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目的评价在急性心肌梗死(AMI)再灌注治疗前开始应用曲美他嗪(TMZ)对再灌注治疗的影响。方法 60例接受再灌注治疗的 AMI 患者随机分为 TMZ 组和对照组。经冠状动脉造影证实血管再通。TMZ 组患者在确诊 AMI 后即刻服用 TMZ 60 mg,随后给予20 mg,3次/d。比较两组患者再灌注治疗前后的心电图 ST 段降幅以及血浆丙二醛(MDA)、内皮素(ET-1)水平的变化。记录住院期间和发病3个月内的主要临床事件。结果 TMZ 组患者再灌注治疗后 ST 段下降幅值显著高于对照组[(7.14±3.50)mm比(3.79±1.32)mm,P=0.041];ST 段下降幅度>70%者显著多于对照组(68.8%比42.9%,P=0.043)。TMZ 组的血 MDA 水平于再灌注4 h后各个时间段内均显著低于对照组。TMZ 组的血 ET-1水平于再灌注后8 h和第7天显著低于对照组。结论 AMI 患者于再灌注治疗前即开始应用 TMZ 可增加 ST 段降低的幅值,减少 MDA 的生成及 ET-1的释放,具有心肌细胞保护作用。
Objective To evaluate the effect of trimetazidine (TMZ) on reperfusion therapy before reperfusion in acute myocardial infarction (AMI). Methods Sixty AMI patients undergoing reperfusion therapy were randomly divided into TMZ group and control group. Coronary angiography confirmed by recanalization. TMZ patients received TMZ 60 mg immediately after diagnosis of AMI, followed by 20 mg 3 times daily. The changes of ST segment decline and plasma malondialdehyde (MDA) and endothelin (ET-1) levels before and after reperfusion were compared between the two groups. Record the main clinical events during hospitalization and within 3 months of onset. Results The decrease of ST segment in TMZ group after reperfusion was significantly higher than that in control group [(7.14 ± 3.50) mm vs (3.79 ± 1.32) mm, P = 0.041], and the ST segment decreased more than 70% Group (68.8% vs. 42.9%, P = 0.043). The blood levels of MDA in TMZ group were significantly lower than those in control group at various time points after 4 h of reperfusion. The level of ET-1 in TMZ group was significantly lower than that in control group at 8 h and 7 d after reperfusion. Conclusions The application of TMZ in patients with AMI before reperfusion can increase the amplitude of ST segment depression and decrease the production of MDA and the release of ET-1, which has cardioprotective effects.