曲美他嗪对冠心病患者介入治疗术后生长分化因子15的影响

Effects of trimetazidine on serum growth differentiation factor-15 and prognostic value in patients with coronary heart disease underwent percutaneous coronary intervention

目的观察冠心病患者在经皮冠状动脉介入治疗围手术期使用曲美他嗪对术后生长分化因子15(GDF-15)、单核细胞趋化蛋白1(MCP-1)以及高敏C反应蛋白(hs-CRP)的影响。评估曲美他嗪使用对冠心病患者预后的影响。方法连续入选冠心病患者共96例并分为两组,观察组(56例)入院后即给予曲美他嗪常规治疗(20 mg,每日3次)至少7天,并在介入治疗术前使用负荷剂量的曲美他嗪(60 mg),术前负荷量的抗血小板药物使用同对照组一致,术后至少服用1月以上维持量曲美他嗪,对照组(40例)术前仅使用常规抗血小板药物,术后24 h内抽血测定GDF-15、MCP-1、hs-CRP浓度,并对出院的患者进行门诊及电话随访,分析两组患者净临床不良事件(NACE)以及主要不良心脑血管事件(MACCE)发生率。结果观察组患者术后GDF-15浓度低于对照组(737.24±299.85 ng/L比1175.84±523.52 ng/L,P=0.002)。MCP-1及hs-CRP浓度在两组患者中差异无显著性。患者平均随访时间(30.26±8.80)月,观察组出现NACE事件2例,对照组出现NACE事件7例,生存分析结果提示观察组NACE事件发生率低于对照组,差异有统计学意义(P=0.012)。结论使用曲美他嗪的冠心病患者介入术后GDF-15浓度较低,NACE事件发生率降低。

Aim To observe the effects of high-loading-dose trimetazidine on serum growth differentiation factor-15( GDF-15),monocyte chemoattractant protein-1( MCP-1),and high sensitive C-reactive protein( hs-CRP) level in patients with coronary heart disease underwent percutaneous coronary intervention( PCI). To evaluate the beneficial effects of high-loading-dose of trimetazidine before PCI in patients with coronary heart disease. Methods Totally 96 consecutive patients with coronary heart disease were divided into trimetazidine group( 56 cases) and control group( 40 cases).Standard medical therapies were given in all patients. In trimetazidine group,patients were given high-loading-dose of trimetazidine( 60 mg) 30 minutes before PCI and maintenance dose at least 1 month after PCI. The GDF-15,MCP-1,and hs-CRP were measured in all enrolled subjects 24-hour after PCI. The net adverse clinical events( NACE) and major adverse cardiovascular cerebral events( MACCE) during the follow-up period were observed. Results The serum GDF-15 levels in trimetazidine group were lower than control group( 737. 24 ± 299. 85 ng/L vs 1175. 84 ± 523. 52 ng/L,P =0.002). The MCP-1 and hs-CRP levels between the two groups had no statistical difference. Incidence of NACE in trimetazidine group were lower than control group( P = 0.012),with statistical difference. Conclusions High-loading-dose of trimetazidine before PCI reduces GDF-15 level and incidence of NACE. GDF-15 is independent risk factor for prognosis of coronary heart disease.