曲美他嗪治疗老年慢性心力衰竭合并肌少症患者的效果

Therapeutic effect of trimetazidine on elderly patients with chronic heart failure and muscular dystrophy

目的探讨曲美他嗪对合并肌少症的老年慢性心力衰竭患者的疗效。方法以随机数字法将216例合并肌少症的老年慢性心力衰竭患者分为2组,每组108例。对照组给予常规心脏药物治疗,观察组加用曲美他嗪。检测患者心功能指标、炎性细胞因子、骨骼肌功能相关指标、并统计两组的治疗效果。结果治疗后,观察组左心射血分数(LVEF)、左室舒张早期快速充盈的充盈峰/舒张晚期充盈的充盈峰(E/A)、6 min步行试验(6MWT)为(45.53±8.61)%、(1.23±0.14)、(362.4±67.9)m,明显高于治疗前[(33.74±6.65)%、(0.67±0.12)、(250.54±61.2)m](P<0.05),且明显高于对照组治疗后[(39.23±58.2)%、(0.86±0.10)、(299.47±59.6)m](P<0.05);治疗后,观察组左心室舒张末容量(LVEDV)、左心室收缩末期容积(LVESV)为(119.83±17.92)m L、(68.82±10.41)m L,明显低于治疗前的[(169.52±18.21)m L、(98.43±9.23)m L](P<0.05),且明显低于对照组治疗后[(152.31±17.43)m L、(80.61±8.18)m L](P<0.05)。治疗后,观察组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)为(387.51±18.26)ng/L、(10.28±2.39)ng/L,明显低于治疗前的[(442.32±21.52)ng/L、(15.52±3.17)ng/L](P<0.05),且明显低于对照组治疗后[(412.32±16.38)ng/L、(13.43±3.24)ng/L](P<0.05)。治疗后,观察组手握力(HS)、用步速测量仪测定速度(GS)、测定简易体能状况量表(SPPB)为(22.35±3.22)kg、(0.87±0.09)m/s、(8.18±2.34),明显高于治疗前[(17.37±3.15)kg、(0.69±0.21)m/s、(6.24±1.92)](P<0.05),且明显高于对照组治疗后[(18.12±3.02)kg、(0.69±0.24)m/s、(6.86±1.08)](P<0.05);治疗后,观察组C1q为(534.25±27.32)ng/L,明显低于治疗前的(586.50±31.22)ng/L(P<0.05),且明显低于对照组治疗后(579.45±18.32)ng/L(P<0.05)。观察组治疗总有效率为89.3%,显著高于对照组的71.4%(P<0.05)。结论曲美他嗪能改善老年慢性心力衰竭并肌少症患者的心脏功能,增加运动耐量。

Objective To investigate the efficacy of trimetazidine on elderly patients with chronic heart failure and muscular dystrophy. Methods 216 patients with elderly patients with chronic heart failure and muscular dystrophy were randomly divided into two groups with 108 cases in each group. The control group was treated with conventional car- diac medication, and treatment of observation group was supplemented with trimetazidine. The cardiac function indexes, inflammatory cytokines and skeletal muscle function were measured, and the therapeutic effect was estimated. Results After treatment,LYEF,E/A and 6MWT of observation group were [ （45.53 ± 8.61 ）% , （ 1.23 ± 0.14） , （362.4 ± 67.9 ） m ], which were significantly higher compared with pre-treatment status [ （ 33.74 ± 6.65 ） %, （ 0.67 ：i： 0. 12 ）, （250.54 ± 61.2） m ], and control group [ （ 39.23 ± 58.2 ） %, （ 0.86 ± 0.10）, （ 299.47 ± 59.6 ） m ] ; After treatment, LVEDV and LVESV of observation group were [ （ 119.83 ± 17.92） mL, （68.82 ± 10.41 ） mL] ,which were significant- ly lower compared with pre-treatment status [ （ 169. 52 ± 18. 21 ） mL, （98. 43 ± 9. 23 ） mL], and control group [ （152. 31 ± 17. 43 ） mL, （ 80. 61 ± 8. 18 ） mL]. After treatment, TNF-ct and IL-6 of observation group were [ （387.51 ± 18.26） ng/L, （10.28 ± 2.39） ng/L] , which were significantly lower compared with pre-treatment status [（442.32±21.52） ng/L,（15.52±3.17） ng/L],and control group E（412.32 ±16.38） ng/L,（13.43 ±3.24） ng/L]. After treatment, HS, GS, and SPPB of observation group were [ （22.35 ± 3.22） kg, （0.87 ± 0.09 ） m/s, （8.18 ±2.34） ] ,which were significantly higher compared with pre-treatment status ± （ 17.37 ± 3.15 ） kg, （0.69 ± 0. 21 ） m/s, （6.24 ± 1.92） ], and control group E （ 18.12 ± 3.02 ） kg, （ 0.69 ± 0. 24 ） m/s, （ 6.86 ± 1.08 ） ] ; After treatment, C1 q of observation group was（534.25 ± 27.32） ng/L,whieh was significantly lower compared with pre-treat- ment status （ 586.50 ± 31.22 ） ng/L, and eantrol group （ 579.45 ± 18.32 ） ng/L （ P 〈 0.05 ）. The total effective rate of observation group was 89.3 % ,which was significantly higher than control group （71.4% ,P 〈 0.05 ）. Conclusion U- sing TMZ combined with conventional cardiac therapy can significantly improve the cardiac function, increase the exer- cise tolerance of elderly patients with chronic heart failure and muscular dystrophy.