摘要:
目的 探讨曲美他嗪对老年冠状动脉粥样硬化性心脏病(冠心病)伴慢性心力衰竭患者临床疗效和组织纤溶酶原激活物(tPA)及纤溶酶原激活物抑制物(PAI-1)表达的影响.方法 选择2015年1月至2016年12月四川省广安市人民医院收治的老年冠心病伴慢性心力衰竭患者112例.根据随机数字表法,将患者分为对照组和观察组,各56例.对照组接受常规治疗;观察组在常规治疗基础上口服曲美他嗪治疗.2组均连续治疗6个月.比较2组患者治疗效果、治疗前后心功能指标、N末端B型脑钠肽前体(NT-proBNP)及纤溶因子水平.结果 观察组治疗总有效率明显高于对照组[92.9%(52/56)比76.8%(43/56)],差异有统计学意义(P <0.001).治疗前,2组患者左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)水平比较,差异均无统计学意义(均P>0.05).治疗后,观察组LVESD及LVEDD水平均低于,而LVEF水平高于对照组[(33.2 ±0.9)mm比(37.1±1.1)mm、(51±5)mm比(56±6)mm、(51.2±1.6)%比(43.2±1.3)%],差异均有统计学意义(均P<0.05).治疗前,2组患者血清NT-proBNP、tPA及PAI-1水平比较,差异均无统计学意义(均P>0.05);治疗后,观察组血清NT-proBNP及PAI-1水平低于,而tPA水平高于对照组[(532±123) ng/L比(934±144) ng/L、(62±4) μg/L比(71±5)μg/L、(17.4 ±3.1)μg/L比(13.1±2.8)μg/L],差异均有统计学意义(均P<0.05).结论 曲美他嗪治疗老年冠心病伴慢性心力衰竭患者效果明显,能够降低血清NT-proBNP及PAI-1水平,提高血清tPA水平,控制心肌重塑,调节纤溶系统功能,有效改善心肌细胞功能.%Objective To investigate the effect of trimetazidine on cardiac function,tissue plasminogen activator(tPA) and plasminogen activator inhibitor-1 (PAI-1) in patients with coronary atherosclerotic heart disease (CHD) complicated with chronic heart failure.Methods Totally 112 elderly CHD patients with chronic heart failure from January 2015 to December 2016 in Guang'an People's Hospital were randomly divided into control group and observation group,with 56 cases in each group.The control group had conventional treatment;the observation group had trimetazidine besides conventional treatment;both groups were treated for 6 months.Effective rate,cardiac function indexes,N-terminal pro-brain natriuretic peptide (NT-proBNP) and fibrinolytic factors were analyzed.Results The total effective rate in observation group was significantly higher than that in control group [92.9% (52/56) vs 76.8% (43/56)] (P < 0.001).There were no significant differences of left ventricular end-systolic diameter (LVESD),left ventricular end-diastolic diameter (LVEDD),left ventricular ejection fraction (LVEF),NT-proBNP,PAI-1 and tPA between groups before treatment (P > 0.05).After treatment,LVESD and LVEDD in observation group were significantly lower and LVEF was significantly higher than those in control group [(33.2 ±0.9)mm vs (37.1 ±1.1)mm,(51±5)mm vs (56 ±6)mm,(51.2±1.6)% vs (43.2 ± 1.3)%] (P <0.05);serum levels of NT-proBNP and PAI-1 in observation group were significantly lower and tPA was significantly higher than those in control group[(532 ± 123)ng/L vs (934 ± 144) ng/L,(62 ±4)μg/L vs (71 ±5)μg/L,(17.4 ±3.1) μg/L vs (13.1 ±2.8)μg/L] (P<0.05).Conclusion Trimetazidine treating elderly CHD patients with chronic heart failure can obviously decrease NT-proBNP,PAI-1 and increase tPA in serum,regulate fibrinolytic function,control myocardial remodeling and improve myocardial cell function.