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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (3): 282-288    DOI: 10.3785/j.issn.1008-9292.2019.06.08
    
Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic
YE Pingxian*(),YE Pingzhen,HE Jinping
Department of Cardiology, Zhejiang Jinhua Guangfu Hospital, Jinhua 321000, Zhejiang Province, China
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Abstract  

Objective: To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic. Methods: In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-α, angiotensin Ⅱ and endothelin concentration were determined before and after treatment. Results: In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (VE) to late diastolic velocity (VA) ratio (VE/VA) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all P < 0.05); plasma concentration of hr-CRP, TNF-α, angiotensin Ⅱ and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all P < 0.05) and with placebo (all P < 0.05). There were no significant differences in any of above parameters after treatment in placebo group (all P>0.05). No severe adverse reaction was observed in both groups. Conclusion: For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.



Key wordsTrimetazidine/therapeutic use      Hypertension/complications      Hypertension/drug therapy      Diabetes complications/drug therapy      Ventricular function, left      Diastole      Exercise tolerance      Randomized controlled trial     
Received: 10 January 2019      Published: 04 September 2019
CLC:  R544  
Corresponding Authors: YE Pingxian     E-mail: yepingxian@qq.com
Cite this article:

YE Pingxian, YE Pingzhen, HE Jinping. Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic. J Zhejiang Univ (Med Sci), 2019, 48(3): 282-288.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.06.08     OR     http://www.zjujournals.com/med/Y2019/V48/I3/282


曲美他嗪对高血压合并糖尿病患者心功能及运动耐量的影响

目的: 观察曲美他嗪治疗对高血压合并2型糖尿病患者心功能及运动耐量的影响。方法: 采用随机、双盲、安慰剂对照的前瞻性研究方法。选择高血压合并2型糖尿病患者60例,随机分成曲美他嗪治疗组和对照组各30例。两组均给予规范降压、降糖、抗血小板及他汀类药物降脂治疗,治疗组在此基础上口服盐酸曲美他嗪治疗,对照组使用安慰剂治疗,疗程为1年。两组治疗前后均行心脏超声心动图检查、运动心肺功能测定、血浆氨基端脑钠肽前体(NT-ProBNP)浓度测定,并测定其超敏C反应蛋白、TNF-α、血管紧张素Ⅱ、血浆内皮素等血浆细胞因子水平。结果: 曲美他嗪治疗组治疗后,左心室质量指数、二尖瓣血流频谱E峰与A峰比值、二尖瓣环运动舒张早期峰速度与舒张晚期峰速度比值及收缩期峰值速度均明显改善,与治疗前及对照组治疗后差异均具有统计学意义(均P < 0.05);NT-ProBNP下降,与治疗前及对照组治疗后差异均具有统计学意义(均P < 0.05);运动耐量改善,表现为运动时间延长,运动当量、最大摄氧量、无氧阈增大,各指标与治疗前及对照组治疗后差异均有统计学意义(均P < 0.05);治疗组超敏C反应蛋白、血浆内皮素、TNF-α、血管紧张素Ⅱ下降,相比治疗前及对照组治疗后差异均有统计学意义(均P < 0.05)。对照组未见上述指标在治疗前后有明显差异(均P>0.05)。两组均未发生严重不良反应。结论: 曲美他嗪能有效改善高血压合并糖尿病患者的心功能,提高运动耐量。


关键词: 曲美他嗪/治疗应用,  高血压/并发症,  高血压/药物疗法,  糖尿病并发症/药物疗法,  心室功能, 左,  心舒期,  运动耐量,  随机对照试验 
(n或$\bar x \pm s$)
组别 n 年龄(岁) 性别(男/女) 吸烟 体质指数(kg/m2) 心率(次/min) 收缩压(mmHg) 舒张压(mmHg) 高血压病程(年) 糖尿病病程(年) 用药情况
ACEI/ARB β受体阻滞剂 钙离子拮抗剂 利尿药 阿司匹林/氯吡格雷 他汀类 口服降糖药 胰岛素
ACEI:血管紧张素转换酶抑制剂;ARB:血管紧张素Ⅱ受体拮抗剂.1 mmHg=0.133 kPa.
治疗组 30 62.8±10.8 18/12 4 24.2±2.1 69±10 132±11 80±10 10.6±9.8 5.8±1.6 23/7 15 15 2 30 30 28 3
对照组 30 62.3±10.6 18/12 4 24.3±2.4 70±8 131±12 81±9 11.5±10.2 5.6±1.8 23/7 15 15 2 30 30 27 3
Tab 1 Baseline characteristics of treatment group and control group
($\bar x \pm s$)
组别 n 左心室质量指数(g/m2) 左心室射血分数(%) E(cm/s) A(cm/s) E/A E峰减速时间(msec) 等容舒张时间(msec) Vs(cm/s) VE(cm/s) VA(cm/s) VE/VA
与治疗前比较,*P<0.05;与对照组治疗后比较:#P<0.05.E:舒张早期血流峰速度;A:舒张晚期血流峰速度;VE:舒张早期二尖瓣环运动峰速度;VA:舒张晚期二尖瓣环运动峰速度;Vs:收缩期二尖瓣环运动峰值速度.
治疗组  治疗前 30 118±13 64.6±9.5 69±15 85±15 0.80±0.20 216±42 84±23 7.20±1.53 6.99±1.96 8.75±1.92 0.80±0.22
        治疗后 30 108±11*# 65.8±9.1 74±16 82±16 0.91±0.21*# 202±42 77±22 8.12±1.70*# 8.12±2.03*# 8.83±2.01 0.92±0.21*#
对照组  治疗前 30 118±12 64.6±9.6 68±16 86±16 0.79±0.20 216±40 85±21 7.19±1.60 6.98±1.98 8.57±2.06 0.80±0.21
        治疗后 30 116±10 65.0±10.0 69±18 88±16 0.80±0.19 210±40 83±20 7.20±1.62 7.02±1.92 8.66±2.12 0.81±0.20
Tab 2 Results of cardiac function examination before and after treatment in treatment group and control group
组别 n 运动时间(min) 代谢当量 最大摄氧量 无氧阈
与治疗前比较,*P<0.05;与对照组治疗后比较:#P<0.05.单位为mL·kg-1·min-1
治疗组
  治疗前 30 8.3±1.9 5.6±1.5 19.6±4.8 13.4±4.8
  治疗后 30 9.8±2.0*# 6.7±1.7*# 22.5±5.0*# 16.2±5.0*#
对照组
  治疗前 30 8.2±2.0 5.6±1.7 19.5±4.9 13.3±4.9
  治疗后 30 8.3±1.8 5.8±1.5 19.7±4.8 13.5±4.8
Tab 3 Exercise tolerance between treatment group and control group ($\bar x \pm s$)
($\bar x \pm s$)
组别 n 超敏C-反应蛋白(mg/L) 血浆内皮素(ng/L) TNF-α(ng/L) 血管紧张素Ⅱ(ng/L)
与治疗前比较,*P < 0.05;对照组治疗后比较,#P < 0.05.
治疗组
  治疗前 30 2.41±1.24 73±19 122±41 97±18
  治疗后 30 1.69±0.90*# 64±12*# 98±36*# 86±14*#
对照组
  治疗前 30 2.39±1.18 75±20 123±42 96±17
  治疗后 30 2.36±1.15 73±17 122±41 96±15
Tab 4 Inflammation and vascular endothelial function between treatment group and control group
($\bar x \pm s$)
组别 n 总胆固醇(mmol/L) 低密度脂蛋白(mmol/L) 三酰甘油(mmol/L) 高密度脂蛋白(mmol/L) 空腹血糖(mmol/L) 餐后2 h血糖(mmol/L) 糖化血红蛋白(%)
治疗组  治疗前 30 4.1±1.0 2.2±0.9 2.4±0.6 1.0±0.4 6.4±1.7 9.4±2.0 7.1±0.9
        治疗后 30 3.8±0.9 2.0±0.8 2.3±0.6 1.1±0.4 6.1±1.7 8.9±2.1 6.9±0.8
对照组  治疗前 30 4.2±1.0 2.1±1.0 2.4±0.6 1.0±0.4 6.5±1.6 9.4±1.9 7.0±0.8
        治疗后 30 3.8±0.9 2.0±1.0 2.3±0.6 1.0±0.5 6.2±1.7 8.9±2.6 7.1±0.7
Tab 5 Blood lipid metabolism and glucose measurements between treatment group and control group
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