曲美他嗪联合左卡尼汀治疗缺血性心肌病疗效及对患者肌钙蛋白I和同型半胱氨酸水平的影响

Effects of Trimetazidine combined with 1-Carnitine on the treatment of ischemic cardiomyopathy and serum troponin I and Hcy levels in the patients

目的 探讨曲美他嗪联合左卡尼汀治疗缺血性心肌病疗效及对患者血清肌钙蛋白I(troponin I,cTnI)、同型半胱氨酸(homocysteine,Hcy)水平的影响.方法 选取2014年6月至2017年6月于我院就诊的老年缺血性心肌病患者192例作为研究对象,采用随机数字法将患者分为两组,每组96例.对照组患者入院后接受缺血性心肌病的常规治疗,观察组在对照组基础上应用注射用左卡尼汀2 g加入0.9%氯化钠200ml中,静脉滴注,1次/d,同时给予盐酸曲美他嗪片治疗,20 mg(1片)/次,3次/d,两组患者连续治疗28d.对比两组患者治疗前后的cTnI和Hcy的水平和超声心动图指标的变化,并记录临床疗效及治疗期间不良反应情况,并对患者进行为期1年的随访.结果 观察组治疗总有效率为85.42%,对照组治疗总有效率为69.79%,差异有统计学意义(x2=16.071,P<0.001);治疗前1d两组患者左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)等心功能指标及cTnI、Hcy水平未见统计学差异(P>0.05);药物治疗后,两组患者的LVESD、LVEDD血清cTnI、Hcy水平均明显降低,其中在药物治疗2周、3周以及4周后观察组下降更为明显,经重复性方差分析显示两组间不同时间点差异具有统计学意义(P<0.05).观察组患者不良反应发生率为9.38%;对照组患者不良反应发生率为6.25%.两组间不良反应发生率比较通过Fisher精确检验,未见统计学差异(P=0.593).随访期间,与观察组相比,对照组发生主要不良心血管事件(major adverse cardiovascular events,MACE)的风险增加了1.57倍(95%CI 1.26~1.79,P=0.023);Kaplan-Meier生存分析显示,差异有统计学意义(P<0.05).结论 曲美他嗪联合左卡尼汀治疗缺血性心肌病时可有效的改善患者心功能及cTnI、Hcy水平,且不良反应并未增加,有助于患者预后,值得临床推广应用.

Objective To investigate the curative effect of Trimetazidine combined with 1-Camitine on the treatment of ischemic cardiomyopathy and the serum troponin I (cTnI) and homocysteine (Hey) of the patients. Methods Total of 192 elderly patients with ischemic cardiomyopathy admitted to our hospital from June 2014 to June 2017 were selected as the study subjects. The patients were divided into two groups with 96 cases in each group by random number method. Patients in the control group received routine treatment for ischemic cardiomyopathy after admission. On the basis of the routine treatment, patients in the observation group were treated with Levocamitine 2 g for injection, added into 0.9% sodium chloride 200 ml, intravenous drip, once a day;and Trimetazidine hydrochloride tablets at the same time, 20 mg (1 tablet) per time, 3 times per day. Patients in the two groups were treated for 28 days continuously. The changes of serum troponin I and Hey levels and cardiac ultrasound indexes before and after treatment in the two groups were compared;and the clinical efficacy and adverse reactions during treatment were recorded. All the patients were followed up for one year.Results The total effective rate in the observation group was 85.42%. The total effective rate in the control group was 69.79%, with statistically significant difference(/^= 16.071, P<0.001).There were no significant differences in cTnI and Hey levels between the two groups (P>0.05) before the treatment. The incidence of adverse reactions in the observation group was 9.38%. The incidence of adverse reactions in the control group was 6.25%. The incidence of adverse reactions between the two groups was compared by Fisher's exact test and the difference was not statistically significant (P=0.593). During the follow-up period, compared with the observation group, the risk of major adverse cardiovascular events in the control group increased by 1.57 times (95%C/ 1.26?1.79, P= 0.023). Kaplan-meier survival analysis showed that the difference was statistically significant (P<0.05). Conclusion Trimetazidine combined with 1-Camitine in the treatment of ischemic cardiomyopathy can effectively improve the patients' cardiac function, serum troponin and Hey levels, and there is no increase in adverse reactions, which is helpful for the prognosis of patients and worthy of clinical application.