CAJ | 학술논문

目的：探讨曲美他嗪对慢性心力衰竭患者血管内皮功能的影响。方法采用随机、开放、对照的方法连续入选滨州医学院烟台附属医院2012年7月-2013年7月就诊的慢性心力衰竭患者68例，依据随机数字表将其均分为曲美他嗪组（34例）和对照组（34例）。对照组应用利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂（ ACEI）等药物，曲美他嗪组在对照组基础上加用曲美他嗪20 mg/次，3次/d。两组疗程均为4周。观察两组患者治疗前后肱动脉内皮依赖性血管舒张（FmD）功能、血浆一氧化氮（NO）和内皮素-1（ET-1）水平的变化。结果治疗前对照组与曲美他嗪组的肱动脉基础内径（D0）、反应性充血后肱动脉内径（D1）、FmD功能比较，差异均无统计学意义（P﹥0.05）；治疗后对照组与曲美他嗪组的D1、FmD功能比较，差异有统计学意义（P﹤0.05）；曲美他嗪组治疗后FmD功能与治疗前比较，差异有统计学意义（ P﹤0.05）。治疗后曲美他嗪组血浆NO水平高于对照组，而血浆ET-1水平低于对照组（P﹤0.05）；两组治疗后血浆NO水平高于治疗前，而血浆ET-1水平低于治疗前（P﹤0.05）。两组治疗前后血压、心率、肝功能、肾功能、血常规比较，差异均无统计学意义（ P﹥0.05）；且两组均无明显不良反应发生。结论曲美他嗪能通过升高血浆NO水平和降低血浆ET-1水平明显改善慢性心力衰竭患者血管内皮功能，且无不良反应发生，可为临床防治心力衰竭提供有益参考。
목적：탐토곡미타진대만성심력쇠갈환자혈관내피공능적영향。방법채용수궤、개방、대조적방법련속입선빈주의학원연태부속의원2012년7월-2013년7월취진적만성심력쇠갈환자68례，의거수궤수자표장기균분위곡미타진조（34례）화대조조（34례）。대조조응용이뇨제、β수체조체제、혈관긴장소전환매억제제（ ACEI）등약물，곡미타진조재대조조기출상가용곡미타진20 mg/차，3차/d。량조료정균위4주。관찰량조환자치료전후굉동맥내피의뢰성혈관서장（FmD）공능、혈장일양화담（NO）화내피소-1（ET-1）수평적변화。결과치료전대조조여곡미타진조적굉동맥기출내경（D0）、반응성충혈후굉동맥내경（D1）、FmD공능비교，차이균무통계학의의（P﹥0.05）；치료후대조조여곡미타진조적D1、FmD공능비교，차이유통계학의의（P﹤0.05）；곡미타진조치료후FmD공능여치료전비교，차이유통계학의의（ P﹤0.05）。치료후곡미타진조혈장NO수평고우대조조，이혈장ET-1수평저우대조조（P﹤0.05）；량조치료후혈장NO수평고우치료전，이혈장ET-1수평저우치료전（P﹤0.05）。량조치료전후혈압、심솔、간공능、신공능、혈상규비교，차이균무통계학의의（ P﹥0.05）；차량조균무명현불량반응발생。결론곡미타진능통과승고혈장NO수평화강저혈장ET-1수평명현개선만성심력쇠갈환자혈관내피공능，차무불량반응발생，가위림상방치심력쇠갈제공유익삼고。
Objective Toobservetheeffectsoftrimetazidineonendothelialfunctioninpatientswithchronicheartfail-ure,inordertoprovideatheoreticalbasisfortreatment.Methods Sixty-eightpatientswithchronicheartfailurefromJuly 2012 to July 2013 were randomly divided into two groups(34 per group). The control group received conventional medicine such as diuretics,beta blockers,angiotensin -converting enzyme inhibitors( ACEI),and digitalis for treatment of heart failure. The trimetazidine group received trimetazidine as a control. Both groups were treated for four weeks. Flow-mediated vasodila-tion of the brachial artery(FmD),serum nitric oxide(NO),and endothelin-1(ET-1)in the two groups were measured beforeandaftertreatment.Results TherewasnostatisticallysignificantofD0,D1,FmDfunctionbetweencontrolgroupand trimetazidine group before treatment(P﹥0. 05). There was statistically significant of D1,FmD function between control group and trimetazidine group after treatment(P﹤0. 05). The FmD of the trimetazidine group was significantly superior to the control group(P﹤0. 05). Serum NO in the trimetazidine group was significantly increased,and serum ET -1 in the trimetazidine group was significantly decreased than control group after treatment(P﹤0. 05). After treatment,serum NO levels higher than before treatment,and pre-treatment serum ET-1 levels below(P﹤0. 05). Blood pressure,heart rate,hepatic and renal function,and routine analysis of blood,urine,and stool between groups were compared before and after treatment,and showed nostatisticallysignificantdifference(P﹥0.05).Conclusion Trimetazidine,comparedwithconventionaltherapy,cansignif-icantly improve vascular endothelial function of patients with chronic heart failure by increasing the serum nitric oxide and reducing endothelin-1 levels. There were no demonstrable side effects.