尼可地尔对2型糖尿病微血管性心绞痛并冠状动脉慢血流患者心脏微循环的影响  

Influence of nicorandil on cardiac microcirculation function in patients with type 2 diabetes mellitus complicated with microvascular angina and coronary artery slow flow

作　　者：王珍[1] 彭柯[1] 王强[1] 杨大春[1] 辛东[2] 李德[1] WANG Zhen;PENG Ke;WANG Qiang;YANG Dachun;XIN Dong;LI De(Department of Cardiology,Chendu Military General Hospital,Chendu 610083,China)

机构地区：[1]成都军区总医院心血管内科,成都610083 [2]成都军区总医院心血管外科,成都610083

出　　处：《中华实用诊断与治疗杂志》2018年第9期911-914,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81500224)

摘　　要：目的探讨2型糖尿病微血管性心绞痛并冠状动脉慢血流患者应用尼可地尔治疗后冠状动脉微循环的改善情况。方法 2型糖尿病微血管性心绞痛并冠状动脉慢血流患者98例,随机分为尼可地尔组和对照组各49例。对照组给予常规治疗,尼可地尔组在对照组治疗基础上口服尼可地尔片5mg/次,3次/d,连续12个月。2组分别于治疗前、后行实时超声心肌声学造影及冠状动脉造影评估心脏微循环灌注情况,ELISA法检测血清一氧化氮(nitric oxide,NO)、6-酮前列腺素F1α(6-ketone prostaglandin F1α,6-Keto-PGF1α)、内皮素-1(endothelin-1,ET-1)、血栓素B2(thromboxane B2,TXB2)水平。结果尼可地尔组治疗前左前降支(left anterior descending branch,LAD)、左回旋支(left circumflex branch,LCX)、右冠状动脉(right coronary artery,RCA)校正TIMI帧数(corrected TIMI frame count,CTFC)值[(26.9±3.3)、(36.3±5.6)、(36.1±6.1)帧]与对照组[(26.8±4.5)、(35.9±6.2)、(35.8±5.9)帧]比较差异无统计学意义(P>0.05);尼可地尔组、对照组治疗后CTFC值在LAD[(18.2±4.1)、(22.1±4.9)帧]、LCX[(25.3±6.4)、(30.6±4.9)帧]、RCA[(25.8±5.6)、(30.9±5.2)帧]均明显低于治疗前(P<0.05),且尼可地尔组低于对照组(P<0.05);尼可地尔组治疗前心肌声学造影A值[(4.65±0.58)dB]、β值[(0.60±0.02)s]、Aβ值[(2.72±0.14)dB/s]与对照组[(4.68±0.34)dB、(0.61±0.07)s、(2.79±0.13)dB/s]比较差异无统计学意义(P>0.05);尼可地尔组、对照组治疗后A值[(5.61±0.37)、(4.98±0.29)dB]、β值[(0.97±0.06)、(0.78±0.05)s]、Aβ值[(5.14±0.22)、(3.85±0.11)dB/s]均高于治疗前(P<0.05),且尼可地尔组高于对照组(P<0.05);尼可地尔组治疗前血清NO[(131.9±22.4)μmol/L]、6-Keto-PGF1α[(209.8±28.5)ng/L]、ET-1[(131.2±23.1)ng/L]、TXB2[(140.5±19.7)pmol/L]水平与对照组[(132.6±19.4)μmol/L、(216.2±32.7)ng/L、(129.6±20.3)ng/L、(138.7±26.5)pmol/L]比较差异无统计学意义(P>0.05);尼可地尔组、对照组治疗后血清NO[Objective To investigate the effect of nicorandil on cardiac microcirculation function in patients with type 2 diabetes mellitus （T2DM） complicated with microvascular angina and coronary artery slow flow. Methods Ninety-eight patients with T2DM complicated with microvascular angina and coronary artery slow flow were randomly divided into nicorandil group （n=49） and control group （n=49）. Control group received conventional therapy and nicorandil group was treated with oral administration of nicorandil 5 mg each time, 3 times a day, totally for 12 months besides the conventional therapy. The cardiac microcirculation was evaluated by real-time myocardial contrast echocardiography and coronary angiography, while the levels of serum nitric oxide （NO）, 6-ketone prostaglandin F1α （6-Keto-PGF1α）, endothelin-1 （ET-1） and thromboxane B2 （TXB2） were detected by ELISA before and after treatment. Results There were no significant differences in the corrected TIMI frame counts in the left anterior descending branch （LAD）, left circumflex branch （LCX） and right coronary artery （RCA） between nicorandil group （26.9 ± 3.3, 36.3 ± 5.6, 36.1± 6.1） and control group （26.8±4.5, 35.9±6.2, 35.8±5.9） before treatment （P〈0.05）. The corrected TIMI frame counts were significantly lower in LAD （18.2±4.1, 22.1±4.9）, LCX （25.3±6.4, 30.6±4.9） and RCA （25.8±5.6,30.9±5.2） both in nicorandil group and control group after treatment than those before treatment （P〈0.05）, and in nicorandil group than those in control group after treatment （P〈0.05）. Real time myocardial contrast echocardiography showed that there were no significant differences in the A-value （（4. 65 ±0. 58） dB vs （4. 68± 0. 34） dB）, β-value （（0.60±0.02） s vs （0.61±0.07） s） and A β-value （（2. 72±0. 14） dB/s vs （2. 79±0. 13） dB/s） between nicorandil group and control group before treatment （P〉0.05）. A-values （（5.61±0.37）, （4.98±0.29） d

关 键 词：2型糖尿病 微血管性心绞痛 冠状动脉慢血流 尼可地尔 冠状动脉微循环 

分 类 号：R587.2[医药卫生—内分泌] R541.4[医药卫生—内科学]