尼可地尔对梗阻性冠心病患者冠状动脉微循环障碍的影响  

Impact of Nicorandil Treatment on Coronary Microvascular Dysfunction in Patients with Obstructive Coronary Artery Disease

作　　者：官兵[1] 苏杨[1] 韦旭斌[1] 张莹[1] GUAN Bing;SU Yan;WEI Xu-bin;ZHANG Ying(Dept.of Cardiology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院心内科三病区,昆明云南650101

出　　处：《昆明医科大学学报》2020年第2期68-75,共8页Journal of Kunming Medical University

基　　金：云南省教育厅科学研究基金资助项目(2015Z080)。

摘　　要：目的探讨冠心病(CAD)患者口服尼可地尔对冠状动脉微循环障碍(CMD)的治疗效果。方法通过腺苷负荷冠状动脉造影、冠状动脉压力/温敏导丝检查确定心肌微循环阻力指数(IMR),检出伴有CMD的CAD患者[≥50%狭窄、冠脉血流储备分数(FFR)≤0.8],并且这些患者未行冠状动脉支架植入。将患者随机分为尼可地尔组(n=12和对照组(n=9),尼可地尔组口服尼可地尔5mg,3次/d;对照组口服硝酸异山梨酯5mg,3次/d。180 d后,复查腺苷负荷IMP以及行腺苷负荷心肌首过磁共振灌注成像(CMR)测定磁共振心肌灌注储备指数(MPRI),并比较2组腺苷负荷IMP及MPRI的差异。结果尼可地尔治疗组IMR显著低于对照组(P<0.01);尼克地尔组的平均腺苷负荷MPRI低于对照组(P<0.01)。结论尼可地尔可改善冠心病患者冠状动脉微循环功能。Objective To assess the impact of nicorandil treatment on coronary microvascular dysfunction(CMD)values in patients with obstructive coronary artery disease(CAD).Methods CAD patients(≥50%stenosis,fraction flow reserve(FFR)≤0.8)with CMD,who were diagnosed by invasive adenosine stress coronary reactivity testing(CRT),and whose index of microcirculatory resistance(IMR)was measured using the intracoronary pressure/temperature sensor-tipped guide after successful CRT but did not receive PCI,were selected in this study.The patients were randomly assigned to the nicorandil treatment group(5 mg,three times a day,n=12 and sosorbide Dinitrate reatment group(5 mg,three times a day,n=9)groups.After 180 days,the adenosine stress IMR was measured again,and adenosine stress cardiac magnetic resonance(CMR)first-pass perfusion imaging was completed to determine myocardial perfusion reserve index(MPRI)between the nicorandil group and control group.The differences of IMP and MPRI in the two groups were compared.Results The nicorandil group had lower IMR values(P<0.01),and lower mean adenosine stress MPRI values(P<0.01)compared with the control group on coronary microvascular dysfunction(CMD)in patients with obstructive coronary artery disease.Conclusions Nicorandil was associated with reduced coronary microvascular dysfunction in patients with obstructive coronary heart disease.

关 键 词：尼可地尔 冠状动脉微循环障碍 微血管性心绞痛 经皮腔内冠状动脉介入术 

分 类 号：R541.4[医药卫生—心血管疾病]