曲美他嗪对经皮冠状动脉介入术相关心肌损伤的保护作用

摘要

目的 观察曲美他嗪对经皮冠状动脉介入术(PCI)相关心肌损伤的影响.方法 入选拟行PCI的不稳定型心绞痛患者80例,采用随机数字表法分为曲美他嗪组和对照组,各40例,所有入选患者均服用阿司匹林、氯吡格雷及常规药物治疗,曲美他嗪组PCI术前3d开始口服曲美他嗪,20 mg/次,3次/d,直至采血结束;于PCI术前及术后6、24 h采血测定血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)的浓度,另测定术前及术后6h白细胞介素6(IL-6)的浓度.结果 术前2组患者各项指标差异均无统计学意义(P＞0.05).曲美他嗪组PCI术后在各个测量时点的cTnI、CK-MB、CRP、IL-6均明显低于对照组[术后6 h:cTnI为(0.52 ±0.22) μg/L比(1.96-1.08) μg/L、CK-MB为(52±13) U/L比(89±19)U/L、CRP为(9.6±2.8) mg/L比(12.7±2.5) mg/L、IL-6为(23±6) ng/L比(32±6)ng/L;术后24h:cTnI为(0.44±0.26) μg/L比(1.98±1.12) μg/L、CK-MB为(43±10) U/L比(72±18) U/L、CRP为(14.8±5.6)mg/L比(23.2±7.2) mg/L] (P＜0.05).结论 曲美他嗪能明显降低PCI术后患者的心肌损伤标志物和炎性因子水平,减轻心肌损伤,对心肌有保护作用.%Objective To observe the protective effect of trimetazidine on myocardial injury induced by percutaneous coronary intervention (PCI).Methods Eighty patients with unstable angina were randomly divided into control group (n =40) and trimetazidine group (n =40).All patients were administrated with aspirin,clopidogrel and other medicines;the patients in trimetazidine group were additionally administrated with oral trimetazidine 3 days before PCI (20 mg/time,3 times/d) till the end of venous sampling.The levels of myocardial injury markers troponin I (cTnI),creatine kinase isoenzyme (CK-MB) and C-reactive protein (CRP) were measured before,6 and 24 h after PCI;the level of interleukin (IL) 6 was detected before and 6 h after PCI.Results There were no significant differences of all indexes between two groups before PCI (all P ＞ 0.05).The serum levels of cTnI,CK-MB,CRP 6 and 24 h after treatment and the level of IL-6 6 h after treatment in trimetazidine group was significantly decreased compared with those in control group [6 h after PCI:cTnI (0.52 ± 0.22) μg/L vs (1.96 ± 1.08) μg/L,CK-MB (52 ± 13) U/L vs (89 ± 19) U/L,CRP (9.6 ± 2.8) mg/L vs (12.7 ± 2.5) mg/L,IL-6 (23 ± 6) ng/L vs (32 ±6) ng/L;24 h after PCI:cTnI (0.44 ±0.26) μ g/L vs (1.98 ± 1.12) μg/L,CK-MB (43 ± 10) U/L vs (72 ± 18)U/L,CRP (14.8 ±5.6)mg/L vs (23.2 ±7.2)mg/L] (all P ＜0.05).Conclusion Trimetazidine can reduce the levels of myocardial injury markers and inflammatory cytokines after PCI and has myocardial protective effect.