罗格列酮对2型糖尿病合并稳定型心绞痛血脂水平的影响

目的探讨罗格列酮对2型糖尿病合并稳定型心绞痛病人血脂水平的影响。方法2型糖尿病合并稳定型心绞痛病人58例,随机分人对照组和罗格列酮组。对照组采用原来降血糖药和冠心病二级预防药作常规治疗,不加用罗格列酮。罗格列酮组在原来降血糖药的基础上给予罗格列酮4mg口服,每日1次,共30日。治疗前后分别测定血清总胆固醇,甘油三酯,高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平。结果治疗30日后,两治疗组血脂水平血清总胆固醇,甘油三酯,低密度脂蛋白胆固醇,载脂蛋白A和载脂蛋白B均有不同程度的下降,高密度脂蛋白胆固醇升高,但两组的改变程度差异有统计学意义（P〈0．05）。结论罗格列酮在常规治疗的基础上可以使血脂水平进一步改善,使2型糖尿病合并稳定型心绞痛病人受益。     

曲美他嗪治疗稳定型心绞痛合并糖尿病疗效观察

目的探讨曲美他嗪(trimetazidine)在稳定型心绞痛合并2型糖尿病患者中的临床疗效。方法选取我院2000年1月～2004年9月102例心绞痛合并糖尿病患者,随机分为常规口服药物治疗组(A组)和曲美他嗪组(B组)。B组在常规口服药物基础上加曲美他嗪20mg,每日3次,持续4周。在服药前以及服药期间每周随诊观察,共4周,询问病史及进行运动负荷(平板)试验。结果患者全部完成疗程,2例服药后有轻微上腹部不适但无需停药。B组胸痛发作每周次数减少(4.2±0.5)次,而A组减少(2.1±0.8)次,两组相比差异有统计学差异(P<0.05)。B组病人硝酸甘油消耗量平均减少(6.1±0.7)片,A组病人平均减少(3.3±0.9)片(P<0.05)。运动平板试验持续时间B组病人增加(63.6±2.3)秒,A组病人增加(31.6±2.2)秒(P<0.05)。结论在传统药物治疗的基础上联用曲美他嗪,可以使稳定型心绞痛合并糖尿病患者受益,且病人耐受良好。     

曲美他嗪治疗稳定型心绞痛合并糖尿病临床分析

目的　评价曲美他嗪治疗稳定型心绞痛合并糖尿病疗效。方法　选取 10 3例稳定型心绞痛合并糖尿病病人 ,其中男 72例 ,女 31例 ,年龄 4 6～ 72岁 ,平均 ( 5 9±11 8)岁 ,常规服用曲美他嗪 2 0mg每天 3次 1个月 ,在此之前及 1个月后进行病史询问、生化检查及活动平板检查。结果　全部病人完成随访 ,1例服药后有轻微上腹部不适 ,1例便秘 ,无需停药。每周心绞痛发作次数从 ( 8 8± 3 9)次减少为( 4 5± 2 9)次 (P <0 0 1) ,硝酸甘油消耗量减少 ( 5 0±2 7)片减少至 ( 3 1± 1 9)片 (P <0 0 1)。活动平板运动持续时间从 ( 2 12 1± 5 4 3)s增加至 ( 2 76 3± 5 4 1)s ,运动耐量从 ( 84 2± 8 9) %增至 ( 95 6± 4 3) % (P <0 0 1) ,运动至ST段下移 1mm的时间 ( 176 4 3± 4 7 2 )s延长至 ( 2 4 3 78±5 1 9)s(P <0 0 0 1) ,运动至ST段压低的最大幅度从 ( 2 2±0 6 )mm减少至 ( 1 7± 0 7)mm(P <0 0 0 1)。结论　在传统血流动力学药物治疗的基础上联用曲美他嗪 ,可以使稳定型劳力型心绞痛合并糖尿病患者的心绞痛症状减轻 ,运动耐量增加 ,且安全性好。     

Results of a 2-year prospective study of patients with ischemic heart disease with stable angina pectoris

Data of dynamic control of 278 coronary patients with stable angina pectoris are presented. Coronarography was performed in all cases to determine changes in the heart coronary arteries which were of varying markedness. The anginal syndrome, ECG at rest, exercise tolerance, incidence of myocardial infarction and mortality rate were assessed after one and two years of dynamic observation. The incidence of nonfatal myocardial infarction was estimated at an average of 6.3% per year, whereas the mortality rate was 3.8%. The prognosis for patients with stenosing coronary atherosclerosis depends on the number of affected coronary arteries, the functional class of angina pectoris and exercise tolerance. Data on the efficiency of long-term pharmacological treatment of patients with stable angina and stenosing coronary atherosclerosis are obtained.     

曲美他嗪对冠心病稳定性劳力型心绞痛患者心肌缺血的影响

目的探讨曲美他嗪对冠心病(CHD)稳定性劳力型心绞痛患者心肌缺血的影响.方法选择在1周内经2次运动试验结果为阳性,且运动持续时间变异低于10%的CHD稳定性劳力型心绞痛患者40例,在原有治疗不变的情况下,加用曲美他唪20mg每日3次,治疗12周.治疗前后均行平板运动试验,观察用药前后下述指标的变化(1)用药前后每周心绞痛发作的次数;(2)每周硝酸甘油片的用量;(3)心率及心率与收缩压的乘积;(4)运动诱发心绞痛发作所需的时间;(5)运动后ST段下降limn所需的时间;(6)运动持续时间;(7)总工作量.结果曲美他嗪应用12周后,患者每周心绞痛发作次数及硝酸甘油片的用量明显下降(P＜0.05),而对心率及心率与收缩压的乘积的影响无统计学显著意义(P＞0.05).与试验前相比,运动耐量和总工作量显著提高(P＜0.01),至心绞痛发作的时间及ST段下降1mm所需的时间均明显延长(P＜0.01).不良反应较少.结论曲美他嗪能增加CHD稳定性劳力型心绞痛患者的运动耐量,改善运动诱发心绞痛的心肌缺血,且安全有效,易于耐受.     

曲美他嗪对稳定型劳力性心绞痛患者 心肌缺血的影响

目的探讨曲美他嗪对冠心病(CHD)稳定型劳力性心绞痛患者心肌缺血的影响。方法选择经冠状动脉造影确诊的CHD稳定型劳力性心绞痛患者14例,在原有治疗不变的情况下,加用曲美他嗪治疗12周,治疗前后均行平板运动试验,观察用药前后下述指标的变化①用药前后每周心绞痛发作的次数;②每周硝酸甘油片的用量;③心率及心率和收缩压的乘积;④运动诱发心绞痛发作所需的时间;⑤运动后ST段下降0.1mV所需的时间;⑥运动持续时间。结果患者每周心绞痛发作的次数及硝酸甘油片的用量均明显下降(P＜0.05);心率及心率和收缩压乘积轻度变化(P＞0.05);明显延长运动诱发心绞痛所需的时间及运动后ST段下降≥0.1mV所需的时间(P＜0.05)。结论曲美他嗪能改善运动诱发的心肌缺血,对CHD劳力性心绞痛患者有一定的疗效。     

尼可地尔对经皮冠状动脉介入治疗后心绞痛合并2型糖尿病患者的疗效

目的评价尼可地尔对经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后再发心绞痛合并2型糖尿病患者的疗效和安全性。方法选取PCI治疗后再发心绞痛合并2型糖尿病患者60例．随机（电脑随机数字表法）分为两组,两组均给予常规治疗。试验组使用尼可地尔．对照组在常规治疗的基础上给予单硝酸异山梨酯片治疗。结果治疗1周后,试验组心绞痛发作次数[（6．5±2．8）次弧（10．2±4．8）次,P〈0．05]、持续时间[（1．5±0．9）min vs．（2．4±2．3）min,P〈0．05]、显效率[80．0％（24／30）vs.53．3％（16／30）,P〈0．05],心电图改善[80．0％（24／30）vs.40％（12／30）,P〈0．05]均优于对照组,差异有统计学意义（P〈0．05）。试验组出现轻中度头痛2例,对照组出现轻中度头痛4例,两组比较差异有统计学意义（P〈0．05）。两组均无明显低血压发生,对血糖也无明显影响。结论尼可地尔能明显降低冠状动脉粥样硬化性心脏病（冠心病）合并2型糖尿病患者PCI治疗后再发心绞痛的发生风险。     

辛伐他汀对血脂正常的稳定型心绞痛患者的抗心肌缺血作用

目的 :探讨辛伐他汀对血脂正常的稳定型心绞痛患者的抗心肌缺血作用。方法 :85例血脂正常的稳定型心绞痛患者随机分为治疗组 (常规治疗外 ,加服辛伐他汀 ,4 5例 )和对照组 (仅常规治疗 ,4 0例 ) ,于治疗前 ,治疗后 3、6和 12个月时分别行 2 4hHolter检测心肌缺血总负荷 (TIB)并记录缺血相关事件。结果 :①治疗后 6个月治疗组TIB低于对照组 ,但差异无显著性意义 (P >0 .0 5 ) ,治疗后 12个月治疗组TIB显著低于对照组 (P <0 .0 5 ) ;②治疗组的缺血相关事件明显少于对照组 (P <0 .0 5 ) ,但治疗 6个月内两组间差异无显著性意义。结论 :辛伐他汀对血脂正常的稳定型心绞痛患者具有长期的抗心肌缺血和减少缺血相关事件的作用     

踏车运动对老年稳定型心绞痛患者预后的影响

目的：探讨踏车运动对老年稳定型心绞痛患者预后的影响。方法：82例老年稳定型心绞痛患者被随机分成踏车运动组（40例）：进行踏车运动和常规药物治疗4个月,常规治疗组（42例）：行常规药物治疗。测定试验前后血浆C-反应蛋白（CRP）、白介素-6（IL-6）、血栓素A2（TXA2）、低密度脂蛋白-胆固醇（LDL—C）水平,并随访两组间主要不良心脏事件（MACE）的发生率。结果：两组治疗后较治疗前血浆CRP、IL-6、TXA2、LDL—C水平均有明显下降（P〈0．05）,且两组间比较无显著差异;两组治疗后均随访2年,踏车运动组MACE的发生率较常规治疗组明显减少（15．8％比44．7％,P〈0．01）。结论：踏车运动对老年稳定型心绞痛患者预后有明显改善作用。     

老年冠心病患者稳定型心绞痛治疗的探讨

近年来,我国冠状动脉粥样硬化性心脏病（冠心病）发病率逐年增加,是严重威胁人类生存的疾病之一。仅北京地区平均每年急性猝死的发生率增加2.3%,其中慢性稳定型心绞痛是最常见的。慢性稳定型心绞痛通常见于冠状动脉至少一支主要分支管腔直径狭窄在50%以上的患者,是体力或精神应激时导致暂时性心肌缺血引起的以胸痛为主要特征的临床综合征[1]。     

Effect of atorvastatin on exercise-induced myocardial ischemia in patients with stable angina pectoris

To investigate whether marked and sustained lipid-lowering in subjects with stable angina pectoris and dyslipidemia reduces exercise-induced myocardial ischemia, 17 subjects were treated with dose-adjusted atorvastatin over 1 year and underwent serial evaluation of exercise electrocardiographic ischemic parameters, serum biomarkers, and brachial artery endothelial function. Endothelial function improved progressively and C-reactive protein, P-selectin, and tissue plasminogen activator inhibitor levels decreased, but there was no decrease in exercise electrocardiographic ischemia.     

Effect of benazepril on myocardial ischaemia in patients with chronic stable angina pectoris

The anti-ischaemic properties of benazepril, a non-sulfhydrylinhibitor of angiotensin-converting enzyme, were assessed in20 patients with chronic stable angina pectoris, by repeatedexercise tests and repeated 72-h ambulatory electrocardio-graphicmonitoring. The study was a double-blind, placebo-controlledcross-over; 11 patients received benazepril 10 mg b.i.d. andnine received 20 mg b.i.d. All patients had a positive treadmillstress test and at least three ischaemic episodes during 24h of ambulatory electrocardiographic monitoring. Benazepril at a dose of 10 mg b.i.d. did not improve the exerciseduration, the time taken to reach 1 mm ST depression. Similarfindings were observed during treatment with 20 mg b.i.d. Benazeprilat a dose of 10 mg b.i.d. was ineffective in improving ischaemicparameters during daily activities. However, among the ninepatients who received 20 mg b.i.d. the number of ischaemic episodeswas reduced from 142 to 103, and the total duration of ischaemiawas reduced from 1099 to 531 min. The number of weekly anginalattacks was reduced from 58 to 33, and the weekly sublingualnitroglycerin tablets consumption was reduced from 31 to 14.When the two doses (10 mg and 20 mg) were combined (N = 20),the number of ischaemic episodes was reduced from 314 to 260(P= 0.074), and the duration of ischaemia was reduced from 3453to 2514 min (P = 0.072).     

Effect of acute hyperglycemia on the ischemic preconditioning effect of prodromal angina pectoris in patients with a first anterior wall acute myocardial infarction

Acute hyperglycemia abolishes the ischemic preconditioning effect of prodromal angina pectoris in patients with acute myocardial infarction. We investigated a potential explanation for the association between acute hyperglycemia and adverse outcomes after acute myocardial infarction.     

Clinico-instrumental criteria of functional classes of patients with ischemic heart disease and stable angina pectoris

The study was undertaken to define the clinical and instrumental signs that significantly divide coronary heart disease patients with stable angina into functional classes. Diagnostic criteria constructed on the basis of various clinical and instrumental evidence were developed with regard to the results of the examination of 163 patients with stable angina by using the mathematical statistical methods. The authors provide a procedure for determining and assessing the informative value of the diagnostic index in the long-term prospective survey of patients with coronary heart disease. Concurrent application of clinical parameters and bicycle ergometric findings as part of the index enhances the accuracy and validity of definition of a functional class in patients with stable angina.     

Efficacy of pentoxifylline in patients with stable angina pectoris

Pentoxifylline, a methyl xanthine derivative, improves symptoms of peripheral vascular disease probably by reducing whole blood viscosity. The authors assessed the value of this agent in treating myocardial ischemia in 11 patients with angiographically documented coronary artery disease and stable angina pectoris. Maximal, symptom limited treadmill exercise stress tests were performed before and after six weeks of therapy with 1200 mg of pentoxifylline per day. Clinical symptoms proved in 9 [82%] of patients; none developed drug side effects. After therapy, mean total exercise time [7.7 +/- 1.3 vs 10.1 +/- 1.2 minutes], time to onset of angina [5.5 +/- 0.9 vs 7.9 +/- 1.0 minutes], heart rate at onset of angina [93.4 +/- 6.7 vs 112.0 +/- 10.5 beats/min] and rate at onset of ST depression [94.0 +/- 5.8 vs 115.9 +/- 7.4 beats/min] all increased significantly [p less than 0.05]. Mean maximum ST segment depression also decreased [1.6 +/- 0.3 vs 1.2 +/- 0.4mm], but the difference was not significant. Thus, pentoxifylline increases exercise performance in patients with angina pectoris and increases exercise capacity before development of of myocardial ischemia. It may, therefore, be a useful agent for treating ischemic heart disease.     

心脏康复对稳定型心绞痛患者预后的影响

目的探讨心脏康复对稳定型心绞痛(SAP)患者预后的影响。方法 139例SAP患者随机分成心脏康复治疗组(66例)和对照组(73例),心脏康复组进行踏车运动和常规药物治疗4个月,对照组实行常规药物治疗。测定试验前后血浆C-反应蛋白(CRP)、白介素-6(IL-6)、血栓素A2(TXA2)、低密度脂蛋白胆固醇(LDL-C)水平,并随访两组间心血管事件的发生率。结果两组治疗后较治疗前血浆CRP、IL-6、TXA2、LDL-C水平均有下降;心脏康复组血浆CRP、IL-6水平较常规药物治疗组下降更明显(均为P0.05);两组治疗后均随访1年,心源性死亡、再次急性心肌梗死的发生率差异无统计学意义;心脏康复治疗组需血运重建者更少(6.3%比20.0%)(P0.05)。结论心脏康复对SAP患者预后有明显改善;减轻炎症反应可能是改善SAP患者预后的一个重要机制。     

Switch to oral hypoglycemic agent therapy from insulin injection in patients with type 2 diabetes

Aim: We aimed to determine the feasibility of substituting thiazolidinedione‐based therapy for insulin injection therapy in patients with type 2 diabetes. Methods: Thirty‐six subjects (17 men and 19 women) aged 67.8 ± 11.3 years with an average insulin dose of 0.46 ± 0.17 U/kg bodyweight, a duration of insulin therapy of 6.1 ± 8.2 years and an average hemoglobin A1c (HbA1c) of 6.8 ± 1.3% were switched from insulin injection therapy to pioglitazone, glimepiride and voglibose combination therapy. Results: The number of subjects achieving HbA1c levels of less than 7% at 4 months was 30. The success rate of switch therapy was 83% (30/36). HbA1c was significantly reduced from 6.7 ± 1.3% to 5.9 ± 0.7% at 4 months after the switch (P < 0.01) in 32 patients who completed the planned 4‐month study. No adverse effects including heart failure, liver dysfunction or severe hypoglycemia were observed. The insulin dose and the maximum blood glucose on the switch day were significantly lower and the age was significantly higher in the subjects who achieved HbA1c less than 7% at 4 months compared to those who did not (P < 0.05). Conclusion: Thiazolidinedione‐based oral combination therapy may efficiently and safely substitute relatively high‐dose insulin injection therapy in patients with type 2 diabetes.     

Effect of various antianginal agents on the frequency and duration of myocardial ischemic episodes in patients with stable angina pectoris]

The effects of verapamil, nifedipine, propranolol, and combinations of nifedipine+propranolol and nifedipine+verapamil were studied in 60 patients with stable angina pectoris. Verapamil was found to have a pronounced antianginal activity against all types of myocardial ischemia, whereas nifedipine relieved mainly painful ischemic episodes. By the end of 12-week therapy with propranolol, the agent lost its antiischemic effect in a third of patients, which was accompanied by an increase in the number and severity of silent ischemic episodes.