尼可地尔在肾脏疾病中作用研究的进展

尼可地尔是一种临床中常见的血管舒张药物,广泛应用于心绞痛的治疗,近年来不断有研究讨论尼可地尔对肾脏疾病的作用和影响,但却罕有相关的研究及试验.本文旨在讨论尼可地尔在肾脏疾病中作用研究的进展,为临床治疗提供参考依据.     

尼可地尔对心绞痛患者的血液动力学影响

本文对34例稳定型心绞痛患者口服尼可地尔5mg或10mg进行踏车运动试验。口服后,尼可地尔的降压作用与剂量相关,对心率几无影响。连续口服2周,运动耐受力可延长44.38～65.63%,运动诱发心绞痛时间延长43.06～63.18%。     

尼可地尔在心肌缺血再灌注中的作用

目的：观察非特异性KAT,通道开放剂尼可地尔在心肌缺血再灌注中的作用及效果。方法：建立在体大鼠心脏缺血再灌注模型,将60只大鼠随机分成3组：缺血再灌（IR）组,尼可地尔（NIC）组,空白对照（CON）组。测定各组血清肌酸激酶（CK）,乳酸脱氢酶（LDH）的浓度,应用罗丹明行线粒体染色,观察各组细胞能量代谢的变化。结果：与IR组比较,尼可地尔组血清CK,LDH浓度显著降低（P〈0．05）,N1C组心肌细胞线粒体的跨膜电位（罗丹明线粒体染色）显著升高,即线粒体能量代谢较强（P〈0．05）。结论：尼可地尔在心肌缺血再灌注中能起到一定的保护作用。     

尼可地尔联合氨氯地平对不稳定性心绞痛患者疗效观察

目的:观察尼可地尔联合氨氯地平对不稳定性心绞痛(UA)患者治疗效果,为UA患者的临床治疗提供更多的科学理论依据.方法:将75例UA患者随机分为观察组42例和对照组33例.观察组在常规心绞痛治疗基础上加用尼可地尔联合氨氯地平,对照组给予常规心绞痛治疗基础上加用氨氯地平.6个月后观察两组的总有效率、缺血发作次数、ST段最大下降幅度及不良反应发生率.结果:观察组UA患者总有效率显著高于对照组,且不良反应显著低于对照组.差异均有统计学意义(P＜0.05).结论:在常规治疗基础上,加用尼可地尔联合氨氯地平能有效提高UA患者的临床疗效,缺血发作次数显著减少、ST段下降幅度明显,且不良反应少,利于患者的康复.     

尼可地尔在缺血性心脏病患者中的疗效研究

目的探讨尼可地尔对缺血性心脏病患者的疗效。方法入选解放军总医院2014年1月~2015年12月诊断为缺血性心脏病患者160例,随机分为对照组和尼可地尔组,每组各80例;应用PICCO监测患者心功能;观察两组患者治疗治疗前、治疗后1周及治疗后1年心指数(CI)、左室射血分数(LVEF)、6分钟步行实验(6MWT)的变化;比较两组患者服药1年时主要心血管临床不良事件(包括心源性死亡、再发心肌梗死、脑卒中、急性心力衰竭发作)发生情况。结果服药后7 d,两组患者CI、LVEF无明显统计学差异(P0.05)。服药后1年与对照组比较,尼可地尔组左室射血分数[(38.2±5.1)%vs.(44.1±5.6)%,P0.05]、6分钟步行实验[(223±30)m vs.(324±33)m,P0.05]、主要心血管事件发生率(30.0%vs.86.3%,P0.05)均有明显改善,两组差异有统计学意义。结论缺血性心脏病患者长期服用尼可地尔可改善心功能,降低主要心血管事件发生率,提高生活质量。     

稳定型心绞痛患者口服尼可地尔对冠状动脉微循环阻力指数影响

目的探讨稳定型心绞痛患者服用尼可地尔治疗对冠状动脉微循环阻力指数(IMR)的影响。方法选取2014-03~2016-03该院收治的56例拟行介入术治疗的稳定型心绞痛患者,根据入院时间随机分为研究组和对照组,每组28例。两组入院后均给予常规药物治疗,对照组服用硝酸异山梨酯,研究组服用尼可地尔,均治疗4周,对治疗前后两组患者的IMR及临床效果进行比较分析。结果治疗后,研究组的IMR为(16.87±4.71),低于对照组的(26.21±8.61),差异有统计学意义(P0.05)。研究组显效14例,有效12例,无效2例。对照组显效9例,有效11例,无效8例。研究组疗效优于对照组(P0.05)。结论对稳定型心绞痛患者在常规用药基础上加服尼可地尔,可有效降低IMR,改善患者的冠状动脉微循环和心功能。     

尼可地尔治疗不稳定型心绞痛临床疗效观察

目的探讨研究尼可地尔应用于不稳定型心绞痛治疗的效果。方法选择我院2010年9月至2011年8月在昆明医学院第一附属医院心内科住院治疗不稳定型心绞痛患者132例,通过抽签的方法随机性将其分成观察组与对照组,两组在基础治疗的同时,观察组(64例)应用尼可地尔片予以治疗;对照组(68例)应用消心痛片予以治疗,1个疗程时间为4周。观察两组患者在治疗前、后,临床症状、心电图改善程度。结果对照组68例患者总有效率为79.4%远远小于治疗组的89.2%,差异性特别显著,有统计学意义(P0.05)。结论尼可地尔应用于不稳定型心绞痛的治疗效果尤为满意。     

尼可地尔预防桡动脉痉挛的临床观察

目的 探讨应用尼可地尔预防冠状动脉造影（CAG）时桡动脉痉挛（RAS）的可行性和价值。方法 选择2015年1～12月期间经桡动脉行CAG检查的患者450例,随机分为对照组、硝酸甘油组和尼可地尔组,观察记录三组患者的一般情况、伴随疾病、穿刺次数、血肿、RAS及药物不良反应等情况。结果 尼可地尔组和硝酸甘油组患者的RAS发生率分别为9.3%和8.0%,均明显低于对照组患者的24.0%,且差异均有统计学意义（P＜0.05）。而三组患者在体重、年龄、伴随疾病、一针穿刺成功率等方面比较未见统计学差异（P＞0.05）。结论 口服尼可地尔可以有效减少桡动脉痉挛的发生,且无严重不良反应,安全有效。     

比索洛尔与尼可地尔联用对冠心病介入治疗后心绞痛的影响

目的观察比索洛尔与尼可地尔联合用药对冠心病介入治疗后心绞痛症状及预后的影响。方法选择经皮冠状动脉介入治疗(PCI)后的心绞痛患者68例,随机分为治疗组(比索洛尔5mg/d+尼可地尔5mg,3次/日)和对照组(比索洛尔5mg/d)。两组患者PCI术后常规给予基础治疗,观察术后14d患者心绞痛缓解情况及3月内主要不良心血管事件。结果术后14d治疗组患者心绞痛缓解和心电图表现均好于对照组(P<0.05)。随访3月,两组均未发生死亡、心肌梗死、脑卒中等事件。结论比索洛尔联用尼可地尔对PCI术后心绞痛具有很好的缓解作用。     

尼可地尔对劳力型心绞痛病人运动耐力的影响

对１９例劳力型心痛病人给予尼可地尔口服２周，通过卧位踏车试验观运动心电图二尖瓣口多普勒血流变化。用药后Ｓ－５段下降消失时间，运动持续时间及运动工作负荷明显改善，静息及运动工作后Ａ／Ｅ比，Ｅ峰减时间及减速度明显改善，表明尼可地尔能改善冠心病人的左室舒张功能，提高运动耐力。     

冠状动脉钙化积分与不稳定型心绞痛患者预后的关系

目的 探讨冠状动脉钙化积分(CCS)与不稳定型心绞痛(UA)患者冠状动脉病变严重程度的关系,以及CCS对经皮冠状动脉介入治疗(PCI)术后UA患者临床预后的预测价值.方法 回顾性分析2009年1月至2011年1月首次接受PCI术治疗的466例UA患者资料,入选患者均在术前接受心脏及冠状动脉320层螺旋CT检查并计算CCS.PCI术后对患者进行12个月的随访,记录术后有无死亡、非致命性心肌梗死、靶病变血运重建及再发心绞痛入院等主要心脏不良事件(MACE).结果 入选患者按CCS水平分为CCS≤100、100＜CCS≤400和CCS＞ 400组,CCS＞ 400组患者的冠状动脉多支病变比例、B2/C型病变比例及冠状动脉病变Gensini积分均显著高于另外两组患者(47.60％比29.70％比18.30％;45.00％比27.30％比15.70％;56.8±16.9比52.8±13.6比36.7±17.1;均为P＜0.05).随访12个月,Kaplan-Meier生存分析发现,CCS≤100、100＜ CCS≤400组和CCS＞ 400组患者累积无MACE事件生存率差异有统计学意义(88.2％比84.2％比77.2％,Logrank8.044,P=0.005),在校正了年龄后,多因素Cox回归分析显示CCS＞ 400是UA患者PCI术后MACE发生的独立预测因子.CCS ＞400组患者较CCS≤100组术后发生MACE的风险增加4.741倍(RR =4.741,P＜0.01).结论 UA患者CCS水平越高表明冠状动脉病变越严重,CCS升高是接受PCI治疗的UA患者临床预后不良的强有力预测因子.     

血脂康治疗不稳定心绞痛疗效观察

目的:探讨血脂康的非调脂功能。方法:比较治疗组(血脂康组)与对照组治疗冠心病不稳定型心绞痛的疗效,包括心绞痛发作情况和心电图变化。结果:与对照组比较,治疗组显著减少心绞痛发作(P<0.05)和改善心电图变化(P<0.05)。结论:血脂康治疗不仅可用于高脂血症的治疗,且对冠心病不稳定型心绞痛也有一定的疗效。     

体外反搏治疗冠心病不稳定型心绞痛200例临床观察

目的:探讨体外反搏治疗冠心病不稳定型心绞痛的疗效。方法:200例冠心病不稳定型心绞痛患者被随机分为体外反搏组(100例):在药物治疗的同时,采用体外反搏治疗,每日1次,每次1h,总治疗时间为40h;常规治疗组(100例):仅采用口服药物治疗。治疗3个月,复查两组患者运动平板试验,评估加拿大心血管学会(CCS)心绞痛分级、纽约心脏协会(NYHA)心功能分级、西雅图心绞痛量表(SAQ)评分、6min步行距离(6MWD)。结果:体外反搏治疗组患者在3个月时平板运动试验总有效率明显优于常规治疗组(89%比70%,P<0.05);与治疗前及常规治疗组治疗后比较,体外反搏组NYHA心功能分级[(2.16±0.69)级、(2.01±0.56)级比(1.49±0.65)级]显著减少,CCS心绞痛分级[(2.72±0.46)级、(2.26±0.72)级比(1.49±0.65)级]显著减少,SAQ评分[(65.96±11.78)分、(70.81±8.81)分比(76.49±8.65)分]、6MWD[(339.44±83.37)m、(380.46±87.99)m比(427.93±63.32)m]明显增加,P均<0.05。结论:体外反搏治疗是一项无创、安全、有效的疗法,可作为冠心病治疗的选择。     

Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events.

AIMS: We investigated the role of asymmetric dimethylarginine (ADMA) for clinical outcome of patients with unstable angina. METHODS AND RESULTS: Forty-five patients with stable angina, 36 patients with unstable angina, and 40 healthy controls were included in this study. Coronary artery disease (CAD) patients were prospectively followed for 1 year. ADMA levels were measured at baseline and after 6 weeks using a validated ELISA. Baseline ADMA concentration in controls was significantly lower than in patients with CAD (0.59+/-0.23 vs. 0.76+/-0.17 micromol/L; P<0.001). Patients with unstable angina had significantly higher baseline ADMA levels than patients with stable angina (0.82+/-0.18 vs. 0.73+/-0.15 micromol/L; P=0.01). There was a significant reduction of ADMA levels at 6 weeks after percutaneous coronary intervention (PCI) in patients with unstable angina who experienced no recurrent cardiovascular event (from 0.81+/-0.14 to 0.73+/-0.19 micromol/L; P<0.05). In contrast, patients with unstable angina who had an event showed no significant decrease in ADMA at 6 weeks. Actuarial survival analysis showed a significantly higher event rate in patients with persistently elevated ADMA plasma concentrations. CONCLUSION: ADMA is significantly elevated in patients with unstable angina. A reduced ADMA level at 6 weeks after PCI may indicate a decreased risk of recurrent cardiovascular events.     

不稳定型心绞痛患者氧化型低密度脂蛋白自身抗体水平增高的探讨

目的探讨血清氧化型低密度脂蛋白自身抗体(anti-Ox-LDL)水平与冠心病患者病变稳定性及病变程度的关系.方法根据临床诊断标准和冠状动脉造影检查结果,将76名患者分为对照组、不稳定型心绞痛组和稳定型心绞痛组三组,采用ELISA法测定血清anti-Ox-LDL浓度.结果不稳定型心绞痛组血清anti-Ox-LDL水平[(491.19±307.01)mU/ml]明显高于稳定性心绞痛和对照组,而稳定型心绞痛组anti-Ox-LDL水平[(242.18±95.91)mU/ml]与对照组[(304.57±170.96)mU/ml]比较差异无显著性.Logistic回归分析发现血清anti-Ox-LDL水平与不稳定型心绞痛呈正相关(χ2=7.146,P=0.008,OR=0.989).冠心病多支血管病变组血清anti-Ox-LDL水平[(453.19±285.93)mU/ml]明显高于单支血管病变组和对照组,而单支血管病变组anti-Ox-LDL水平[(283.71±197.36)mU/ml]与对照组比较差异无显著性.结论血清anti-Ox-LDL水平不仅反映冠心病患者病变的严重程度,而且可以评价冠心病斑块的稳定性.     

在非ST段抬高急性冠脉综合征检测hscTnT的意义

目的：研究非ST段抬高急性冠脉综合征（NSTE—ACS）患者冠状动脉循环中血清高敏心脏肌钙蛋白T（hscTnT）含量的变化。方法i研究对象均选自我院,其中NSTE—ACS患者（NSTE—ACS组）46例,稳定型心绞痛患者（SAP组）42例及冠脉造影阴性者（健康对照组）30例,分别检测其冠状静脉窦、冠状动脉与外周血清中hscTnT浓度,并进行比较分析。结果：NSTE-ACS和SAP患者冠状静脉窦、冠状动脉与外周静脉血清中hscTnT浓度均较健康体检者显著升高（P均〈0．01）,且NSTE-ACS患者冠状静脉窦血清hscTnT浓度较冠状动脉及外周静脉的显著升高[（1．3018±1．1024）μg／L比（0．9657±0．5863）μg／L比（0．9562±0．7853）μg／L,P〈0．05]。结论：非ST段抬高急性冠脉综合征患者外周静脉、冠状动脉和冠状静脉窦血清高敏心脏肌钙蛋白T浓度显著升高,以冠状静脉窦的升高最明显。     

急性心肌梗塞和不稳定心绞痛患者餐后血压与冠脉病变程度的相关性

目的：探讨急性非ST段抬高心肌梗塞（NSTEMI）和不稳定心绞痛（UAP）患者餐后血压的变化特点及其与冠状动脉病变程度的相关性。方法：对120例预备行冠状动脉造影的NSTEMI和UAP患者，晨8时在空腹状态按标准方法用水银汞柱血压计测量血压，然后进食标准餐，于进食后30min、60min、90min、120min重复测量血压。所有患者行经皮选择性冠状动脉造影检查，采用累积积分法评价冠状动脉病变程度。结果：NSTEMI和UAP患者餐后血压下降33．3％，血压不变41．7％，血压升高者仅25．0％，进一步分析表明，餐后血压下降者糖尿病及女性患者比例较高（P〈0．05），并且主干及多支病变的比例达到84．1％，冠脉平均累积积分、血磷酸肌酸激酶同工酶（CK～MB）及肌钙蛋白I（TnI）的浓度也明显高于血压不变组及血压升高组（P〈0．05～〈0．01）。结论：急性非ST段抬高心肌梗塞和不稳定心绞痛患者的餐后血压变化和冠状动脉病变程度有关。     

Interleukin-18: a strong predictor of the extent of coronary artery disease in patients with unstable angina

The aim of this study was to confirm that plasma interleukin (IL)-18 level is associated with the extent of coronary artery disease in unstable angina patients. Previous studies have shown that patients with unstable angina have significantly higher plasma IL-18 levels than healthy volunteers. However, the association between IL-18 and the extent of coronary artery atherosclerosis in patients with unstable angina remains unclear. Plasma concentrations of IL-18 and high-sensitivity C-reactive protein (hs-CRP) were measured in 166 consecutive patients admitted for coronary arteriography. One hundred and eighteen patients with unstable angina had coronary artery disease (coronary artery disease group; severity score: 2.32 ± 1.47; Gensini score: 31.3 ± 25.9), and 48 patients with coronary risk factors and without coronary artery lesions served as the risk control group. Plasma levels of IL-18 were higher in the coronary artery disease group than in the risk control group (P = 0.062). Additionally, plasma levels of IL-18 were significantly higher in 77 coronary artery disease patients with severity score ≥2 than in the risk control group (242.3 ± 110.6 vs 209.8 ± 120.3 pg/ml, P = 0.016). By univariate analysis, log-transformed plasma IL-18 concentration was positively correlated with coronary artery disease severity score (r = 0.244, P = 0.009). By multiple regression analyses, the association between coronary artery disease severity score and IL-18 remained significant (β = 0.733, P = 0.017) when controlling for age, diabetes mellitus and left ventricular ejection fraction. Additionally, coronary artery disease severity score was greater in the highest tertile (>246 pg/ml) of plasma IL-18 levels than in the middle (176–246 pg/ml) and the lowest (<176 pg/ml) tertiles (2.79 ± 1.52 vs 2.05 ± 1.08 vs 2.13 ± 1.66, P = 0.028). Of note, plasma hs-CRP level had no significant correlation with coronary artery severity. Plasma IL-18 level is associated with the extent of coronary artery disease in unstable angina patients, suggesting the link between IL-18 and coronary artery atherosclerosis in these patients.     

尼可地尔对冠状动脉慢血流患者冠状动脉贮备功能的影响

目的探讨尼可地尔治疗对冠状动脉慢血流患者冠状动脉贮备功能的影响。方法选择冠状动脉造影正常但存在冠状动脉慢血流的患者44例,所有患者随机分为治疗组和对照组,对照组(20例)予常规治疗,治疗组(24例)在常规治疗基础上加用尼可地尔5 mg,每天3次,治疗期为6个月。利用腺苷负荷超声记录左前降支远端血流频谱评价冠状动脉储备功能。结果经过6个月尼可地尔的治疗后,治疗组静息冠状动脉血流速度较对照组和治疗前无明显差别(26.37±5.39 cm/s比24.72±4.35 cm/s,26.37±5.39 cm/s比24.61±6.18 cm/s,均P>0.05),最大冠状动脉扩张状态较对照组和治疗前明显增加(73.69±9.84 cm/s比55.97±7.62 cm/s,73.69±9.84cm/s比51.29±9.72 cm/s,均P<0.05),而冠状动脉血流储备功能较对照组和治疗前明显增加(2.79±0.53比1.99±0.47,2.79±0.53比2.08±0.44,均P<0.05)。结论长期尼可地尔治疗可以有效改善冠状动脉慢血流患者冠状动脉贮备功能。     

Treatment of unstable angina with trimetazidine

Objective To evaluate the clinical therapeutic effects oftrimetazidine on the treatment of unstable angina （UA） as well as its effects on endothelin- 1 level and complications of patients. Methods One hundred and twenty patients with UA were randomized into the trimetazidine group （n =60） and the control group （n =60）, the trimetazidine group was subjected to treatment with 60 mg trimetazidine everyday for six months plus conventional treatment, and the clinical symptoms, changes in electrocardiogram, changes in the number of plasma circulating endothelial cells （CEC） and endothelin- 1 level of the two groups were observed after treatment for four weeks; and the incidence rates of cardiac arrhythmias, cardiac failure, hospitalization due to angina, myocardial infarction and sudden death were also observed after treatment for six months. Results 1） The total effective rate of integrative clinical therapeutic effects in the trimetazidine group and the control group after treatment for four weeks were 86.7% and 68.3%,respectively （P〈0.05）, and the excellence rates were 36.7% and 15% （P〈0.01）respectively; the total effective rates for the therapeutic effects in electrocardiogram were 66.7% and 46.7%,respectively （P〈0.05）, and the excellence rates were 30.0% and 11.7%, respectively （P〈0.01）. 2） The number of plasma CEC and endothelin-1 level of the two groups after treatment for four weeks significantly decreased （P〈0.05）, but the decreases in the trimetazidine group were even significant （P〈0.01 ）. 3） The incidence rates for cardiac arrhythmia in the trimetazidine group and the control group after treatment for six months were 10% and 20% （P〈0.05）, respectively, and the incidence rates for cardiac failure were 8.3% and 18.3%, respectively （P〈0.05）, and the incidence rates for hospitalization due to angina were 10% and 15%, and the incident rates for myocardial infarction were 3.3% and 13.3% respectively （P〈0.05）. Conclusion Trimetazidine can significantly improve the symptoms of UA and myocardial ischemia, reduce the damages to blood vessel endothelium and complications, and improve the prognosis.