Klinicheskie gorizonty kardioprotektsii: "kal'tsievyy sled" trimetazidina


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Abstract

Применение цитопротекторов при ишемической болезни сердца (ИБС) официально рекомендовано Американской ассоциацией сердца в 1997 г. В то время триметазидин (1-[2,3,4-триметоксибензил] пиперазин дигидрохлорид; предуктал) был единственным препаратом этого класса, имеющим основательную доказательную базу для клинического применения у больных с хронической коронарной недостаточностью. И до сих пор триметазидин остается наиболее изученным и наиболее широко применяемым современным цитопротектором. В основе применения триметазидина при хронической коронарной недостаточности лежит его способность блокироватьb-окисление жирных кислот за счет селективной ингибиции длинноцепочной 3-кетоацил КоА-тиолазы в митохондриях ишемизированного миокарда [1]. Подобное вмешательство ведет к уменьшению участия жирных кислот в формировании митохондриями макроэргических соединений и увеличению использования для этих целей глюкозы. Замена потребляемого в энергетическом обмене исходного субстрата приводит к более эффективному использованию кислорода и как следствие к более адекватному энергетическому обеспечению функционирующего миокарда. В клинике это находит свое отражение в снижении количества приступов стенокардии напряжения, в удлинении времени переносимой нагрузки и увеличении ее величины. Применение триметазидина на фоне других антиангинальных и антиишемических препаратов ведет к уменьшению ранее используемых доз этих медикаментов и увеличению эффективности антиангинального и антиишемического лечения.

About the authors

A. A Aleksandrov

ГУ Эндокринологический научный центр РАМН, Москва

Отделение кардиологии

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