核素心肌灌注显像对曲美他嗪治疗扩张型心肌病的疗效评价

Evaluation of the effect of radionuclide myocardial perfusion imaging on the treatment of dilated cardiomyopathy with trimetazidine

目的利用核素心肌灌注显像评价曲美他嗪治疗扩张型心肌病的疗效。方法选取2015年1月至2017年12月河南省人民医院扩张型心肌病患者105例,按随机数字表法分为对照组46例和治疗组59例。对照组接受标准剂量基础药物治疗,治疗组加用曲美他嗪20 mg/次,3次/d口服,疗程均为6个月。治疗前后均行99mTc-MIBI核素静息心肌灌注显像、6 min步行试验、N末端B型利钠肽原(NT-proBNP)等检查,比较两组患者心功能变化。结果经治疗后,两组左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)均较治疗前明显改善,6 min步行距离较治疗前增加,血浆NT-proBNP水平较治疗前降低,差异均有统计学意义(均为P <0. 05);且治疗后,曲美他嗪治疗组较对照组改善更为明显[LVESV:(82. 28±29. 38) ml比(100. 50±37. 34) ml,t=3. 785,P=0. 006; LVEDV:(142. 29±41. 40) ml比(162. 91±37. 19) ml,t=1. 872,P=0. 032; LVEF:47. 08%±8. 52%比43. 17%±7. 22%,t=1. 982,P=0. 02; NT-proBNP:(1 202. 48±503. 28) pg/ml比(1 700. 66±600. 31) pg/ml,t=4. 625,P=0. 007; 6 min步行距离:(446. 80±60. 20) m比(408. 04±65. 75) m,t=2. 638,P=0. 028]。结论核素心肌灌注显像可用于曲美他嗪对扩张型心肌病患者心功能和运动耐量的疗效评价。

Objective Evaluation of the efficacy of trimetazidine(TMZ)in patients with dilated cardiomyopathy(DCM)using nuclear myocardial perfusion imaging. Methods The 105 patients diagnosed of DCM in Henan Provincial People??s Hospital from January 2015 to December 2017 were randomly divided into control group(n=46)and TMZ group(n=59).Besides conventional therapies for DCM patients in both groups for 6 months,the patients in treatment group were treated with TMZ 20 mg tid.Before and after treatment,myocardial perfusion imaging was carried out to compare left ventricular function between both groups,referring to 6 minutes walking test(6MWT)and the level of NT-proBNP in serum.Results After treatment,left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)and left ventricular ejection fraction(LVEF)were significantly improved compared with those before treatment in each group;the 6 minutes walking distance was increased compared with before treatment;the level of NT-proBNP in serum was lower than that before treatment(both P<0.05).Furthermore,After the treatment,the TMZ group improved more significantly than the control group[LVESV:(82.28±29.38)ml vs.(100.50±37.34)ml,t=3.785,P=0.006;LVEDV:(142.29±41.40)ml vs.(162.91±37.19)ml,t=1.872,P=0.032;LVEF:47.08%±8.52%vs.43.17%±7.22%,t=1.982,P=0.02;NT-proBNP:(1 202.48±503.28)pg/ml vs.(1 700.66±600.31)pg/ml,t=4.625,P=0.007;6MWT:(446.80±60.20)m vs.(408.04±65.75)m,t=2.638,P=0.028].Conclusions For patients with dilated cardiomyopathy,radionuclide myocardial perfusion imaging may be used to evaluate the efficacy of trimetazidine on cardiac function and exercise tolerance.