曲美他嗪对高血压病患者心脏的保护作用

目的探讨心肌代谢类药物曲美他嗪对高血压病患者心脏的保护作用。方法采用随机表法将267例高血压病患者随即分为对照组（105例）和干预组（162例）。对照组常规抗高血压治疗，干预组在常规抗高血压治疗的基础上加用曲美他嗪（20mg，3次／d）=观察血压、6min步行距离变化；做超声心动图检测，得左心室质量指数（LVMI）、左心室射血分数（LVEF）、二尖瓣血流频谱E／A比值；观察新发冠心病、合并冠心病患者急性冠脉事件的发生风险。结果干预治疗2年后，①两组间血压水平均明显下降（P〈0．0001）；②干预组LVMI、二尖瓣血流频谱E／A比值均显著改善（P〈0．0001），LVEF亦显著改善（P〈0．05），对照组LVMI、二尖瓣血流频谱E／A比值、LVEF均无显著改善（P〉0．05）；③十预组6min步行距离显著增加（P〈0．0001），对照组显著下降（P〈0．0001）；④干预组2例（1．23％）、对照组为5例（4．76％）新发冠心病，RR=0．26（P〉0．05）；⑤干预组7例（4．23％）、对照组13例（12．38％）发生急性冠脉事件，RR=0．35（P〈0．025）。结论高血压病患者仅常规抗高血压治疗对心脏结构和功能的保护作用极为有限。在有效抗高血压治疗的基础上加用心肌代谢药物曲美他嗪，可使其心脏结构和功能均得到明显改善。

Protective effect of trimetazidine to patients with hypertension

ObjectiveTo discuss the protective effect of trimetazidine （myocardial metabolic agent） on the heart in the patients with hypertension. Methods The random table method was used to divide 267 cases of hypertension into the control group （n = 105） and intervention group （n = 162）. The control group was treated with routine anti-hypertension therapy and the intervention group, with trimetazidine （ 20 mg, thrice a day） besides the routine therapy. The changes of blood pressure and 6-minute walk distance test （6MWD） were observed. The echocardiogram was used to get left ventricular mass index （LVMI） ,left ventricular ejection fraction （LVEF） and E/A ratio of mitral flow spectrum. The risk of acute coronary event was observed in the patients with new-onset coronary heart disease （ CHD） or complicated CHD. Results After interventional treatment for 2 years,① the blood pressure decreased significantly in two groups （ P 〈 0. 0001 ） ;② LVMI, E/A ratio and LVEF were improved significantly in the intervention group （P 〈 0. 0001 ,P 〈 0.05） ,but not improved in the control group （P 〉 0.05） ;③6MWD was increased significantly in the intervention group （P 〈 0. 0001 ） and decreased significantly in the control group （ P 〈 0. 0001 ） ; ④ there were 2 cases （1.23%） of new-onset CHD in the inlervention group and 5 （4.76%） in the control group （RR = 0.26,P 〉 0.05） ;⑤ there were 7 cases （4.23%） with acute coronary event in the intervention group and 13 （ 12.38% ） in the control group （ RR = 0.35,P 〈 0. 025 ）. Conclusion The protective effect of routine anti-hypertension therapy on the heart structure and function is limited in the patients with hypertension. When myocardial metabolic agent-trimetazidine is administrated besides the routine therapy the heart strueture and function will be improved effectively.