目的 观察急性前壁心肌梗死患者应用曲美他嗪(trimetazidine, TMZ)对急诊经皮冠状动脉介入治疗术(percutaneous coronary interventions, PCI)后心肌缺血再灌注损伤(ischemia reperfusion, I/R)的保护作用。方法 266例初发ST段抬高型急性前壁心肌梗死患者随机分为曲美他嗪组(132例)和对照组(134例)。曲美他嗪组于确诊急性心肌梗死后即刻给予负荷剂量曲美他嗪(60 mg),术后继续应用曲美他嗪(20 mg,3/d)3个月。记录两组患者PCI术中TIMI血流分级和TIMI心肌组织灌注分级(TIMI myocardial perfusiongrade, TMPG)。术后24 h分别测定两组患者血清肌钙蛋白I(cTNI)和肌酸激酶同工酶(CK-MB)水平。在PCI术前及术后1、3个月分别超声心动图测量左室射血分数。结果 与对照组相比,曲美他嗪组PCI术中血流达到TIMI-3级和TMPG-3级例数较多,术后24 h心肌酶TNI[(17.04±1.71)ng/ml vs(14.39±1.42)ng/ml,P=0.001]、CKMB[(90.32±9.26)U/L vs (82.55±8.04)U/L,P=0.001]较显著降低。PCI术后3个月,曲美他嗪组患者左室射血分数明显优于对照组[(54.81±3.27)%比(52.26±2.55)%,P=0.001]。结论 急性前壁心肌梗死患者早期应用曲美他嗪能降低PCI术中心肌缺血再灌注损伤,长期应用曲美他嗪能够改善远期心脏功能。
Abstract
Objective To observe the protective effect of trimetazidine on myocardial ischemia reperfusion (I/R) injury in patients with acute anterior myocardial infarction treated with primary percutaneous coronary intervention(PCI).Methods 266 cases of newly diagnosed anterior acute ST segment elevation myocardial infarction were randomly divided into the trimetazidine group (132 cases) and the control group (134 cases). The treatment group received loading-dose trimetazidine of 60 mg before PCI and continued to take trimetazidine(20 mg tid) for three months after PCI. TIMI flow grade and TIMI myocardial perfusion grade(TMPG) of each group were recorded during PCI. The cardiac troponin Ic (cTNI) and creatine kinase-MB (CK-MB) levels of each group were measured 24 hours after operation. Left ventricular ejection fraction was also detected before PCI and at one month and three months after PCI by echocardiographic measurements.Results There were more cases of TIMI-3 blood flow and TMPG-3 myocardial perfusion in the trimetazidine group than in the control group. After PCI, the levels of cTNI[(17.04±1.71)ng/ml vs(14.39±1.42)ng/ml,P=0.001] and CK-MB[(90.32±9.26)U/L vs (82.55±8.04) U/L,P=0.001] in the trimetazidine group were significantly lower than those of the control group. Left ventricular ejection fraction of the trimetazidine group was also significantly higher than that of the control group[(54.81±3.27)% vs(52.26±2.55)%,P=0.001] at three months after PCI.Conclusions Early application of trimetazidine in patients with acute anterior myocardial infarction can reduce ischemia reperfusion (I/R) injury during PCI and long-term use of trimetazidine can improve heart function.
关键词
曲美他嗪 /
急性前壁心肌梗死 /
再灌注治疗 /
缺血再灌注损伤
Key words
trimetazidine /
acute anterior myocardial infarction /
reperfusion therapy /
ischemia-reperfusion injury
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基金
中国健康促进基金会心脏康复与代谢治疗药物研究基金资助项目(2015),武警后勤学院附属医院种子基金重点项目(编号:FYZ201502)
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