目的 探讨曲美他嗪联合氯吡格雷对急性心肌梗死患者心功能和血清巨噬细胞迁移抑制因子（MIF）、白细胞介素-10（IL-10）水平的影响。方法 选取2017年5月—2019年5月在武汉市红十字会医院治疗的老年急性心肌梗死患者96例作为研究对象，将患者随机分为对照组和观察组，每组各48例。对照组口服硫酸氢氯吡格雷片，75 mg/次，1次/d。观察组在对照组基础上口服盐酸曲美他嗪片，20 mg/次，3次/d。两组均治疗1个月。比较两组患者的左室射血分数（LVEF）、心输出量（CO）及左室舒张末期内径（LVEDD）等心功能指标水平、MIF、IL-10水平及药物安全性。结果 治疗后，两组LVEF、CO水平显著升高，LVEDD水平显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，观察组LVEF、CO水平显著高于对照组，而观察LVEDD水平显著低于对照组（P<0.05）。两组治疗后血清MIF和血清IL-10水平均显著低于治疗前，同组治疗前后比较差异具有统计学意义（P<0.05）；观察组治疗后血清MIF和IL-10水平均显著低于对照组（P<0.05）。观察组治疗后心律失常、心源性休克及出血发生率显著低于对照组（P<0.05）。结论 曲美他嗪联合氯吡格雷用于急性心肌梗死患者中能改善患者心功能，降低MIF和IL-10水平，且不增加不良反应及不良心脏事件的发生率，具有一定的临床推广应用价值。

Objective To investigate the effect of trimotaziaine combined with clopidogrel on cardiac function and serum MI) and IL-10 levels in patients with acute myocardial infarction. Methods A total of 96 elderly patients with acute myocardial infarction treated in the Wuhan Red Cross Hospital from May 2017 to May 2019 were selected as the research objects and randomly divided into control group and observation group, with 48 patients in each group. Patients in the control group were po administered with Clopidogrel Hydrogen Sulphate Tablets on the basis of conventional treatment, 75 mg/time, once daily. Patients in the observation group were po administered with Trimetazidine Dihydrochloride Tablets on the basis of the control group, 20 mg/time, three times daily. Both groups were treated for 1 month. After treatment, the cardiac parameter levels of LVEF, CO, LVEDD, the levels of MIF, IL-10, and drug safety between two groups were compared. After treatment, LVEF and CO levels in two groups were significantly increased, while the LVEDD levels were significantly decreased, the difference in the same group before and after treatment was statistically significant (P<0.05). Results After treatment, LVEF and CO levels in the observation group were significantly higher than those in the control group, while the LVEDD levels in the observation group were significantly lower than those in the control group, with statistically significant differences between the two groups (P<0.05). After treatment, the serum levels of MIF and IL-10 in two groups were significantly lower than those before treatment, and the difference in the same group before and after treatment was statistically significant (P<0.05). After treatment, the serum levels of MIF and IL-10 in the observation group were significantly lower than those in the control group, with statistically significant differences between the two groups (P<0.05). After treatment, the incidence of arrhythmia, cardiogenic shock, and bleeding in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Trimotaziaine combined with clopidogrel in treatment of acute myocardial infarction can improve cardiac function, reduce the levels of MIF and IL-10, without increasing the incidence of adverse reactions and adverse cardiac events, which has certain clinical application value.

R972

湖北省卫计委资助项目（W2017M1059）