目的 探讨曲美他嗪联合卡维地洛对高血压心脏病慢性心力衰竭(CHF)患者心功能及N末端脑钠肽前体(NT-proB-NP)、肌钙蛋白Ⅰ(cTnⅠ)的影响.方法 选取高血压心脏病CHF患者70例,采用随机数字表法分为观察组和对照组,各35例.两组均进行常规治疗,对照组加用卡维地洛,起始剂量为6.25 mg· d-1,以后根据个人情况调整剂量,最大可加至25~50 mg· d-1,观察组在对照组基础上加用曲美他嗪20毫克/次,3次/天,两组均治疗6个月后进行评价.两组治疗前后采用Lee氏评分进行心力衰竭症状评分,彩色多普勒超声测定LVEF,记录6 min步行距离(6 MWD);采集两组治疗前后清晨空腹静脉血,采用放射免疫法测定血浆NT-proBNP、cTnⅠ,ELISA法测定脂联素(APN),Clauss法测定纤维蛋白原(FG);采用全自动生化分析仪测定三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平.结果 观察组治疗后Lee氏评分为(2.03 ±0.35)分,对照组为(2.91 ±0.79)分,观察组治疗后Lee氏评分低于对照组(t=6.025,P<0.001);观察组治疗后LVEF、6 MWD分别为(54.27 ±6.55)%、(283.59 ±23.79)m,对照组分别为(44.17 ±7.43)%、(219.74 ±25.68)m,观察组治疗后LVEF、6 MWD高于对照组(t=6.034,P<0.001;t=10.791,P<0.001);观察组治疗后TC、LDL-C水平分别为(4.24 ±0.62)mmol· L-1、(1.87 ±0.71)mmol· L-1,对照组分别为(5.07 ±0.85)mmol· L-1、(2.65 ±0.72) mmol· L-1,观察组治疗后TC、LDL-C水平低于对照组(t=4.667,P<0.001;t=4.564,P<0.001),观察组治疗后HDL-C水平为(1.67 ±0.28)mmol· L-1,对照组为(1.32 ±0.26)mmol· L-1,观察组治疗后HDL-C 水平高于对照组(t=,5.419,P<0.001);观察组治疗后NT-proBNP、cTnⅠ、APN、FG水平分别为(1.54 ±0.27)μg· L-1、(0.68 ±0.21)μg· L-1、(7.38 ±2.24) mg· L-1、(2.98 ±0.64)g· L-1,对照组分别为(2.56 ±0.38)μg· L-1、(1.25 ±0.14)μg· L-1、(11.76 ±3.19)mg· L-1、(3.75 ±0.51)g· L-1观察组治疗后NT-proBNP、cTnⅠ、APN、FG水平低于对照组(t=12.945,P<0.001;t=13.361,P<0.001;t=6.648,P<0.001;t=5.567,P<0.001).结论 曲美他嗪联合卡维地洛可有效调节高血压心脏病CHF患者血脂水平,降低NT-proBNP、cTnⅠ、APN、FG水平,从而有效改善心功能.%Objective To explore the effect of trimetazidine in combined with carvedilol on the cardiac function,NT-proBNP,and cTnI in patients with hypertensive heart disease and chronic heart failure(CHF).Methods A total of 70 patients with hypertensive heart disease and CHF randomized into the experiment group and the control group.The patients in the two groups were given routine treat-ments.The patients in the control group were given carvedilol,with initial dosage of 6.25 mg· d-1.The dosage could be adjusted ac-cording to the conditions,and the maximum dosage could be added to 25~50 mg· d-1.On this basis,the patients in the experiment group were given trimetazidine,20 mg/time,3 times/d.After 6-month treatment,the efficacy was evaluated.Lee grading was used to e-valuate the heart failure symptoms before and after treatment in the two groups.The color Doppler ultrasound was used to detect LVEF. 6MWD was recorded.The morning fasting venous blood before and after treatment in the two groups was collected.RIA was used to de-tect the plasma NT-proBNP and cTnⅠ.ELISA was used to detect APN.Clauss was used to detect FG.The full automatic biochemical analyzer was used to detect TG,TC,LDL-C,and HDL-C levels.Results Lee score after treatment in the experiment group(2.03 ± 0.35)was significantly lower than that in the control group(2.91 ±0.79)(t=6.025,P<0.001).LVEF(54.27 ±6.55)% and 6MWD(283.59 ±23.79)m after treatment in the experiment group were significantly higher than those in the control group[(44.17 ±7.43)%,(219.74 ±25.68)m,respectively](t=6.034,P<0.001;t=10.791,P<0.001).TC(4.24 ±0.62)mmol· L-1and LDL-C(1.87 ±0.71)mmol· L-1after treatment in the experiment group were significantly lower than those in the control group[(5.07 ±0.85)mmol· L-1,(2.65 ±0.72)mmol· L-1,respectively](t=4.667,P<0.001;t=4.564,P<0.001),while HDL-C level(1.67 ±0.28)mmol· L-1was significantly higher than that in the control group(1.32 ±0.26)mmol· L-1(t=5.419,P<0.001).NT-proBNP,cTnⅠ,APN,and FG levels[(1.54 ±0.27)μg· L-1,(0.68 ±0.21)μg· L-1,(7.38 ±2.24)mg· L-1,(2.98 ± 0.64)g· L-1,respectively]after treatment in the experiment group were significantly lower than those in the control group[(2.56 ± 0.38)μg· L-1,(1.25 ±0.14)μg· L-1,(11.76 ±3.19)mg· L-1,(3.75 ±0.51)g· L-1,respectively](t=12.945,P<0.001;t=13.361,P<0.001;t=6.648,P<0.001;t=5.567,P<0.001).Conclusions Trimetazidine in combined with carvedilol can effectively regulate the serum lipid level in patients with hypertensive heart disease and CHF,and reduce NT-proBNP,cTnⅠ,APN,and FG levels in order to improve the cardiac function.
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