曲美他嗪对高血压性心脏病患者心肌重构和氧化应激水平的影响

Effects of Trimetazidine on Myocardial Remodeling and Oxidative Stress in Patients with Hypertensive Heart Disease

目的:前瞻性研究曲美他嗪对高血压性心脏病(简称高心病)患者心肌重构和氧化应激水平的影响,为该药用于高心病的临床治疗提供参考。方法:选取我院2014年1月-2016年6月收治的高心病患者82例,根据抽签法随机分为对照组和观察组,各41例。对照组患者给予常规高心病化学药物(降压药、降脂药、降糖药、抗血小板药等)治疗;观察组患者在对照组基础上再给予曲美他嗪20 mg,tid。疗程均为3个月。于治疗前和治疗3个月后,比较两组患者收缩压(SBP)、舒张压(DBP)、纽约心脏病协会(NYHA)心功能分级、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室重量指数(LVMI)和血清中谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)、活性氧(ROS)水平变化,并观察其不良反应发生情况。结果:治疗前,两组患者各指标差异均无统计学意义(P>0.05)。治疗3个月后,两组患者SBP、DBP较治疗前显著降低(P<0.01),但两组间差异无统计学意义(P>0.05);两组患者NYHA心功能分级较治疗前以及两组间比较差异均无统计学意义(P>0.05);观察组LVESD、LVEDD、LVMI较治疗前显著降低(P<0.05),LVEF较治疗前显著升高(P<0.05),且观察组LVEDD、LVMI显著低于对照组(P<0.05);对照组仅SOD水平较治疗前显著降低,而观察组GSH-Px、SOD水平较治疗前均显著升高,MDA、ROS水平均显著降低,且观察组MDA、ROS水平显著低于对照组,差异均有统计学意义(P<0.05)。两组患者均未见明显不良反应事件发生。结论:曲美他嗪可改善高心病患者的心肌重构、降低其氧化应激水平,且安全性较好。

OBJECTIVE： To prospectively study the effects of trimetazidine on myocardial remodeling and oxidative stress in patients with hypertensive heart disease （HHD） , in order to provide reference for clinical treatment of HHD. METHODS： Eighty-two HHD patients were selected from our hospital during Jan. 2014-Jul. 2016, and they were divided into control group and observation group by sortition randomization method, with 41 cases in each group. Control group received routine HHD chemical drug （antihypertensive drugs, lipid-lowering drugs, hypoglycemic agents and antiplatelet drugs, etc.） therapy. Observation group was additionally given trimetazidine 20 rag, tid, on the basis of control group. Both groups were treated for 3 months. Before treat- ment and after 3 months of treatment, SBP, DBP, New York Heart Association （NYHA） cardiac function grade, LVEF, LVESD, LVEDD, LVMI and the levels of GSH-Px, SOD, MDA and ROS were compared between 2 group. The occurrence of ADR was observed in 2 groups. RESULTS： Before treatment, there was no statistical significance in each index between 2 groups （P〉0.05）. After 3 months of treatment, SBP and DBP of 2 groups were decreased significantly compared to before treatment （P〈0.01） ; there was no statistical significance between 2 groups （P〉0.05）. There was no statistical significance in NYHA cardiac function grade compared to before treatment or between 2 groups （P〉0.05）. LVESD, LVEDD and LVMI of observation group were de- creased significantly compared to before treatment （P〈0.05）; LVEF was increased significantly compared to before treatment （P〈 0.05） ; LVEDD and LVMI of observation group were significantly lower than control group （P〈0.05）. Compared to before treat- merit, SOD level of control group was decreased significantly, while the levels of GSH-Px and SOD in observation group were in- creased significantly; MDA and ROS of observation group were significantly lower than those of control group, with statistical sig- nificance （P〈0.05）. No obvious ADR was found in 2 groups. CONCLUSIONS： Trimetazidine can improve cayocardial remodel- ing and reduce oxidative stress level of HHD patients with good safety.