曲美他嗪治疗稳定型心绞痛的疗效观察

目的：评价曲美他嗪（TMZ）治疗稳定型心绞痛的疗效。方法：22例稳定型心绞痛患者，均于常规应用β－阻滞剂，硝酸酯类药物和／或钙拮抗剂的基础上，加用TMZ20mg每日3次治疗12周，对TMZ治疗前后患者的心绞痛发作情况和心电图踏车运动试验结果进行对比分析，结果：TMZ应用12周后，（1）心绞痛发作次数减少62％（P＜0．001），硝酸甘油消耗量减少68％（P＜0．001），心绞痛程度明显改善（P＜0．01）。（2）运动持续时间延长18％（P＜0．001），运动总作功增加30％（P＜0．001），运动至ST段下移1mm的时间延长37％（P＜0．001），运动至ST段压低的最大幅度减少21％（P＜0．001），而静息和运动高峰时的心率，收缩压，率压积均没有明显变化（P＞0．05），（3）其中1例既往有癫痫病史，服用曲美他嗪后有诱发癫痫发作的先兆而停药退出，另外上腹部不适1例，心悸1例，便秘1例，均无需停药。结论：（1）在传统血流动力学药物治疗的基础上联用TMZ,可以使稳定型心绞痛患者的心绞痛症状减轻，运动耐量增加，缺血阈改善，且安全性好。（2）曲美他嗪对血流动力学没有影响，其抗缺血机制可能与其直接的细胞保护作用有关。

Efficacy of Trimetazidine in the Treatment of Stable Angina Pectoris

Objective: To investigate the antianginal efficacy of trimetazidine(TMZ) , in patients with stable angina pectoris Method: Twenty - two patients with stable angina were finally included. All patients continued their previous antianginal treatments (beta - blockers,nitrates and/or calcium antagonists) , then they were given TMZ 20mg three times daily for 12 weeks. Their states of angina attacks and results of electrocardiogram ergo - metric exercise tests were compared between at inclusion and after 12 weeks of therapy .Results: after TMZ were given 12 weeks, (1) the number of angina attacks were reduced by 62% (P < 0.001) and the nitrate consumption by 68% ( P < 0.001), with a significant improvement of angina attack degrees( P < 0.01) . (2) exercise duration and rime to 1 mm ST segment deptession were prolonged by 18% and 37% respectively (P < 0.001 for each) ,the total work load was increased by 30% (P < 0.001) and the maximum ST segment depression was decreased by 21% ( P < 0.001) .However the heart rate and systolic blood pressure and thus rate - pressure product at rest and at peak exercise did not change significantly (P > 0.05) . (3) one patient dropped out because TMZ had potential to activate the recurrence of epilepsy, one had diseomfortable feeling in upper abdomen , one had palpitation and one had constipation. Conclusion: (1) In patients with stable angina pectoris not sufficiently controlled by conventional antianginal agents (beta - blockers,calcium antagonists or nitrates or any combination,additive TMZ (20mg 3 times daily) improves symptoms of angina pectoris, increases exercise tolerance, improves ischemic threshold with an excellent safety profile. (3) TMZ is likely to exert anti - ischemic efficacy by direct myocardial cytoprotection with no significant changes in haemodynamics.