Effects Of Trimetazidine On The Serum Levels Of Tumor Necrosis Factor-α And Plasminogen Activator Inhibitor-1 In Patients With Unstable Angina Pectoris

Objective To investigate the potential mechanism of Trimetazidine (TMZ)in patients with Unstable Angina Pectoris(UAP) by observing the serum levels of tumor necrosis factor-α(TNF-α) and plasminogen activator inhibitor-1(PAI-1) after 1 week and 2 weeks of Trimetazidine treatment.Methods Forty patients with UAP were divided randomly into two groups: the routine treatment group(n=20) and the Trimetazidine treatment group(n=20). Clinical data such as the patients'history,symptom,creatase, chest radiogram,ECG and coronary angiography (CAG) were recorded. Both groups were received conventional therapy at the first two weeks and the TMZ group was administered TMZ (20 mg, 3 times per day). TNF-αand PAI-1 in both groups were detected by ELISA before and after the 1st week and the 2nd week of TMZ treatment .Results (1) The concentration of TNF-αdecreased at the 1st week and the 2nd week in two groups compared with that of pre-treatment(P<0.01, respectively). What's more, the concentration of TNF-αmeasured at the 2nd week was singnificantly lower than that of the 1st week in two groups (P<0.01, respectively); The decline of TNF-αmeasured at the 1st week in TMZ group was distinctly lower than that of routine group(p=0.029), and the same as the 2nd week(P=0.000). (2)The concentration of PAI-1 decreased at the 1st week and the 2nd week in two groups compared with that of pre-treatment(P<0.01, respectively);What's more, the concentration of PAI-1 measured at the 2nd week was singnificantly lower than that of the 1st week in two groups(P<0.01, respectively); The decline of PAI-1 measured at the 1st week in TMZ group was distinctly lower than that of routine group(P<0.01);and the same as the 2nd week(P<0.01). (3)After taking the time and managing factors into account, the concentration of TNF-αand PAI-1 in both groups still existed significant difference. (P value is 0.046 and 0.039, respectively). (4) The related analysis before the clinical treatment demonstrated that the TNF-α,PAI-1 and CRP were positively correlated with each other(all P<0.01);But the WBC count,HDL-cholesterol,total cholesterol and blood glucose did not have correlation with TNF-αand PAI-1.(all P>0.05).Conclusions (1)An adjunctive therapy of trimetazidine in patients with UAP could further reduce the serum levels of TNF-αand PAI-1. It suggested that TMZ could protect the myocardial cells not only through optimizing the cardiac energy metabolism but also affecting the serum levels of TNF-αand PAI-1 which subsequently attenuated the inflammation.(2)The positive correlation among the levels of TNF-α,PAI-1 and CRP detected in the UAP indicated that the three factors might interact each other and affect the inflammatory response in patients with UAP.