曲美他嗪联合阿托伐他汀对老年不稳定性心绞痛患者血清指标及超声参数的影响

Impact of trimetazidine combined with atorvastatin on serum indicators and ultrasound parameters in elderly patients with unstable angina pectoris

目的 分析曲美他嗪联合阿托伐他汀对老年不稳定性心绞痛(unstable angina pectoris, UAP)患者血清血管生成素2(angiopoietin-2,Ang-2)、甲壳质酶蛋白40(chitinase protein 40,YKL-40)水平及超声参数的影响。方法 收集2021年1月至2024年3月解放军陆军第八十一集团军医院收治的老年UAP患者133例,根据治疗方法将患者分为对照组64例和曲美他嗪组69例,对照组行阿托伐他汀治疗,曲美他嗪组行阿托伐他汀联合曲美他嗪治疗。治疗4周后观察2组临床疗效,比较2组治疗前及治疗4周后西雅图心绞痛量表(Seattle Angina Questionnaire, SAQ)评分、硝酸甘油服用量、脂代谢[总胆固醇、三酰甘油、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)]、心脏超声参数[左心室射血分数(left ventricular ejection fraction, LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter, LVEDD)、左心室质量指数(left ventricular mass index, LVMI)]、血清指标[Ang-2、YKL-40、血管性血友病因子(von Willebrand factor, vWF)、基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)]差异,记录2组治疗期间不良反应发生情况。结果 曲美他嗪组总有效率显著高于对照组(84.1%vs 67.2%,P<0.05)。2组治疗后SAQ评分、HDL-C、LVEF均较治疗前显著升高(P<0.05),且曲美他嗪组治疗后SAQ评分、HDL-C、LVEF高于对照组(P<0.01);2组治疗后硝酸甘油服用量、总胆固醇、三酰甘油、LDL-C、LVEDD、LVMI、血清Ang-2、YKL-40、vWF、MMP-9均较治疗前显著降低(P<0.05),且曲美他嗪组治疗后硝酸甘油服用量、总胆固醇、三酰甘油、LDL-C、LVEDD、LVMI、血清Ang-2、YKL-40、vWF、MMP-9低于对照组(P<0.01)。曲美他嗪组与对照组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 曲美他嗪联合阿托伐他汀治疗老年UAP能提升疗效,改善老年UAP患者脂代谢及心功能,下调血清Ang-2、YKL-40、vWF、MMP-9水平可能是其作用机制。

Objective To analyze the influence of trimetazidine combined with atorvastatin on serum angiopoietin-2(Ang-2)and chitinase protein 40(YKL-40)levels and ultrasound parameters in elderly patients with unstable angina pectoris(UAP).Methods A total of 133 elderly UAP patients admitted in Hospital of the 81st Group of PLA Army from January 2021 to March 2024 were enrolled,and according to their treatment methods,they were divided into control group(64 cases,simple atorvastatin)and trimetazidine group(69 cases,atorvastatin+trimetazidine).After 4 weeks of treatment,the clinical efficacy was observed in the two groups.Seattle Angina Questionnaire(SAQ)score and nitroglycerin dosage,lipid metabolic indicators(TC,TG,LDL-C and HDL-C),cardiac ultrasound parameters[LVEF,LVEDD and left ventricle mass index(LVMI)],serum indicators[Ang-2,YKL-40 and von Willebrand factor(vWF),matrix metallo proteinase-9(MMP-9)]were compared between the two groups before treatment and after 4 weeks of treatment.The adverse reactions during treatment were also recorded in the two groups.Results The total effective rate was significantly higher in the trimetazidine group than the control group(84.06%vs 67.19%,P<0.05).The SAQ score,HDL-C level and LVEF value were significantly risen in the two groups after treatment(P<0.05),and these indicators were obviously higher in the trimetazidine group than the control group(P<0.01).The nitroglycerin dosage,levels of TC,TG and LDL-C,LVEDD and LVMI values and serum contents of Ang-2,YKL-40,vWF and MMP-9 were significantly reduced in the two groups after treatment when compared with those before treatment(P<0.05),and these indicators in the trimetazidine group were lower than those in the control group(P<0.01).There was no statistical difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Trimetazidine combined with atorvastatin can enhance the efficacy and improve the lipid metabolism and cardiac function in the treatment of elderly UAP patients,which might be due to down-regulating the serum levels of Ang-2,YKL-40,vWF and MMP-9.