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目的 探讨曲美他嗪对经皮冠状动脉介入治疗(PCI)术相关心肌损伤及术后左心室功能的影响.方法 本研究为一项单中心前瞻、随机、对照研究,采用随机数字表法将132例拟行择期PCI术的不稳定性心绞痛患者分为曲美他嗪组和对照组.最终纳入106例成功完成PCI术的不稳定性心绞痛患者,曲美他嗪组51例,对照组55例.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术后随访期间坚持口服常规剂量曲美他嗪(20 mg、3次/d).分别测定PCI术前和术后16 ～ 18 h患者血清心肌肌钙蛋白I(cTnI)浓度,通过超声心动图随访、评价两组患者PCI术后心功能,比较主要心血管事件(MACE)的发生情况.结果 PCI术后16～ 18 h时,曲美他嗪组患者cTnI水平由术前[0.02(0.01,0.03)] μg/L升至[0.11 (0.07,0.13)] μg/L (P＜0.05),对照组患者cTnI水平由术前[0.02(0.01,0.03)] μg/L升至[1.31(0.44,2.31)] μg/L (P＜0.05);曲美他嗪组术后cTnI水平明显低于对照组(P＜0.05),且曲美他嗪组术后cTnI＞0.10 μg/L患者的比例明显低于对照组[54.9％ (28/51)比94.5％(52/55),P＜0.01].平均随访12个月后,曲美他嗪组左心室收缩末内径低于对照组[(31.00 ±4.33)mm比(33.29 ±2.11) mm,P＜0.05],左心室射血分数高于对照组[(65.65±3.94)％比(62.29±3.06)％,P＜0.01],两组MACE发生率差异无统计学意义.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,术后长期服用可以改善患者的左心室功能.

Objective To explore the effects of trimetazidine therapy on left ventricular (LV) function after percutaneous coronary intervention (PCI).Methods A total of 106 patients with unstable angina pectoris underwent successful elective PCI were randomly assigned to standard therapy group (control,n =55) or trimetazidine group (n =51,60 mg trimetazidine loading dose prior to PCI followed by 20 mg Tid after PCI on top of standard therapy).cTnI level was measured before and at 16-18 hours after PCI.LV function was evaluated by echocardiography and major adverse cardiac events (MACE,including death,re-infarction and target vessel revascularization) at 12 months after PCI was compared between the two groups.Results Post procedural cTnI level increased from [0.02 (0.01,0.03)] μg/L at baseline to [0.11 (0.07,0.13)] μg/L (P ＜ 0.05) at 16-18 hours in the trimetazidine group,while [0.02 (0.01,0.03)] μg/L to [1.31 (0.44,2.31)] μg/L in the control group (P ＜ 0.05).Post procedural cTnI level was significantly reduced in the trimetazidine group compared to the control group (P ＜ 0.05).At 12 months follow-up,left ventricular ejection fraction in the trimetazidine group was significantly higher than in control group [(65.65 ± 3.94) ％ vs.(62.29 ± 3.06) ％,P ＜ 0.01] while incidence of MACE was similar between the two groups.Conclusion Trimetazidine can reduce the post-PCI cTnI release and improve left ventricular function after PCI in patients with unstable angina pectoris.