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目的探讨曲美他嗪联合法舒地尔治疗慢性心力衰竭(CHF)的疗效和可能作用机制。方法 CHF患者88例,随机分为两组。对照组43例,采用常规治疗加法舒地尔(30 mg,静脉滴注,bid,10 d为一疗程,共6个疗程)治疗,试验组45例在上述基础上加用曲美他嗪(20 mg,口服,tid,共6个月)。比较两组疗效和治疗前后血清和肽素(CPP)、半乳糖凝集素3(Gal-3)浓度、左室射血分数(LVEF)、左室舒张末径(LVEDD)和二尖瓣血流最大流速E峰和A峰比值(E/A)的变化。另选健康体检者30例设为正常对照组。结果试验组总有效率高于对照组(93%vs.72%,P<0.05)。治疗前CHF患者的血清CPP、Gal-3浓度明显高于正常对照组(均P<0.05),Pearson相关分析显示,血清CPP、Gal-3浓度与LVEF、E/A成显著负相关(均P<0.05),与LVEDD成显著正相关(均P<0.05)。治疗后两组血清CPP、Gal-3浓度和LVEDD均下降(P>0.05),试验组下降幅度大于对照组(P<0.05);LVEF和E/A值均升高(P<0.05),试验组上升幅度大于对照组(P<0.05)。两组均无明显不良反应发生。结论曲美他嗪联合法舒地尔能够显著降低CHF患者血清CPP和Gal-3浓度,改善心功能,从而对CHF患者起到治疗作用。
Objective To investigate the efficacy and possible mechanism of trimetazidine and fasudil in the treatment of chronic heart failure (CHF). Methods 88 CHF patients were randomly divided into two groups. The control group (n = 43) was treated with routine therapy plus fasudil (30 mg, intravenous drip, twice daily for 10 days for 6 courses). In the experimental group, 45 patients were treated with trimetazidine 20 mg, oral, tid, a total of 6 months). The levels of serum copeptin (CPP), galectin 3 (Gal-3), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and mitral valve flow The maximum flow velocity E peak and A peak ratio (E / A) changes. Another 30 healthy subjects were selected as normal control group. Results The total effective rate of the experimental group was higher than that of the control group (93% vs 72%, P <0.05). Serum concentrations of CPP and Gal-3 in CHF patients before treatment were significantly higher than those in normal controls (all P <0.05). Pearson correlation analysis showed that serum CPP and Gal-3 levels were significantly negatively correlated with LVEF and E / A <0.05), with a significant positive correlation with LVEDD (all P <0.05). After treatment, the levels of serum CPP, Gal-3 and LVEDD in the two groups decreased (P> 0.05), and decreased more significantly in the experimental group than those in the control group (P <0.05); LVEF and E / A increased Group increased more than the control group (P <0.05). No significant adverse reactions occurred in both groups. Conclusion Trimetazidine combined with fasudil can significantly reduce the serum CPP and Gal-3 concentrations in CHF patients and improve cardiac function, which may play a therapeutic role in patients with CHF.