曲美他嗪对冠心病患者介入治疗损伤及心绞痛的影响

Effect of trimetazidine on myocardial injury and angina pectoris after percutaneous coronary in- tervention in patients with coronary disease

目的探讨不稳定型心绞痛患者在经皮冠状动脉介入治疗（PCI）术前应用曲美他嗪对PCI相关心肌损伤及术后长期应用对心绞痛的影响。方法选择拟行PCI的不稳定型心绞痛患者180例，随机分为曲美他嗪组与对照组。对照组给予阿司匹林、氯吡格雷、阿托伐他汀等治疗，曲美他嗪组入院时在常规治疗基础上给予曲美他嗪40mg负荷量，以后20mg／次，3次／d。于入院时，术后6、12、24、48h检测血清心肌肌钙白I（eTnI）和肌酸激酶同工酶（CK-MB），术后12个月随访心绞痛缓解情况及心电图改善情况。结果最终有132例完成实验，曲关他嗪组69例，对照组63例，两组患者入院时血清eTnI（F组间=8．392，P〉0．05）与CK-MB（F组间=6．725，P〉0．05）水平差异未见统计学意义（P〉0．05），术后两组患者血清水平均有升高，但曲美他嗪组升高幅度明显低于对照组，差异有统计学意义（P〈0．05）；经过12个月随访，曲美他嗪组患者心绞痛缓解及心电图改善均较对照组明显（P〈0．05）。结论曲美他嗪能够预防或改善PCI相关的心肌损伤，长期应用可明显缓解心绞痛发作。

Objective To investigate the effect of trimetazidine on percutaneous coronary inter- vention （PCI） related myocardial injury and long-term angina pectoris in patients with unstable angina pectoris after PCI. Methods A total of 180 patients with unstable angina peetoris scheduled to have PCI were randomly divided into trimetazidine group and control group, the control group was given aspirin, clopidogrel and atorvastatin treatment, and trimetazidine 40 mg loading dose was given on the basis of routine treatment in trimetazidine group on admission, later 20 mg for 3 times a day. The levels of serum cardiac troponin I （eTnI） and ereatine kinase isoenzyme （CK-MB） were measured at admission and 6, 12, 24 and 48 h after operation, and the remission of angina pectoris and the improvement of ECG were observed during 12 months after the operation. Results A total of 132 patients completed the study, 69 cases in trimetazidine group, and 63 cases in control group, respectively. There was no significant differ- ence in the serum levels of cTnI （ P 〉 0.05 ） or CK-MB （P 〉 0. 05 ） between the two groups before PCI. The serum levels of cTnI and CK-MB of the two groups elevated after PCI, but those in the trimetazidine group were remarkably lower than those in the control group, the differences were significant （P 〈 0.05 ）. During the 12 months follow-up, the remission of angina pectoris and the improvement of ECG in patients with trimetazidine group were more significant than those in the control group （P 〈 0. 05 ）. Conclusions Trimetazidine can prevent or improve PCI related myocardial injury, and the long-term ap- plication of trimetazidine can significantly relieve the angina pectoris attack.