曲美他嗪治疗失代偿缺血性心肌病患者的2年随访观察  

A Two-YeaRFollow-up Results of Trimetazidine in the Treatment of Decompensated Ischemic Cardiomyopathy.

作　　者：熊挺淋 张丽莎[1] 刘涛[1] 王浩宇[1] 周振宇[1] 赵景宏[1] 覃夏川[1] 张荣驿 Xiong Tinglin;Zhang Lisha;Liu Tao(Department of Cardiology,Department of Ultrasound,Nanchong Central Hospital,The Second Clinical Medical College,North Sichuan Medical College,Nanchong,Sichuan 637000,China.)

机构地区：[1]川北医学院第二临床医学院·南充市中心医院心内科,超声科,四川南充637000

出　　处：《四川医学》2021年第9期902-907,共6页Sichuan Medical Journal

基　　金：南充市市校科技战略合作项目(编号:18SXHZ0367)。

摘　　要：目的探讨曲美他嗪(TMZ)对缺血性心肌病的长期疗效,研究TMZ对心脏功能的影响。方法选择168例失代偿缺血性心肌病伴心力衰竭患者,随机分为TMZ组和安慰剂组,TMZ组给予曲美他嗪片20mg,3次/d,安慰剂组给予安慰剂。比较两组主要心血管不良事件(MACE)发生率、每周心绞痛发作次数及含服硝酸酯类药物的次数;加拿大心血管病学会(CCS)心绞痛分级和纽约心脏协会(NYHA)心功能分级的比较;评估左室舒张末期内径(LVEDD)及左室射血分数(LVEF)的变化情况。结果最终完成2年随访的145例作为研究对象,其中TMZ组75例,安慰剂组70例。与基线相比,TMZ组的每周心绞痛发作次数和含服硝酸酯类药物的次数明显降低,差异有统计学意义(P<0.05),安慰剂组无明显改变(P>0.05)。与安慰剂组相比,TMZ组中的CCS心绞痛I级和NYHA心功能I级的发生率明显增加,而CCS心绞痛III级和NYHA心功能III级的发生率明显减少,差异有统计学意义(P<0.05);与基线水平相比,TMZ组的LVEDD缩小约9%,差异有统计学意义(P<0.05),而安慰剂组的LVEDD无明显改变(P>0.05);TMZ组的LVEF升高约16%,差异有统计学意义(P<0.05),而安慰剂组的LVEF降低约6%,差异无统计学意义(P>0.05)。结论TMZ对失代偿性缺血性心肌病伴心力衰竭患者是有益的,可以改善心脏功能,但还需要进行更大范围的随访研究。Objective To explore the long-term effect of trimetazidine(TMZ)on ischemic cardiomyopathy,and study the effect of trimetazidine on cardiac function.Methods A total of 168 patients with decompensated ischemic cardiomyopathy and heart failure were selected and were randomly divided into two groups-TMZ group which was provided with trimetazidine(TMZ)tablet 20mg three times daily,and placebo group,along with other conventional medications.The incidence of major cardiovascular adverse events(MACE),the number of angina attacks per week,and the number of nitrates were compared between the two groups.Comparison of Canadian Cardiovascular Society(CCS)angina grading and New York Heart Association(NYHA)cardiac function grading;The changes of left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection volume fraction(LVEF)were evaluated.Results 145 patients who completed the 2-year follow-up were chosen as the study subjects,including 75 patients in the TMZ group and 70 patients in the placebo group.Compared with the baseline,the number of weekly angina attacks and the number of nitrates were significantly reduced in the TMZ group,and the differences were statistically significant(P<0.05),and there was no significant change in placebo group(P>0.05).Compared with the placebo group,the incidence of CCS angina pectoris class I and NYHA cardiac function class I were significantly increased,while the incidence of CCS angina pectoris class III and NYHA cardiac function class III were significantly decreased in TMZ group,and the differences were statistically significant(P<0.05).Compared with the baseline,the LVEDD decreased by about 9%in TMZ group,and the difference was statistically significant(P<0.05),while there was no significant change in placebo group(P>0.05).The LVEF increased by about 16%in TMZ group,the difference was statistically significant(P<0.05),while the LVEF decreased by about 6%in placebo group,and the difference was not statistically significant(P>0.05).Conclusion TMZ is beneficial to patients wi

关 键 词：缺血性心肌病 曲美他嗪 心力衰竭 心脏功能 

分 类 号：R541.6[医药卫生—心血管疾病]