CAJ | 학술논문

目的：评估曲美他嗪对不稳定型心绞痛患者经皮冠状动脉介入治疗（PCI）围术期的影响。方法选取2013年12月~2014年11月顺义区医院住院并行冠状动脉介入治疗的不稳定型心绞痛患者79例，其中男性52例，女性27例，平均年龄（59.3±9.4）岁。入选者随机分为常规治疗组（40例）和曲美他嗪组（39例）。常规治疗组给予阿司匹林、硫酸氢氯吡格雷、他汀类等药物治疗，曲美他嗪组在常规药物治疗的基础上于PCI术前3 d口服曲美他嗪20 mg，3/日，术后继续服用。所有患者均于PCI术前、术后24h检测肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白T（cTnT）变化情况。比较两组临床疗效。采用TIMI帧数（TFC）评估冠状动脉血流改善情况。结果常规治疗组PCI术后较术前CK、CK-MB和cTnT浓度升高，差异有统计学意义（P均＜0.05）。与常规治疗组术后比较，曲美他嗪组CK、CK-MB和cTNT均降低，（102.52±30.40）U/Lvs.（82.37±22.40）U/L、（19.52±3.49）U/Lvs.（14.37±2.68）U/L、（0.13±0.12） ng/mlvs.（0.05±0.08）ng/ml，差异有统计学意义（P均＜0.05）。常规治疗组临床显效16例（40.0%），有效14例（35.0%），总有效率为75.0%；曲美他嗪组临床显效26例（66.7%），有效9例（23.1%），总有效率为89.7%，两组临床总有效率比较差异有统计学意义（P＜0.05）。曲美他嗪组前降支和回旋支的平均TFC值明显低于常规治疗组，差异具有统计学意义（P均＜0.05）。结论曲美他嗪可以抑制PCI围术期相关心肌损伤，且对冠状动脉血流储备具有较好的改善作用。
목적：평고곡미타진대불은정형심교통환자경피관상동맥개입치료（PCI）위술기적영향。방법선취2013년12월~2014년11월순의구의원주원병행관상동맥개입치료적불은정형심교통환자79례，기중남성52례，녀성27례，평균년령（59.3±9.4）세。입선자수궤분위상규치료조（40례）화곡미타진조（39례）。상규치료조급여아사필림、류산경록필격뢰、타정류등약물치료，곡미타진조재상규약물치료적기출상우PCI술전3 d구복곡미타진20 mg，3/일，술후계속복용。소유환자균우PCI술전、술후24h검측기산격매（CK）、기산격매동공매（CK-MB）화심기기개단백T（cTnT）변화정황。비교량조림상료효。채용TIMI정수（TFC）평고관상동맥혈류개선정황。결과상규치료조PCI술후교술전CK、CK-MB화cTnT농도승고，차이유통계학의의（P균＜0.05）。여상규치료조술후비교，곡미타진조CK、CK-MB화cTNT균강저，（102.52±30.40）U/Lvs.（82.37±22.40）U/L、（19.52±3.49）U/Lvs.（14.37±2.68）U/L、（0.13±0.12） ng/mlvs.（0.05±0.08）ng/ml，차이유통계학의의（P균＜0.05）。상규치료조림상현효16례（40.0%），유효14례（35.0%），총유효솔위75.0%；곡미타진조림상현효26례（66.7%），유효9례（23.1%），총유효솔위89.7%，량조림상총유효솔비교차이유통계학의의（P＜0.05）。곡미타진조전강지화회선지적평균TFC치명현저우상규치료조，차이구유통계학의의（P균＜0.05）。결론곡미타진가이억제PCI위술기상관심기손상，차대관상동맥혈류저비구유교호적개선작용。
Objective To review the influence of trimetazidine during percutaneous coronary intervention (PCI) in patients with unstable angina pectoris (UAP).Methods UAP patients (n=79, male 52, female 27 and average age=59.3±9.4) were chosen from Dec. 2013 to Nov. 2014. The patients were randomly divided into routine group (n=40) and trimetazidine group (n=39). The routine group was treated with aspirin, clopidogrel and statins, and trimetazidine group additionally with trimetazidine orally (20 mg, 3 times a day) 3 d before PCI and continuously after PCI. The changes of creatine kinase (CK), creatine kinase MB (CK-MB) and cardiac troponin T (cTnT) were detected in all patients before and 24 h after PCI. The curative effects were compared between 2 groups, and improvement of coronary artery flow was reviewed by using TIMI frame count (TFC).Results The levels of CK, CK-MB and cTnT increased in routine group after PCI (allP<0.05). Compared with routine group after PCI, the levels of CK [(102.52±30.40) U/Lvs. (82.37±22.40) U/L], CK-MB [(19.52±3.49) U/Lvs. (14.37±2.68) U/L] and cTnT [(0.13±0.12) ng/mLvs. (0.05±0.08) ng/mL] decreased in trimetazidine group (allP<0.05). There were 16 cases (40%) with obvious curative effect, 14 (35%) with curative effect and the total effective rate was 75.0% in routine group. There were 26 cases (66.7%) with obvious curative effect, 9 (23.1%) with curative effect and the total effective rate was 89.7% in trimetazidine group (P<0.05). The average TFC values of anterior descending branch and circumflex branch or coronary artery were significantly lower in trimetazidine group than those in routine group (allP<0.05).Conclusion Trimetazidine can inhibit perioperative myocardial injury correlated to PCI, and improve coronary flow reserve.