曲美他嗪在缺血性心脏病中的应用

缺血性心脏病（IHD）其病理特点是冠状动脉内粥样斑块,管腔狭窄或阻塞,导致心肌缺血,患者出现胸痛.斑块破裂提供了血小板聚集和血栓形成的场所,导致不稳定性心绞痛或心肌梗死.稳定性心绞痛常规应用β阻滞剂、硝酸酯类和钙阻滞剂,这些药物是通过增加心肌供氧或减少心肌需氧发挥作用的.近年来,作为代谢调节剂的一组药物,已充分显示其优势.曲美他嗪是该类药物的代表药,已发现在缺血心肌中,脂肪酸氧化增强,葡萄糖氧化受抑制,曲美他嗪通过抑制缺血心肌中脂肪酸的氧化,直接发挥心肌细胞的保护作用.其他的一些研究尚在进行中,以进一步阐明在与IHD有直接或间接关系的其他疾病中曲美他嗪的作用.本综述目的是总结近年来世界范围内所做的各种临床试验研究的结果,以评价该药在IHD中的作用及其确切机制,进一步认识其在心肌保护中的真正价值.

Use of trimetazidine in ischemic heart disease

Ischemic heart disease(IHD) is characterized pathologically by the atheromatous plaque which may induce stenosis or obstruction of the coronary arterial lumen leading to myocardial ischemia,experienced by the patients as chest pain.Plaque rupture provides a focus for platelet deposition and thrombosis,and results in unstable angina or myocardial infarction.Stable angina pectoris is treated conventionally by using beta blockers,nitrates and calcium channel blockers(CCB),all of which act by either increasing the supply or decreasing the demand of oxygen in myocardium.In recent years a group of drugs known as metabolic modulators have been particularly shown to be beneficial in protecting the myocardium.Trimetazidine has been a special target in this group.It has been found that in ischemic myocardium there is high rate of fatty acid(FA) oxidation and subsequent inhibition of glucose oxidation.This drug is thought to have direct cytoprotective action in ischemic myocardium through inhibition of the oxidation of FA.Numerous studies are still being carried out to further clarify its roles in various other conditions related directly or indirectly with IHD.The purpose of the review was to assimilate the results of various trials done all over the world in the recent years to find out the role in IHD and the exact mechanism of action,in order to know its true worth in myocardial protection.