曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者心肌功能及相关免疫指标的影响

Effects of Trimetazidine Combined with Atorvastatin on Myocardial Function and Related Immune Indicators in Elderly Patients with Acute Heart Failure of Dilated Cardiomyopathy

目的探讨曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者心肌功能及相关免疫指标的影响。方法将2013年8月至2015年1月首都医科大学附属北京同仁医院收治的60例老年扩张型心肌病急性心力衰竭患者按照抽签法分为曲美他嗪组、阿托伐他汀组和联合治疗组各20例,分别服用20 mg曲美他嗪(每日3次)、阿托伐他汀20 mg(每日1次)、20 mg曲美他嗪(每日3次)及20 mg阿托伐他汀(每日1次)。记录三组患者心肌功能情况以及肿瘤坏死因子α(TNF-α)、白细胞介素33(IL-33)、转化生长因子β(TGF-β)的变化情况。结果治疗后联合治疗组患者纽约心脏病协会心功能分级显著改善(P<0.05)。治疗后联合治疗组6 min步行试验、左心室射血分数显著高于曲美他嗪组、阿托伐他汀组[(386±19)m比(341±23)m,(343±20)m;(48±9)%比(38±10)%,(39±10)%];左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积、左心室短轴缩短率显著低于曲美他嗪组、阿托伐他汀组[(54.4±0.9)mm比(58.1±3.8)mm,(57.9±3.6)mm;(162±36)m L比(179±29)m L,(187±27)m L;(87±15)m L比(126±29)m L,(123±24)m L;(22.6±4.3)%比(25.3±4.6)%,(25.1±5.3)%],差异有统计学意义(P<0.05)。治疗后联合治疗组患者TNF-α、IL-33和TGF-β水平均比治疗前显著降低,且联合治疗组水平显著低于曲美他嗪组和阿托伐他汀组[(23±4)ng/L比(28±8)ng/L,(27±8)ng/L;(10.3±1.3)pg/L比(12.3±2.4)pg/L,(13.2±1.2)pg/L;(135±11)μg/L比(188±13)μg/L,(190±14)μg/L],差异有统计学意义(P<0.05)。结论采用曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者进行干预治疗后,患者心肌功能及免疫指标改善程度均显著升高,值得在临床工作中推广应用。

Objective To investigate the effects of trimetazidine combined with atorvastatin of atorvastatin on myocardial function and related immune indicators in elderly patients with acute heart failure of dilated cardiomyopathy. Methods From Aug.2013 to Jan.2015,60 elderly patients with acute heart failure of dilated cardiomyopathy treated in Beijing Tongren Hospital,Capital Medical University were divided into a trimetazidine hydrochloride group,an atorvastatin statin group and a combined treatment group according to the lottery method,20 cases each. The trimetazidine hydrochloride group was treated with 20 mg trimetazidine( 3 times daily); the atorvastatin statin group was treated with 20 mg atorvastatin( once daily); the combined treatment group was treated with 20 mg trimetazidine( 3 times daily) and 20 mg atorvastatin( once daily). The myocardial function of the patients and tumor necrosis factor alpha( TNF-α),interleukin 33( IL-33),transformation growth factor beta( TGF-β) index changes of the three groups were recorded. Results After treatment the cardiac function by New York Heart Association grade of the combined treatment group improved significantly( P < 0. 05). The 6 min walk test,left ventricular ejection fraction of the combined treatment group were significantly higher than the trimetazidine group and atorvastatin group [( 386 ± 19) m vs( 341 ±23) m,( 343 ± 20) m;( 48 ± 9) % vs( 38 ± 10) %,( 39 ± 10) % ]; the left ventricular diastolic end diastolic diameter,left ventricular diastolic end diastolic volume,left ventricular end systolic volume,left ventricular short axis shortening rate of the combined treatment group were significantly lower than the trimetazidine group and atorvastatin group[( 54. 4 ± 0. 9) mm vs( 58. 1 ± 3. 8) mm,( 57. 9 ± 3. 6) mm;( 162 ± 36) m L vs( 179 ± 29) m L,( 187 ± 27) m L;( 87 ± 15) m L vs( 126 ± 29) m L,( 123 ± 24) m L;( 22. 6 ± 4. 3) % vs( 25. 3 ± 4. 6) %,( 25. 1 ± 5. 3) %,P < 0. 05]; TNF-α,IL-33 and TGF-β levels of the combined treatment group were significantly lower than before treatment,and the combined treatment group was significantly lower than the trimetazidine group and atorvastatin group [( 23 ± 4) ng / L vs( 28 ± 8) ng / L,( 27 ± 8) ng / L;( 10. 3 ± 1. 3) pg/L vs( 12. 3 ± 2. 4) pg/L,( 13. 2 ± 1. 2) pg/L;( 135 ± 11) μg/L vs( 188 ± 13) μg/L,( 190 ± 14) μg/L,P < 0. 05]. Conclusion The combined treatment of trimetazidine and atorvastatin for elderly patients with acute heart failure of dilated cardiomyopathy can significantly improve the myocardial function and immunological index of the patients,thus is worthy of popularization and application in clinical.