曲美他嗪对缺血性心力衰竭患者心肌能量消耗水平的影响及其与左心室重构的关系研究

摘要

Objective To investigate the impact of trimetazidine on myocardial energy expenditure(MME)level and its correlation with left ventricular reconstitution of patients with ischemic heart failure. Methods From May 2012 to January 2014,a total of 73 inpatients with ischemic heart failure were selected in the Department of Cardiology,the Second Hospital of Huangshi,and they were divided into control group( n = 36) and observation group( n = 37) according to random number table. Patients of both groups received conventional medical treatment and secondary prevention for coronary heart disease and heart failure,while patients of observation group received extra trimetazidine,both groups treated for 12 months. LVIDs,LVM, LVMI,LVEF,MEE level and NT - proBNP level were compared between the two groups before and after treatment,and correlation between MEE level and LVEF,LVMI,NT - proBNP was respectively analyzed. Results No statistically significant differences of LVIDs,LVM or LVMI was found between the two groups before treatment(P ﹥ 0. 05);while LVIDs,LVM and LVMI of observation group were statistically significantly lower than those of control group(P ﹤ 0. 01). No statistically significant differences of LVEF,MEE level or NT - proBNP level was found between the two groups before treatment(P ﹥ 0. 05);after treatment,LVEF of observation group was statistically significantly higher than that of control group,MEE level and NT -proBNP level of observation group were statistically significantly lower than those of control group ( P ﹤ 0. 05 ). Pearson correlation analysis showed that,MEE level was positively correlated with LVMI(r = 0. 319,P ﹤ 0. 001),NT - proBNP level (r = 0. 561,P ﹤ 0. 001),while MEE level was negatively correlated with LVEF(r = - 0. 442,P ﹤ 0. 001). Conclusion Trimetazidine may inhibit left ventricular reconstitution of patients with ischemic heart failure through reducing of MEE level, consequently improve the cardiac function.%目的：探讨曲美他嗪对缺血性心力衰竭患者心肌能量消耗（MEE）水平的影响及其与左心室重构的关系。方法选择2012年5月—2014年1月在黄石市第二医院心内科住院治疗的缺血性心力衰竭患者73例，按照随机数字表法分为观察组37例和对照组36例。两组患者均给予冠心病和心力衰竭二级预防常规药物治疗，观察组患者联合曲美他嗪治疗，两组疗程均为12个月。比较两组患者治疗前后左心室结构指标〔左心室收缩末期内径（ LVIDs）、左心室质量（LVM）及左心室质量指数（LVMI）〕、左心室射血分数（LVEF）、MEE 及氨基末端脑钠肽前体（ NT -proBNP）水平，并分析 MEE 水平与 LVEF、LVMI、NT - proBNP 的相关性。结果治疗前两组患者 LVIDs、LVM 及LVMI 比较，差异均无统计学意义（P ﹥0.05）；治疗后观察组患者 LVIDs、LVM 及 LVMI 低于对照组（P ﹤0.01）。治疗前两组患者 LVEF、MEE 及 NT - proBNP 水平比较，差异均无统计学意义（P ﹥0.05）；治疗后观察组患者 LVEF 高于对照组，MEE 及 NT - proBNP 水平低于对照组（P ﹤0.05）。Pearson 相关性分析结果显示，MEE 水平与 LVMI、NT -proBNP 水平呈正相关（r 值分别为0.319、0.561，P ﹤0.001），与 LVEF 呈负相关（r =-0.442，P ﹤0.001）。结论曲美他嗪可能通过降低缺血性心力衰竭患者 MEE 水平而抑制左心室重构，从而改善患者心功能。