Objective :To study the effect of trimetazidine on the levels of coronary blood flow and cTnl , hs-CRP and LVEF in patients with ST-elevation acute myocardial infarction after emergency PCI . To investigate the effect of trimetazidine and its protective mechanism after PCI . Methods : 150 patients with acute myocardia infarction who undergoing emergency PCI were enrolled . All patients were randomgly divided into trimetazidine-treated group (75 cases) and routine- treated group(75 cases) .The patients in the two goups were all received the routine treatment . Trimetazidine-treated group added trimetazidine (60mg loading dose were gived 2 hours before emergency PCI and 20mg three time per day lasting 3 months). The patients in the two groups were all received the same basically treatment such as B-blocker,ACEI and statins . The TIM I flow of coronary blood were obersered and recorded . The level of cTnl and hs-CRP in patients after PCI were also measured in 24 and 48 hours .Results : The level of cTnl and hs-CRP in routine- treated group were singnificantly increased compare to trimetazidine-treated group . IN trimetazidine-treated group , the level of LVEF in the third months after PCI were singnificantly increased compare to before PCI . While in outine-treated group it had no difference .The rate of TIM I Ⅲ flow of coronary blood in trimetazidine-treated group were higher than in routine- treated group .But it had no singnificantly difference (P＞ .05) .Conclusion : The level of cTnl and hs-CRP after PCI can be decreased by trimetazidine . The level of LVEF can be increased by trimetazidine . That indicates the ischemic myocardium injury can be decreased by trimetazidine . And microcircu-lation and LVEF can be improved by trimetazidine .%目的:本研究通过观察曲美他嗪(TMZ)对急性患者急诊PCI术中血流,术后肌钙蛋白I(cTnI)、高敏C-反应蛋白(hs-CRP)、左室射血分数(LVEF)的影响,探讨TMZ对急性心梗患者急诊冠脉介入治疗的影响及可能的作用机制.方法:选择急诊行PCI治疗的急性心梗患者150例,随机分为TMZ组及对照组.TMZ组除接受常规治疗外,于术前2h给予负荷量TMZ60mg顿服,以后20mg每天3次,共治疗3月;对照组接受常规治疗.两组均采用相同的基础治疗,如抗栓、β-受体阻滞剂、血管紧张素转换酶抑制剂、他汀类药物等.观察并记录患者PCI术中TIMI血流的情况,并分别测定PCI术后24h、48h的cTnI、48h的hs-CRP值,并分别于术前、术后3月行心脏彩超,测量左室射血分数(LVEF).结果:①两组在PCI术后24h、48h时间点的cTnI水平较术前明显升高,且均有显著性差异(P<0.05);对照组升高幅度较TMZ组更高(P<0.05).②PCI术后48h,两组hs-CRP水平较术前均升高(P<0.05);TMZ组升高幅度较对照组低(P<0.05).③TMZ组患者PCI术后3月行超声心动图测量LVEF较术前升高(P<0.05),而对照组PCI术前、术后3月LVEF值无差异.④TMZ组患者PCI术中TIMI血流为Ⅲ级的比率高于对照组,但无显著性差异(P＞0.05).结论:TMZ可减少PCI术后cTnI、hs-CRP浓度升高的水平,使患者LVEF值升高,提示其可减少缺血心肌损伤及可能具有促进心肌微循环改善的作用,同时能改善左心功能.
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