别嘌醇对改善稳定型心绞痛患者缺血症状的有效分析  

Effect of Allopurinol on Exercise in Patients with Chronic Stable Angina

作　　者：肖辉[1] 陈冠瑶[1] 林康华[1] 宁观林[1] 

机构地区：[1]广东省吴川市人民医院内六科,吴川524500

出　　处：《血栓与止血学》2014年第3期117-120,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探讨别嘌醇对改善稳定型心绞痛患者缺血症状的有效性及安全性。方法入选就诊于我院的65例稳定型心绞痛患者,所有患者行运动平板试验。通过计算机随机化法将患者随机分为别嘌醇(100 mg/d)治疗组和安慰剂组。主要研究终点是治疗6个月后运动起始至发生ST段压低的时间,次要终点是总运动时间和运动起始到心绞痛发作的时间。结果在第一个治疗周期,分析了28例别嘌醇组(共31例)和32例安慰剂组患者(共34例)。在第二个周期,分析所有入选的60例患者。别嘌醇组发生ST段压低的平均时间从基线的232 s(IQR 182-380)增加到298 s(IQR211-408),而安慰剂组则增加到249 s(200-375,P=0.0002)。估计值为43 s(两组存在显著差异)(95%CI,31-58)。别嘌醇将平均总运动时间从基线的301 s(IQR 251-447)增加到393 s(IQR 280-519),而安慰剂组则增加到307 s(232-430;P=0.0003);估计值为58 s(95%CI 45-77)。别嘌醇将心痛发作时间从基线的234 s(IQR 189-382)增加到304 s(IQR222-421),安慰剂组则增加到272 s(200-380;P=0.001);估计值为38 s(95%CI 17-55)。别嘌醇组未见不良反应发生。结论别嘌醇对预防心肌缺血缺氧具有一定的疗效,有助于患者增强身体活动能力和缓解心绞痛症状。Objective We ascertained whether allopurinol prolongs exercise capability in patients with chronic stable angina. Methods 65 patients with angiographically documented coronary artery disease,a positive exercise tolerance test,and stable chronic angina pectoris（ for at least 2 months） were recruited into a double-blind,randomised,placebo-controlled,crossover study in the hospital. We used computer-generated randomisation to assign patients to allopurinol（ 100 mg per day） or placebo for 6 weeks before crossover. Our primary endpoint was the time to ST depression,and the secondary endpoints were total exercise time and time to chest pain. Results In the first treatment period,31 patients were allocated to allopurinol and 28 were analysed,and 34 were allocated to placebo and 32 were analysed. In the second period,all 60 patients were analysed. Allopurinol increased the median time to ST depression to 298 s（ IQR 211-408） from a baseline of 232s（ 182-380）,and placebo increased it to 249 s（ 200-375; P = 0. 0002）. The point estimate（ absolute difference between allopurinol and placebo） was 43 s（ 95% CI 31-58）. Allopurinol increased median total exercise time to 393 s（ IQR 280-519） from a baseline of 301 s（ 251-447）,and placebo increased it to 307 s（ 232-430;P = 0. 0003）; the point estimate was 58 s（ 95% CI 45-77）. Allopurinol increased the time to chest pain from a baseline of 234 s（ IQR 189-382） to 304 s（ 222-421）,and placebo increased it to 272 s（ 200-380; P =0. 001）; the point estimate was 38 s（ 95% CI 17-55）. No adverse effects of treatment were reported. Conclusion Allopurinol is a useful anti-ischaemic treatment option in patients with angina that has the advantage of being inexpensive,well tolerated and safe in the long term.

关 键 词：稳定型心绞痛 别嘌醇 

分 类 号：R543.3[医药卫生—心血管疾病]