心力衰竭患者氧自由基的变化及万爽力对其的影响

Effects of trimetazidine on serum oxygen free radicals in congestive heart failure

为探讨充血性心力衰竭 (CHF)患者超氧化物歧化酶 (SOD)、丙二醛 (MDA)、左室收缩功能及评价万爽力治疗对它们的影响。方法 :测定 15例健康者 ,16例心功能Ⅱ级 ,18例心功能Ⅲ级 ,16例心功能Ⅳ级患者血清SOD ,MDA水平 ,超声测定左室射血分数 (EF)和左室收缩末期容量指数 (LVESVI)。并将 5 0例CHF患者随机分为两组 ,一组患者在强心、利尿、硝酸甘油酯扩血管等常规治疗基础上加用万爽力治疗 ,一组仅用常规治疗 ,共 8周。结果 :CHF患者SOD和EF显著降低 (P <0 .0 5 ) ,MDA和LVESVI显著增高 (P <0 .0 5 ) ,随心衰程度的加重 ,而愈显著 ;万爽力治疗组和常规治疗组治疗后SOD和EF显著增加 (P <0 .0 1) ,MDA和LVESVI显著降低 (P <0 .0 1) ,且万爽力治疗组较常规治疗组更加明显 ,(P <0 .0 1)。结论 :氧自由基参与CHF的发生发展 ,血清SOD和MDA水平可以反映CHF严重程度 ,万爽力治疗后不仅能明显增高SOD水平 ,降低MDA水平 。

Objective To investigate the level of serum superoxide dismutase (SOD) and maiondialdehyde (MDA) and left ventricular systolic function in congestive heart failure (CHF) and to evaluate the influence of trimetazidine on them. Methods Serum SOD and MDA were measured in 50 patients with heart function from grade two to four and 15 normal subjects. All the persons underwent echocardiography to dertermine the left ventricular end systolic volume index (LVESVI) and the left ventricular ejection fraction (EF). The patients with CHF were randomly treated with trimetazidine plus routine therapy (n=25) or routine therapy only (n=25) for 8 weeks with evaluations made before and after the treatment. Results The SOD level and EF in the patients with CHF significantly decreased and the MDA level and LVESVI in those patients significantly increased compared with the normal subjects (P<0.05); the severer the CHF, the greater the changes. After the treatment, the SOD level and EF increased significantly and MDA and LVESVI decreased significantly (P<0.01) in both the trimetazidine and the conventional groups. And these changes were more obvious in the trimetazidine group than in the conventional group(P<0.01). Conclusion Oxygen free radicals play an important role in the pathophysiologic changes of CHF. The level of serum SOD and MDA can indicate the degree of CHF. Trimetazidine not only increases the level of SOD and decreases the level of MDA, but also improves the left ventricular systolic function.