CAJ | 학술논문

目的：观察曲美他嗪对老年慢性心力衰竭( CHF )合并贫血患者心功能、肾功能、血红蛋白水平的影响。方法将87例心功能Ⅱ~Ⅳ级( NYHA )的慢性心力衰竭患者随机分为治疗组(44例)及对照组(43例)。在慢性心力衰竭常规治疗基础上，对照组给予口服铁剂，治疗组给予口服铁剂加曲美他嗪片。治疗4周后，观察两组血红蛋白、血肌酐、肌酐清除率、心功能、N末端前脑钠肽( NT－proBNP )变化。结果与治疗前相比，治疗组治疗后血红蛋白明显升高[(113.2±1.5)g/L比(98.3±4.2)g/L，P<0.05]，血清肌酐水平明显降低[(163.4±38.7)μmol/L 比(196.2±40.7)μmol/L，P <0.05]，肌酐清除率增加[(42.8±7.1) mL/min 比(38.0±7.8) mL/min， P <0.05]，心功能分级明显改善[(2.1±0.5)比(3.3±0.7)]，血浆NT－proBNP显著下降[(1233.1±426.7)ng/L比(2219.3±951.2)ng/L， P<0.05]。对照组治疗后上述指标均有所改善，但差异无统计学意义。结论老年慢性心力衰竭合并贫血患者应用曲美他嗪和口服铁剂治疗，在改善心功能的基础上，可进一步纠正贫血、改善肾功能，降低血浆NT－proBNP水平，值得临床推广。
목적：관찰곡미타진대노년만성심력쇠갈( CHF )합병빈혈환자심공능、신공능、혈홍단백수평적영향。방법장87례심공능Ⅱ~Ⅳ급( NYHA )적만성심력쇠갈환자수궤분위치료조(44례)급대조조(43례)。재만성심력쇠갈상규치료기출상，대조조급여구복철제，치료조급여구복철제가곡미타진편。치료4주후，관찰량조혈홍단백、혈기항、기항청제솔、심공능、N말단전뇌납태( NT－proBNP )변화。결과여치료전상비，치료조치료후혈홍단백명현승고[(113.2±1.5)g/L비(98.3±4.2)g/L，P<0.05]，혈청기항수평명현강저[(163.4±38.7)μmol/L 비(196.2±40.7)μmol/L，P <0.05]，기항청제솔증가[(42.8±7.1) mL/min 비(38.0±7.8) mL/min， P <0.05]，심공능분급명현개선[(2.1±0.5)비(3.3±0.7)]，혈장NT－proBNP현저하강[(1233.1±426.7)ng/L비(2219.3±951.2)ng/L， P<0.05]。대조조치료후상술지표균유소개선，단차이무통계학의의。결론노년만성심력쇠갈합병빈혈환자응용곡미타진화구복철제치료，재개선심공능적기출상，가진일보규정빈혈、개선신공능，강저혈장NT－proBNP수평，치득림상추엄。
Objective To investigate the effects of trimetazidine on the cardiac and renal functions, and hemoglobin ( Hb ) parameters in the elderly patients with chronic heart failure ( CHF ) complicating anemia. Methods 87 patients with CHF ( NYHA gradeⅡ-Ⅳ) compli-cating anemia were randomized to the treatment group ( n=44 ) and control group ( n=43 ) . All patients received the conventional treat-ment of heart failure. On this basis the control group was given only oral iron preparation, while the treatment group received oral iron preparation plus trimetazidine. The changes of Hb, serum creatinine, creatinine clearance, plasma NT-proBNP and cardic function were ob-served after 4-week treatment in the two groups. Results Compared with before treatment, Hb after treatment in the treatment group was significantly increased [ ( 98. 3 ± 4. 2 ) g/L vs. ( 113. 2 ± 1. 5 ) g/L, P< 0. 05 ] , serum creatinine level was significant decreased [ ( 196. 2 ± 40. 7 )μmol/L vs. ( 163. 4 ± 38. 7 )μmol/L, P<0. 05 ] , the creatinine clearance was increased [ ( 38. 0 ± 7. 8 ) mL/L vs. ( 42. 8 ± 7. 1 ) mL/min, P< 0. 05 ] , the NYHA cardiac functional grade was significant improved [ ( 3. 3 ± 0. 7 ) vs. ( 2. 1 ± 0. 5 ) ] , the plasma NT-proBNP was significant decreased [ ( 2 215. 3 ± 950. 2 ) ng/L vs. ( 1 236. 1 ± 430. 7 ) ng/L, P<0. 05 ] , the above parameters in the con-trol group were improved to some extent, but the differences between the two groups had no statistical significance. Conclusion Trimetazidine combined with oral iron preparation can improve the cardiac function, on this basis can further correct anemia, improve the renal function and reduce the plasma NT-proBNP level in treating elderly patients with CHF complicating anemia, which deserves to be clinically promoted.