目的 探究曲美他嗪輔助卡維地洛治療高血壓性心臟病的療效及對p38MAPK水平的影響。方法 選擇開封市祥符區(qū)中醫(yī)院2016年10月-2018年10月收治的高血壓性心臟病患者106例為研究對象，根據(jù)其入院順序經(jīng)隨機數(shù)字表法分為兩組，每組53例。其中，對照組給予卡維地洛進行治療，觀察組在對照組基礎上聯(lián)合曲美他嗪進行治療，對比兩組患者的超聲心動圖測定各指標、血壓變化和血清TNF-α、IL-6、p38MAPK水平。結(jié)果 治療前，兩組患者的左室射血分數(shù)（LVEF）、左室舒張末期內(nèi)徑（LVDD）、左室收縮末期內(nèi)徑（LVSD）、左房內(nèi)徑（LAD）、室間隔厚度（IVST）水平對比無顯著性差異；治療后，兩組患者的LVDD、LVSD、LAD、IVST水平均比治療前顯著降低（P<0.05），且觀察組顯著低于對照組（P<0.05）；治療后，兩組患者的LVEF水平均比治療前顯著升高（P<0.05），且觀察組顯著高于對照組（P<0.05）。治療前，兩組患者的收縮壓（SBP）、舒張壓（DBP）水平對比無顯著性差異；治療后，兩組患者的SBP、DBP水平均比治療前顯著降低（P<0.05），且觀察組顯著低于對照組（P<0.05）。治療前，兩組患者的血清腫瘤壞死因子-α（TNF-α）、白介素-6（IL-6）、P38絲裂原活化蛋白激酶（p38MAPK）水平對比無顯著性差異；治療后，兩組患者的血清TNF-α、IL-6、p38MAPK水平均比治療前顯著降低（P<0.05），且觀察組顯著低于對照組（P<0.05）。結(jié)論 曲美他嗪輔助卡維地洛治療高血壓性心臟病的效果顯著，該方法可有效降低患者的血壓水平和炎癥因子水平，并抑制p38MAPK活化，臨床應用效果顯著。

Objective To investigate the effect of trimetazidine-assisted carvedilol on hypertensive heart disease and its effect on p38MAPK. Methods A total of 106 patients with hypertensive heart disease admitted to Xiangfu District Hospital of Traditional Chinese Medicine from October 2008 to October 2018 were enrolled in the study. According to their admission order, they were divided into two groups according to the random number table method, with 53 cases in each group. Among them, the control group was treated with carvedilol, and the study group was treated with trimetazidine on the basis of the control group. The indexes, blood pressure changes, and serum TNF-α, IL-6 and p38 MAPK levels were measured by echocardiography in two groups. Results Before treatment, there was no significant difference in the levels of LVEF, LVDD, LVSD, LAD and IVST between two groups. After treatment, the LVDD, LVSD, LAD, and IVST levels of two groups were significantly lower than those before treatment (P<0.05), and the patients in the study group were lower than those in the control group (P<0.05). After treatment, the LVEF levels of two groups were significantly higher than those before treatment (P<0.05), and the patients in the study group were higher than those in the control group (P<0.05). Before treatment, there was no significant difference in SBP and DBP levels between two groups. After treatment, the SBP and DBP levels in two groups were significantly lower than those before treatment (P<0.05), and the patients in the study group were lower than those in the control group (P<0.05). Before treatment, there was no significant difference in serum TNF-α, IL-6, and p38MAPK levels between two groups. After treatment, serum TNF-α, IL-6, and p38 MAPK levels were significantly decreased (P<0.05), and the indexes in the study group were significantly lower than those in the control group (P<0.05). Conclusion Trimetazidine-assisted carvedilol is effective in treatment of hypertensive heart disease. This method can effectively reduce the blood pressure level and inflammatory factor levels, and inhibit the activation of p38MAPK. The clinical application effect is significant.

2017年河南省科學技術項目（9412017Y0439）