曲美他嗪治疗急性心肌梗死的临床研究

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TMZ60mg,随后给予20mg,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4h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8h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。

Clinical study of trimetazidine for myocardial protection in acute myocardial infarction

OBJECTIVE: To assess the effect of trimetazidine as an adjunctive treatment to reperfusion therapy in acute myocardial infarction. METHODS: Sixty patients with acute myocardial infarction were randomized to receive trimetazidine (a loading dose of 60 mg followed by 20 mg 3 times daily) for 2 weeks (n = 32) or to be controls (n = 28). The loading dose was started early before the reperfusion therapy. Patients received intermittent ST-segment monitoring to assess the resolution of ST-segment deviation one hour after reperfusion therapy. Venous blood samples for measurement of malondialdehyde (MDA) and endothelin (ET-1) were taken immediately on admission and 1, 4, 8, 24 and 48 hours as well as 7 days after reperfusion. In-hospital and 3-months major adverse cardiac events were recorded. RESULTS: Blinded ST-segment analysis showed that there was a more marked return towards baseline one hour after reperfusion therapy in the trimetazidine group, than in the control group [change (7.14 +/- 3.50) mm vs (3.79 +/- 1.32) mm, P = 0.041]. The measurement of plasma MDA showed that, there was a significantly lower level in the trimetazidine group 4, 8, 24, 48 hours and 7 days after reperfusion (P < 0.05). The level of plasma ET-1 was significantly lower in the trimetazidine group 8 hours and 7 days after reperfusion (P < 0.05). There was no side effect due to trimetazidine. Clinical outcomes were similar between the two groups. CONCLUSIONS: Trimetazidine is effective for the resolution of ST-segment elevation. The effect of trimetazidine against malondialdehyde and ET-1 formation suggested that it might be the mechanism of the myocardial protection.