| Objective: Trimetazidine (trimetazidine, TMZ) for piperazine derivatives, is a new type of anti-ischemic drugs.It inhibits myocardial fatty acidβoxidation and increase glucose oxidation, improve the coupling of glycolysis and glucose oxidation, optimize the energy metabolism of myocardial cell primarily by inhibiting the 3 - keto acyl-coenzyme A thiolase (3-KAT)s. A large number of basic research confirmed that trimetazidine reduces intracellular H +, Na +, Ca2 + overload, inhibits oxygen free radicals, stabilize the functional state of mitochondrial membrane, with anti-oxidation, anti-apoptotic and other cell protective effect.And it does not affect hemodynamics, has no negative inotropic effect . Trimetazidine is increasingly popular for Clinicians with excellent pharmacological effects. Atherosclerosis is an important part of the pathophysiology of Coronary Heart Disease (CHD), formation of atherosclerosis is involved in artery wall cells, extracellular matrix, blood composition, regional blood flow dynamics, and many other environmental and genetic factors, it began with vascular endothelial cell injury, while the endothelial dysfunction is endothelial injury in the early stage of the performance. Diabetes is a CHD risk equivalent and independent risk factors. Diabetes make vascular endothelial cell dysfunction, and accelerate atherosclerosis, whill atherosclerosis is an important reason for CHD occurred. Thus, vascular endothelial dysfunction may be a common pathway and pathological physiological basis between DM and CHD .Coronary artery Lesion is severe and diffuse, often multi-vessel Lesion.The incidence is more common with acute coronary syndrome, and the prognosis is poor. In recent years, basic and clinical research results showed that endothelial dysfunction is the initiating agent in many cardiovascular diseases's occurrence and development .It has been reported in patients with coronary heart disease or diabetes that endothelial function is significantly impaired, and the level of endothelial function'injury for coronary heart disease in patients with diabetes mellitus is worse. There is rare article at home and abroad on trimetazidine effects of vascular endothelial function. This study was designed to observe the the changes of plasma nitric oxide (NO) levels, brachial artery endothelium-dependent vasodilation (FMD) after loading of trimetazidine (60mg) two hours to explore the short-term effects of endothelial function in load of trimetazidine for coronary artery disease in patients with diabetes, in order to provide a theoretical basis for clinical medicine.Methods: Selected 60 patients with coronary heart disease and diabetes mellitus, 39 males and 21 females, aged 35 to 72 years old, mean age (53.4±12.3) years old. All selected patients had been diagnosed with coronary angiography coronary artery disease (According to internationally accepted method for evaluation of coronary artery diameter stenosis, who were≥50% stenosis as CHD, <50% by the NCHD), while in line with the WHO in 1999 recommended diagnostic criteria of diabetes, and except for hypertension and hyperlipidemia history. Detection of the first two days after admission in patients with fasting lipids (hyperlipidemia excluded). Detect the plasma NO levels in patients with stable disease state who is not taking the loading dose of trimetazidine on the third day, and immediately to the brachial artery ultrasound baseline brachial artery diameter, under the basis of the value of D0, and then to the brachial artery pressure, detection of reactive hyperemia brachial artery diameter D1, and calculate endothelium-dependent vasodilatation(FMD) of brachial artery brachial ,and followed by hydrochloride trimetazidine 60mg are served burton, after two hours detected NO levels, and once again made the brachial artery ultrasound to detected FMD.Results: 1.The plasma NO levels were significantly higher after leighton service load trimetazidine 60mg two hour(s44.98±2.96 vs 45.87±3.28 umol/L, P<0.05)2.FMD was significantly higher(12.69±1.61 vs 13.21±1.96 % ,P<0.05), Conclusion: 1.Trimetazidine can improve ascular endothelial cell function of coronary heart disease in patients with diabetes mellitus2. Its possible mechanism is by affecting NO levels.
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