曲美他嗪对改善女性冠心病动脉僵硬度的研究

发布时间：2018-01-15 23:27

本文关键词：曲美他嗪对改善女性冠心病动脉僵硬度的研究　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：本研究通过对比女性冠心病患者介入治疗前后臂踝脉搏波速度增强指数和臂踝指数的变化,明确曲美他嗪(trimetazidine, TMZ)对两者的影响,从而进一步探讨臂踝脉搏波速度和臂踝指数的影响因素及其与心血管疾病的关系。研究方法：本研究共纳入2013年3月至2014年12月在我院心内科行经皮冠状动脉介入(Percutaneous intervention, PCI)治疗的女性冠心病患者152例,其中年龄为46-81岁,平均年龄为59.45±11.56岁。随机分为对照组(n=76)和曲美他嗪治疗组(n=76)。对照组给予阿司匹林、氯吡格雷、低分子量肝素、硝酸脂类、他汀类、β受体阻滞剂、ACEI类等常规药物治疗。曲美他嗪组患者在常规治疗的基础上,在PCI术前24 h给予20 mg 3/日的治疗。治疗持续时间为90 d。对所有入选患者的基本资料和病史资料进行详细的记录。患者入院后行临床生化指标的检查,同时行常规超声心动图检查。在患者进行介入治疗前及治疗后3月采用日本Colin公司生产的动脉硬化检测仪VP-1000测定双侧臂踝脉搏波速度和臂踝指数的变化。统计学分析三种指标在治疗前后的差异及其影响它们变化的相关因素。研究结果：在对照组患者中,臂踝脉搏波速度在治疗前后的差异无统计学意义,臂踝指数在治疗前后的差异亦无统计学意义。在曲美他嗪组患者中,臂踝脉搏波速度由治疗前的(1656.96±379.16)cm/s降至治疗后的(1556.72±313.18)cm/s,治疗前后的差异有统计学意义(P0.05),治疗后臂踝脉搏波速度显著改善；臂踝指数有治疗前的1.08±0.15下降至治疗后的1.05±0.19,但差异未见统计学意义(P0.05)。经组间比较,治疗前对照组和曲美他嗪组臂踝脉搏波速度和臂踝指数的差异无统计学意义(P0.05)；治疗后,曲美他嗪组臂踝脉搏波速度与对照组相比出现显著降低(P0.05),而臂踝指数上虽有下降,但无显著性差异。多元回归分析显示,年龄和收缩压是臂踝脉搏波速度的主要影响因素(r=0.436,P0.01；r=0.587,P0.01),臂踝脉搏波速度与冠脉病变程度呈正相关(P0.05)。此外,我们的研究发现患者是否具有糖尿病(P0.05)和空腹血糖(P0.01)是臂踝指数的危险因素。结论：年龄和收缩压是臂踝脉搏波速度的主要影响因素,臂踝脉搏波速度与冠脉病变支数呈密切正相关。糖尿病、脉压是臂踝指数的危险因素。曲美他嗪能对抗肾上腺素、去甲肾上腺素及血管紧张素胺的缩血管作用,能减低血管阻力,扩张冠状动脉,增加冠脉血流量及周围循环血流量,促进心肌代谢及心肌能量的产生,同时减低心脏工作负荷,减低心肌耗氧量及心肌能量的消耗,从而改善心肌氧供平衡明显降低臂踝脉搏波速度、改善动脉僵硬度,并且可能改善胰岛素抵抗、抗氧化、改善血管内皮功能、减少血管平滑肌增殖,减少脂质沉积有关。
[Abstract]:Objective: to study the changes of brachial ankle pulse wave velocity enhancement index and brachial ankle index in female patients with coronary heart disease before and after interventional therapy to determine trimetazidine. The influence of TMZ on both. So as to further study the influence factors of brachial ankle pulse wave velocity and brachial ankle index and the relationship between brachial ankle pulse wave velocity and cardiovascular disease. This study included percutaneous coronary intervention in our hospital from March 2013 to December 2014. Percutaneous intervention. PCI) was used to treat 152 female patients with coronary heart disease, aged 46-81 years. The average age was 59.45 卤11.56 years old. They were randomly divided into control group and trimetazidine treatment group. The control group was given aspirin, clopidogrel and low molecular weight heparin. The patients in trimetazidine group were treated with routine drugs, such as nitrate, statins, 尾 -receptor blockers and ACEI. The patients in trimetazidine group were treated on the basis of routine therapy. 20 mg / d was given 24 hours before PCI. The duration of treatment was 90. D. The basic and historical data of all patients were recorded in detail. The clinical biochemical indexes were examined after admission. At the same time, routine echocardiography was performed. Before and after interventional therapy, the pulse wave velocities of bilateral brachial malleolus and brachial pulse wave were measured with VP-1000 instrument produced by Colin Company of Japan on March. Changes in ankle index. Statistical analysis of the differences between the three indexes before and after treatment and related factors affecting their changes. Results:. In the control group. There was no significant difference in brachial ankle pulse wave velocity before and after treatment, and there was no significant difference in brachial ankle index before and after treatment. The pulse wave velocity of brachial ankle decreased from 1656.96 卤379.16 cm / s before treatment to 1556.72 卤313.18 cm / s after treatment. The difference before and after treatment was statistically significant (P 0.05), and the pulse wave velocity of brachial malleolus was significantly improved after treatment. The brachiolus index decreased from 1.08 卤0.15 before treatment to 1.05 卤0.19 after treatment, but the difference was not statistically significant (P 0.05). There was no significant difference in brachial ankle pulse wave velocity and brachial ankle index between the control group and trimetazidine group before treatment (P 0.05). After treatment, the brachial malleolus pulse wave velocity in trimetazidine group was significantly lower than that in the control group, while the brachial ankle index was decreased, but there was no significant difference. Multiple regression analysis showed. Age and systolic pressure were the main influencing factors of brachial pulse wave velocity. The pulse wave velocity of brachial malleolus was positively correlated with the severity of coronary artery lesion. In addition, there was a positive correlation between the velocity of brachial and ankle pulse wave and the severity of coronary artery lesion. Our study found whether patients had diabetes mellitus (P 0.05) and fasting blood glucose (P 0.01). Conclusion: age and systolic blood pressure are the main influencing factors of brachial ankle pulse wave velocity. The pulse wave velocity of brachial malleolus was positively correlated with the number of coronary artery branches. In diabetes mellitus, pulse pressure was the risk factor of brachial ankle index. Trimetazidine could antagonize the vasoconstriction of epinephrine, norepinephrine and angiotensin amine. It can reduce vascular resistance, dilate coronary artery, increase coronary blood flow and peripheral circulation blood flow, promote myocardial metabolism and myocardial energy production, and reduce cardiac workload. Reduce myocardial oxygen consumption and myocardial energy consumption, thereby improving myocardial oxygen supply balance significantly reduce brachial ankle pulse wave velocity, improve arterial stiffness, and may improve insulin resistance, anti-oxidation. Improving vascular endothelial function, reducing vascular smooth muscle proliferation, reducing lipid deposition.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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