Эффективность триметазидина – селективного ингибитора бета-окисления жирных кислот в лечении больных со стабильной стенокардией и хронической сердечной недостаточностью

Цель    Оценка эффективности триметазидина (ТМЗ) с модифицируемым высвобождением в составе стандартной терапии у больных со стабильной стенокардией и хронической сердечной недостаточностью (ХСН) в рамках подгруппового анализа исследования «ПЕРСПЕКТИВА».

Материал и методы  В анализ включены 806 пациентов: 1‑я группа (n=691) – пациенты, получающие стандартную терапию и ТМЗ с модифицируемым высвобождением (группа «ТМЗ»), и 2‑я группа (n=115) – пациенты, получающие стандартную терапию (контрольная группа). Общая продолжительность исследования 12 мес.

Результаты   В группе ТМЗ число приступов стенокардии за неделю уменьшалось на 41,9 % (р<0,0001) через 2 мес и на 69,6 % (от исходного, р<0,0001) через 12 мес, как и частота приема нитроглицерина – на 40,8 % (р<0,0001) и 67,7 % (р<0,0001) соответственно в отсутствие динамики этих показателей в контрольной группе. В группе ТМЗ при сравнении с контрольной группой выявлены укорочение интервала QT (на 7,9 %; р<0,05), уменьшение конечного систолического размера левого желудочка (ЛЖ, на 13,4 %; р<0,01), толщины межжелудочковой перегородки (на 9,5 %; р<0,01) и задней стенки (12,2 %; р<0,01) ЛЖ, а также увеличение фракции выброса (на 11,4; р<0,05). После приема ТМЗ уменьшилось количество лейкоцитов (на 5,3 %; р<0,01) в периферической крови и содержание высокочувствительного С-реактивного белка (на 30,7 %; р<0,01) в сыворотке крови против их роста в контрольной группе (на 17,9 %; р<0,05 и 17,8 %; р<0,05 соответственно).  Число госпитализированных больных по причине обострения ХСН или стенокардии за 12 мес составило в группе ТМЗ 8,6 %, в контрольной группе – 15,7 % (p=0,001).

Заключение     Включение ТМЗ с модифицируемым высвобождением в стандартную терапию у больных со стабильной стенокардией и ХСН уменьшает количество приступов стенокардии, улучшает структурно-функциональные параметры сердца, снижает активность факторов воспаления и улучшает течение болезни.

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