2019 年第 2 期 第 14 卷

美托洛尔联合曲美他嗪对老年高血压合并慢性心力衰竭患者的疗效

Effect of metoprolol combined with trimetazidine on senile patients with hypertension and chronic heart failure

作者：梁国君廖桂华

英文作者：

单位：610000成都军区总医院干部病房一病区（梁国君），干部病房四病区（廖桂华）

英文单位：

关键词：高血压；慢性心力衰竭；美托洛尔；曲美他嗪；Th17细胞

英文关键词：

• 摘要：

• 【摘要】目的    探讨美托洛尔联合曲美他嗪对老年高血压合并慢性心力衰竭患者的疗效。方法    选取2016年1月至2017年12月成都军区总医院收治的86例老年高血压合并慢性心力衰竭患者为研究对象，按照随机数字表法分为对照组和观察组，各43例。对照组在常规治疗基础上给予琥珀酸美托洛尔缓释片治疗；观察组在对照组基础上给予曲美他嗪片治疗。2组均治疗6个月。比较2组临床疗效，治疗前后心率、血压、心功能指标、CD+4CD+25调节性T细胞和辅助性T细胞17(Th17)细胞表达水平，以及用药期间不良反应发生情况。结果    治疗后，观察组总有效率明显高于对照组［90.7%(39/43)比69.8%(30/43)］，差异有统计学意义（P＜0.01）。治疗后，2组患者心率、血压明显低于治疗前，且观察组心率明显低于对照组［（85±8）次/min比（97±8）次/min］，差异有统计学意义（P＜0.05）。治疗后，观察组患者左心室射血分数、左心室收缩末期内径、左心室舒张末期内径改善均较对照组明显［（50.2±3.3）%比（45.2±2.9）%、（34.3±2.1）mm比（38.7±2.5）mm、（54±3）mm比（58±4）mm］，差异均有统计学意义（均P＜0.05）。治疗后，2组CD+4CD+25调节性T细胞细胞比例明显升高，且观察组明显高于对照组，Th17细胞比例明显下降，且观察组明显低于对照组，差异均有统计学意义（均P＜0.05）。治疗期间，2组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论    美托洛尔联合曲美他嗪治疗老年高血压合并慢性心力衰竭，能明显改善心率，稳定各项心功能指标，调节外周血Th17细胞等炎症因子，缓解免疫系统紊乱，且安全性较好。

• 【Abstract】Objective    To evaluate the effect of metoprolol combined with trimetazidine on senile patients with hypertension and chronic heart failure. Methods    Totally 86 senile patients with hypertension and chronic heart failure admitted to Chengdu Military General Hospital from January 2016 to December 2017 were randomly divided into control group and observation group, with 43 cases in each group. The control group took metoprolol succinate sustained-release tablets and the observation group took trimetazidine tablets additionally; both groups were treated for 6 months. Heart rate, blood pressure, cardiac function, CD+4CD+25 regulatory T cell（Treg）, helper T cell 17（Th17） and adverse drug reactions were analyzed. Results    Total effective rate in observation group was significantly higher than that in control group［90.7%(39/43) vs 69.8%(30/43)］（P＜0.01）. After treatment, heart rate and blood pressure were significantly lower than those before treatment in both groups; heart rate in observation group was significantly lower than that in control group［（85±8）times/min vs （97±8）times/min］（P＜0.05）. After treatment, left ventricular ejection fraction, left ventricular end-systolic diameter and left ventricular end-diastolic diameter in observation group were significantly improved compared to those in control group［（50.2±3.3）% vs （45.2±2.9）%, （34.3±2.1）mm vs （38.7±2.5）mm, （54±3）mm vs （58±4）mm］（P＜0.05）. After treatment, CD+4CD+25 Treg ratio significantly increased and Th17 ratio significantly decreased in both groups; CD+4CD+25 Treg ratio in observation group was significantly higher and Th17 ratio was lower than those in control group（P＜0.05）. There was no significant difference of the incidence of adverse reactions between groups（P＞0.05）. Conclusion    Metoprolol combined with trimetazidine treating senile hypertension with chronic heart failure can significantly improve heart rate and cardiac function, modulate peripheral blood Th17 and relieve immune disorders with good safety.