其疗效一般,仍需进一步证实。

Objective To analyze high dose （120 mg/day） of trimetazidine （TMZ） on dilated cardiomyopathy （DCM） affects the prognosis of patients with heart failure. Methods A retrospective study was performed on 150 DCM patients who were admitted in Xi- jing Hospital and The General Hospital of Shenyang Military Command in 2014. Patients were followed up for 1 to 2 years, 14 cases were lost, 136 cases were involved. According to the different dose of TMZ, patients were divided into the high dose group （40 mg, 3 times/day, n = 13 ）, the conventional dose group （ 20 mg, 3 times/day, n = 99 ） and the control group （ without taking, n = 24）, the three groups were compared before and after treatment in cardiac morphology change, function and related-metabolism index. Results The age, ejection fraction（EF） values of high dose group of patients were low（ P 〈 0. 05 ） ;left ventricular systolic diameter（ LVESD）, CO, shortening fraction （ fractional shortening, FS ）, stroke volume （ SV ） values were high （ P 〈 0. 05 ） ; ACEI or ARB （ 100% ）, diuretics （76. 92% ） and digitalis（76. 92% ）. After medicine taken 1 to 2 years later, BNP, FS value, EF value in high dose group decreased significantly than those in the conventional dose group, LVESD value was significantly increased than that in the conventional dose group. High dose and regular doses of TMZ can reduce CO value, and the SV values changed more than that in the control group. Con- clusion High dose of TMZ is often used in patients with severe disease,its efficacy is generally and needed to be further confirmed. Key words： High dose ; Trimetazidine; Dilated cardiomyopathy; Heart failure