首都医科大学学报 ›› 2012, Vol. 33 ›› Issue (4): 457-461.doi: 10.3969/j.issn.1006-7795.2012.04.007

• 心脏病学专题 • 上一篇    下一篇

曲美他嗪对PCI术相关心肌损伤及术后再发心绞痛症状的临床研究

许晓晗, 张维君, 周玉杰, 周志明, 马涵英, 胡宾, 康云鹏, 雒芳芳   

  1. 首都医科大学附属北京安贞医院心内科, 北京 100029
  • 收稿日期:2012-05-10 修回日期:1900-01-01 出版日期:2012-08-21 发布日期:2012-08-21
  • 通讯作者: 张维君

Protective effect of trimetazidine on myocardial injury and recurrent angina after percutaneous coronary intervention

XU Xiao-han, ZHANG Wei-Jun, ZHOU Yu-jie, ZHOU Zhi-ming, MA Han-ying, HU Bin, KANG Yun-peng, LUO Fang-fang   

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2012-05-10 Revised:1900-01-01 Online:2012-08-21 Published:2012-08-21

摘要: 目的 探讨择期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前应用负荷剂量曲美他嗪(trimetazidine,TMZ)60 mg对不稳定型心绞痛患者PCI术相关心肌损伤的影响;探讨术后长期应用曲美他嗪对PCI术后再发心绞痛症状的影响。方法 93例拟行择期PCI手术的不稳定型心绞痛患者分为曲美他嗪组和对照组。2组患者均接受抗血小板药物等常规药物治疗。曲美他嗪组在常规药物的基础上,于PCI术前0.5~1.0 h一次性口服60 mg曲美他嗪,PCI术后长期口服常规剂量曲美他嗪(20 mg Tid)。分别测定PCI术前和术后16~18 h患者血清心肌肌钙蛋白I(cardiac troponin Ic,cTnI)浓度,电话随访2组患者PCI术后有无再发心绞痛症状。结果 本研究最终纳入79例成功完成PCI手术的不稳定型心绞痛患者(曲美他嗪组35例,对照组44例)。PCI术后16~18 h时,曲美他嗪组与对照组患者的cTnI水平均较术前升高,差异有统计学意义(P<0.05);同对照组相比,曲美他嗪组患者术后cTnI水平升高>0.1 ng/mL患者的比例显著减少(P<0.05);平均随访9月后,与对照组相比,曲美他嗪组再发心绞痛症状患者的比例显著减少(P<0.05)。结论 PCI术前口服负荷剂量曲美他嗪可以减少手术相关心肌损伤,术后长期服用则可以降低再发心绞痛症状的发生率。

关键词: 经皮冠状动脉介入治疗, 肌钙蛋白Ⅰ, 曲美他嗪, 心绞痛

Abstract: Objective To explore the effect of trimetazidine(TMZ) on the level of cardiac troponin Ic(cTnI) in patients with coronary heart disease after percutaneous coronary intervention(PCI) and investigate the effect of trimetazidine on symptoms of recurrent angina after PCI. Methods A total of 93 patients with unstable angina pectoris admitted for elective PCI were randomly assigned to 2 groups to receive or not an acute loading dose of 60 mg of TMZ prior to the intervention and routine dose of 20 mg Tid after it. The frequency of and the increase in the level of cTnI after successful PCI were measured before and 16~18 h after PCI. Recurrent angina and major adverse cardiac events(MACE, including death, re-infarction and target vessel revascularization) at 9 months after the procedure were also compared. Results Totally 79 patients who were successfully undergoing elective PCI were finally enrolled, 35 were assigned into TMA group and 44 into control group. Post-procedural cTnI levels were significantly reduced in the TMZ group at 16~18 h(P<0.05). The frequency of patients with an increase in cTnI over 2 times the upper limit of the control range(0.05 ng/mL) was significantly decreased in the TMZ group(P<0.05). At 9 months follow-up, symptoms of recurrent angina after PCI were significantly relieved in the TMZ group(P<0.05). Conclusion Trimetazidine can limit the post-PCI cTnI release and relieve the symptoms of recurrent angina after PCI.

Key words: percutaneous coronary intervention, cardiac troponin I, trimetazidine, angina

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