曲美他嗪对慢性心力衰竭患者血管内皮功能的影响研究  

Effects of Trimetazidine on Endothelial Function in Patients with Chronic Heart Failure

作　　者：衣绍蕊[1] 孙经武[1] 张明哲[1] 史孟松[1] 王秀花[1] 

机构地区：[1]滨州医学院烟台附属医院心内科,山东省烟台市264000

出　　处：《中国全科医学》2014年第20期2321-2324,共4页Chinese General Practice

摘　　要：目的探讨曲美他嗪对慢性心力衰竭患者血管内皮功能的影响。方法采用随机、开放、对照的方法连续入选滨州医学院烟台附属医院2012年7月—2013年7月就诊的慢性心力衰竭患者68例,依据随机数字表将其均分为曲美他嗪组(34例)和对照组(34例)。对照组应用利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)等药物,曲美他嗪组在对照组基础上加用曲美他嗪20 mg/次,3次/d。两组疗程均为4周。观察两组患者治疗前后肱动脉内皮依赖性血管舒张(FMD)功能、血浆一氧化氮(NO)和内皮素-1(ET-1)水平的变化。结果治疗前对照组与曲美他嗪组的肱动脉基础内径(D0)、反应性充血后肱动脉内径(D1)、FMD功能比较,差异均无统计学意义(P>0.05);治疗后对照组与曲美他嗪组的D1、FMD功能比较,差异有统计学意义(P<0.05);曲美他嗪组治疗后FMD功能与治疗前比较,差异有统计学意义(P<0.05)。治疗后曲美他嗪组血浆NO水平高于对照组,而血浆ET-1水平低于对照组(P<0.05);两组治疗后血浆NO水平高于治疗前,而血浆ET-1水平低于治疗前(P<0.05)。两组治疗前后血压、心率、肝功能、肾功能、血常规比较,差异均无统计学意义(P>0.05);且两组均无明显不良反应发生。结论曲美他嗪能通过升高血浆NO水平和降低血浆ET-1水平明显改善慢性心力衰竭患者血管内皮功能,且无不良反应发生,可为临床防治心力衰竭提供有益参考。Objective To observe the effects of trimetazidine on endothelial function in patients with chronic heart failure, in order to provide a theoretical basis for treatment. Methods Sixty - eight patients with chronic heart failure from July 2012 to July 2013 were randomly divided into two groups （34 per group）. The control group received conventional medicine such as diuretics, beta blockers, angiotensin - converting enzyme inhibitors （ ACEI ） , and digitalis for treatment of heart failure. The trimetazidine group received trimetazidine as a control. Both groups were treated for four weeks. Flow - mediated vasodilation of the brachial artery （FMD）, serum nitric oxide （NO）, and endothelin -1 （ET- 1 ） in the two groups were measured before and after treatment. Results There was no statistically significant of DO, D1, FMD function between control group and trimetazidine group before treatment （P 〉0. 05 ）. There was statistically significant of D1, FMD function between control group and trimetazidine group after treatment （ P 〈 0. 05 ）. The FMD of the trimetazidine group was significantly superior to the control group （P 〈 0.05 ）. Serum NO in the trimetazidine group was significantly increased, and serum ET - 1 in the trimetazidine group was significantly decreased than control group after treatment （ P 〈 0. 05 ）. After treatment, serum NO levels higher than before treatment, and pre - treatment serum ET - 1 levels below （P 〈 0. 05 ）. Blood pressure, heart rate, hepatic and renal function, and routine analysis of blood, urine, and stool between groups were compared before and after treatment, and showed no statistically significant difference （P 〉 0. 05）. Conclusion Trimetazidine, compared with conventional therapy, can significantly improve vascular endothelial function of patients with chronic heart failure by increasing the serum nitric oxide and reducing endothelin -1 levels. There were no demonstrable side effects.

关 键 词：曲美他嗪 慢性心力衰竭 血管内皮功能 不良反应 

分 类 号：R541.6[医药卫生—心血管疾病]