曲美他嗪或尼可地尔对PCI相关心肌损伤的保护作用研究

目的探讨曲美他嗪或尼可地尔对PCI相关心肌损伤的保护作用。方法选取行PCI的冠心病患者126例,在术前48h随机分为曲美他嗪组、联合用药(曲美他嗪+尼可地尔)组、尼可地尔组和对照组,对照组接受他汀类药物、氯吡格雷、β受体阻滞剂等常规治疗,并行PCI治疗。联合用药组在对照组方案的基础上,于PCI术前48h开始口服曲美他嗪20mg,3次/日及尼可地尔5mg,3次/日。曲美他嗪组患者于术前48h口服曲美他嗪20mg,3次/日。尼可地尔组患者于术前48h口服尼可地尔5mg,3次/日。四组均服药至术后24h。检测各组PCI术前及术后12h、18h、24h的肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)。结果对照组术后18h的CK-MB水平明显高于术前(P0.05)。联合用药组、曲美他嗪组和尼可地尔组PCI术后12h、18h、24h的c Tn I水平均低于对照组,差异均有统计学意义(均P0.05);术后12h、18h及24h联合用药组与曲美他嗪组及尼可地尔组c Tn I水平比较,差异均无统计学意义(均P0.05)。结论曲美他嗪或尼可地尔对PCI心肌损伤都有一定的心肌保护作用,但联用曲美他嗪和尼可地尔的效果与单独使用曲美他嗪或尼可地尔时没有显著差异。

Study on Protective Effect of Trimetazidine or Nicorandil on Myocardial Injury After PCI

Objective To investigate the protective effect of trimetazidine or nicorandil on myocardial injury following PCI (percutaneous coronary intervention).Methods 126 CHD (coronary heart disease) patients treated with PCI were included and assigned to trimetazidine group,combined treatment group (trimetazidine + nicorandil),nicorandil group and control group at 48 hours before operation.The control group received statins,clopidogrel,β-blockers and other conventional treatment,and then followed by PCI therapy.On the basis of the control group,combined treatment group took 20mg trimetazidine3 times a day and 5mg nicorandil3 times a day from 48 hours before PCI.Patients in the trimetazidine group and nicorandil group were received 20mg oral trimetazidine and 5mg nicorandil respectively3 times a day from 48 hours before surgery.All the four groups were treated till 24 hours after the surgery.The levels of CK-MB,MPV and cTnⅠ were measured before PCI and 12 hours,18 hours and 24 hours after PCI.Results The level of CK-MB in control group at 18 hours was significantly higher than that before operation (P ＜ 0.05).The levels of cTnⅠ in the combined treatment group,trimetazidine group and nicorandil group were significandy lower than those in the control group at 12 hours,18 hours and 24 hours after PCI (all P ＜ 0.05).There was no significant difference in the levels of cTnⅠ betweenthe combined treatment group,trimetazidine group and nicorandil group at 12 hours,18 hours and 24 hours after PCI (all P ＞ 0.05).Conclusions Trimetazidine or nicorandil had a protective effect on myocardial injury in patients with PCI.However,the differences were not statistically different between using trimetazidine and nicorandil together or separately.