2018 年第 10 期 第 13 卷

缬沙坦联合曲美他嗪治疗冠状动脉粥样硬化性心脏病心力衰竭患者的临床效果

Clinical effect of valsartan combined with trimetazidine on coronary atherosclerotic heart disease complicated with heart failure

作者：朱元吴明华王欣彤陆海芬王石张士权

英文作者：

单位：210000南京，江苏省中医院脑病中心

英文单位：

关键词：冠状动脉粥样硬化性心脏病；缬沙坦；曲美他嗪；心力衰竭；脑钠肽

英文关键词：

• 摘要：

• 【摘要】目的    观察缬沙坦联合曲美他嗪治疗冠状动脉粥样硬化性心脏病（冠心病）心力衰竭患者的临床效果。方法    收集2017年1月至2018年1月江苏省中医院收治的90例冠心病心力衰竭患者临床资料进行分析，依据治疗方案的不同分为对照组和观察组，各45例。对照组于常规治疗基础上口服缬沙坦；观察组于对照组基础上口服曲美他嗪，2组均持续用药2个月。比较2组治疗前后心功能、心肌重塑指标、B型脑钠肽（BNP）及炎症因子指标水平。结果    治疗后2组左心室射血分数均高于、6 min步行距离均长于治疗前，且观察组高于/长于对照组［（46±5）%比（40±4）%、（309±34）m比（286±31）m］；左心室舒张末期内径、左心室收缩末期内径均小于治疗前，且观察组小于对照组［（46±4）mm比（52±5）mm、（42±4）mm比（49±5）mm］；差异均有统计学意义（均P＜0.01）。治疗1、2个月后观察组BNP水平均低于对照组［（3.6±1.0）μg/L比（4.3±1.1）μg/L、（2.5±0.6）μg/L比（3.2±0.9）μg/L］，差异均有统计学意义（均P＜0.01）。治疗后2组高敏C反应蛋白、肿瘤坏死因子α水平均低于治疗前，且观察组低于对照组［（2.7±0.4）mg/L比（4.3±0.4）mg/L、（4.4±0.8）mg/L比（7.6±1.1）mg/L］，差异均有统计学意义（均P＜0.01）。结论    缬沙坦联合曲美他嗪治疗有助于促进冠心病心力衰竭患者心功能改善，逆转心肌重塑，降低BNP水平，减轻炎性反应。

• 【Abstract】Objective    To observe the clinical effect of valsartan combined with trimetazidine on coronary atherosclerotic heart disease（CHD） complicated with heart failure. Methods    Clinical data of 90 CHD patients with heart failure admitted to Jiangsu Province Hospital of Traditional Chinese Medicine from January 2017 to January 2018 were analyzed. The patients were treated with different therapeutic regimens; 45 patients took valsartan; 45 patients took valsartan and trimetazidine; all patients were treated for 2 months. Cardiac function, myocardial remodeling, B-type natriuretic peptide(BNP) and inflammatory factors were analyzed before and after treatment. Results    After treatment, left ventricular ejection fraction higher and 6 min walk distance longer than those before treatment in both groups; left ventricular ejection fraction and 6 min walk distance in the observation group were higher/longer than those in the control group［（46±5）% vs （40±4）%, （309±34）m vs （286±31）m］; left ventricular end-diastolic diameter and left ventricular end-systolic diameter were less than those before treatment; left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the observation group were less than those in the control group［（46±4）mm vs （52±5）mm, （42±4）mm vs （49±5）mm］（P＜0.01）. At 1 and 2 months after treatment, BNP level in the observation group were lower than those in the control group［（3.6±1.0）μg/L vs （4.3±1.1）μg/L, （2.5±0.6）μg/L vs （3.2±0.9）μg/L］（P＜0.01）. After treatment, levels of high-sensitive C-reactive protein and tumor necrosis factor-α were lower than those before treatment; the levels in the observation group were lower than those in the control group［（2.7±0.4）mg/L vs （4.3±0.4）mg/L, （4.4±0.8）mg/L vs （7.6±1.1）mg/L］（P＜0.01）. Conclusion    Valsartan combined with trimetazidine can improve cardiac function, reverse myocardial remodeling, reduce BNP level and reduce inflammation in CHD patients with heart failure.