左卡尼汀联合曲美他嗪治疗慢性心力衰竭的疗效观察

Curative effect of L - carnitine combined with trimetazidine in the treatment of chronic heart failure

目的观察左卡尼汀联合曲美他嗪治疗慢性心力衰竭的临床疗效。方法回顾性分析慢性心力衰竭患者700例的临床资料，按治疗方法不同分为A、B、C、D四组，A组181例，在常规治疗基础上采用左卡尼汀联合曲美他嗪治疗，B组177例，在常规治疗基础上采用左卡尼汀治疗，C组175例，在常规治疗基础上采用曲美他嗪治疗，D组167例，给予常规治疗。比较四组临床疗效。结果A、B、C、D组总有效率分别为83．43％、76．84％、73．71％、62．28％，A组总有效率明显优于其他各组，差异有统计学意义（χ2=22．40，P〈0．05）；B组与C组总有效率差异无统计学意义（χ2=0．46，P〉0．05），但均明显优于D组（χ2=4．37、5．13，均P〈0．05）。四组治疗前后6min步行试验、N末端脑利钠肽前体、左室射血分数、左室短轴缩短率均显著改善（A组：t=33．856、37．474、17．722、31．250，B组：t=27．328、31．559、6．863、25．581，C组：t=23．430、32．640、9．524、16．923，D组：t=15．863、9．602、3．061、10．169，均P〈0．01），A组治疗后上述四项指标均明显优于B、C、D组（F=5．884、38．621、4．357、13．770，均P〈0．01）。结论左卡尼汀联合曲美他嗪可以改善心肌异常代谢状况，优化心肌能量代谢途径，提高患者短期心脏功能效果明显，值得推广联合使用。

Objective To observe the clinical efficacy of L - carnitine combined with trimetazidine in the treatment of chronic heart failure. Methods The clinical data of 700 patients with chronic heart failure were retrospectively analyzed. According to different treatment methods, they were divided into four groups：A, B, C, D. 181 cases of A group used L - camitine combined with trimetazidine treatment on the basis of routine treatment. 177 cases of B group received L - carnitine treatment on the basis of routine treatment. 175 cases of C group received trimetazidine treatment on the basis of routine treatment. 167 cases of D group received conventional treatment. Then, the clinical efficacy of the four groups was compared. Results The total effective rates of A, B, C,D groups were 83.43%, 76. 84% ,73.71% ,62.28%, respectively. The total effective rate of A group was obviously higher than the other groups, the difference was statistically significant（ χ2 = 22.40, P 〈 0.05 ）. There was no significant difference in total effective rate between B group and C group （χ2 = 0.46, P 〉 0.05 ） , but both B and C groups were obviously better than group D （ χ2 = 4. 37, 5. 13, all P 〈 0.05 ）. The data before and after treatment in four groups were significantly improved, such as 6MWT, NT - proBNP, LVEF and FS （ A group ： t = 33. 856,37. 474,17. 722,31. 250, B group ： t = 27. 328,31. 559,6. 863,25.581, C group ： t = 23. 430,32. 640,9. 524,16. 923, D group ： t = 15. 863,9. 602,3.061, 10, 169, all P 〈 0.01 ）. In the above four indicators, those in A group were obviously better than B group, C group and D group （F = 5. 884,38. 621,4. 357,13. 770, all P 〈 0.01 ）. Conclusion L - earnitine combined with trimetazidine can improve the abnormal metabolism of myocardium, optimize the energy metabolism pathway of myocardium,improve the short - term cardiac function of patients markedly. L - carnitine combined with trimetazidine is worthy of promoting joint use.