芪苈强心胶囊联合尼可地尔对射血分数保留性心力衰竭患者心功能及细胞因子的影响

目的 探讨芪苈强心胶囊联合尼可地尔对射血分数保留性心力衰竭患者心功能及细胞因子的影响。方法 连续入选2019年10月至2020年10月诊断为射血分数保留性心力衰竭的患者共90例,随机分为观察组(45例)与对照组(45例)。对照组给予常规抗心力衰竭药物加芪苈强心胶囊治疗,观察组在对照组治疗基础上,加用尼可地尔治疗。比较两组患者一般临床资料、细胞因子水平、心功能各项指标。随访1年患者心功能情况、细胞因子水平以及不良心脑血管事件(MACCEs)发生情况。结果 两组患者接受治疗1年后脑钠肽(BNP)、左室舒张末期内径、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)均降低,射血分数(EF)值较治疗前升高,差异有统计学意义(P<0.05)。组间对比发现,两组患者入院时基础BNP、细胞因子、超声心能指标(LVEF、左室舒张末期内径、左房内径)差异无统计学意义(P>0.05);接受治疗1年后观察组IL-1β、IL-6、TNF-α、BNP、左室舒张末期内径低于对照组,EF值高于对照组,差异有统计学意义(P<0.05)。随访1年对照组共有7例发生终点事件,观察组共有4...     

Prevention of postischemic reperfusion injury: The improvement of myocardial tissue blood flow after ischemia by terminal Nicorandil-Mg cardioplegia

We evaluated the preventive effect of postischemic reperfusion injury by Nicorandil-Mg cardioplegia given just prior to reperfusion as terminal cardioplegia. Twenty seven dogs were placed on cardiopulmonary bypass and the aorta was cross-clamped for 90 min under hypothermic (17–19°C) cardioplegic arrest. The canine hearts were divided into three groups: in group A (n=10) the hearts were reperfused without any treatment; in group B (n=9) the hearts received coronary perfusion with Nicorandil-Mg solution (Nic, 8 mg/l; Mg, 20 mEq/l; glucose, 50 g/l) for 2 min just prior to reperfusion; and in group C (n=8) the hearts received coronary perfusion with Nicorandil-Mg free solution (glucose, 50g/l). During and after ischemia, the myocardial tissue PCO₂ (t-PCO₂) was continuously monitored by an ion-sensitive field effective transistor (ISFET) sensor. In addition, the myocardial tissue blood flow (TBF), oxygen consumption, and lactate flux were then calculated at 5, 10, 20, and 40 min of reperfusion. In the initial reperfusion period, Group B showed an improved TBF compared to group A and C (at 5 min, group B was 42.7±11.9; group A was 29.4±11.2, P<0.025; and group C was 33.9±9.2% of the preischemic control level, P<0.05). T-PCO₂ in group B was significantly decreased at 5 min of reperfusion (group B, 127.5±22.5 42.5±9.7; group A, 117.5±23.0 85.2±17.4, P<0.001; group C, 122.3 mmHg 68.2±18.7 mmHg, P<0.01), and group B had a better metabolic recovery. These results suggest that terminal Nicorandil-Mg cardioplegia might reduce the rate of postischemic reperfusion injury.     

尼可地尔治疗冠心病稳定型心绞痛68例

目的:观察尼可地尔对稳定型心绞痛患者心肌缺血及心功能的影响.方法: 68例稳定型心绞痛患者服用尼可地尔治疗 8周,以超声心动图、动态心电图评价患者心肌缺血及心功能等指标.结果:治疗 8周后,患者心肌缺血发作时间及次数明显减少( P < 0.05),心脏指数( CI)、左室射血分数( LVEF)、左室收缩末期容积指数( ESVI)和心房收缩期二尖瓣血流速度比值( E/A)明显优于治疗前( P < 0.05).结论:尼可地尔可明显改善冠心病稳定型心绞痛患者的心肌缺血及心功能.     

The role of nicorandil in the treatment of myocardial ischaemia

Nicorandil is an anti-anginal agent that has been used in the United Kingdom for over 6 years and is becoming increasingly popular. It induces coronary and peripheral vasodilatation via a dualistic mode of action, mediated by the opening of potassium-ATP channels (K_ATP) and its nitrate effect by stimulation of adenyl cyclase, with an increase in cGMP levels. Comparison to nitrates and other anti-anginal agents have shown it to be of equal efficacy in relieving ischaemic symptoms. Recent evidence suggests a role for nicorandil as a myocardial preconditioning agent but this may be limited by systemic vasodilatation. There is ongoing research into its role in improving the long-term outcome of patients with ischaemic heart disease (IHD). It has been shown to be of proven efficacy in the treatment of IHD and further research will clarify other uses of this agent.     

尼可地尔对缺血性心力衰竭大鼠心功能的保护作用及机制

目的探讨尼可地尔对缺血性心力衰竭大鼠心功能和左室重构的保护作用及相关机制。方法将40只大鼠随机分为空白对照组(Con组)、尼可地尔组(NIC组)、生理盐水组(NS组)及假手术组(Sham组),每组10只,分别采取不同处理方式。记录各组大鼠体重、呼吸模式、活动量和毛色差异。术后8周所有大鼠行超声心动图检查。实验结束后对大鼠左心室前壁组织进行HE染色及电镜观察。检测心肌组织中p-Akt、Bcl-2、Bax蛋白的相对表达量。结果与Con组及Sham组相比,NS组及NIC组左心室射血分数(LVEF)、速度最大值(E)/心房收缩心室充盈速度最大值(A)(E/A)降低,NS组LVEF下降最多,差异有统计学意义(P<0.05)。左心室舒张末期容积(LVEDV)则呈相反趋势,3组间存在差异,NS组LVEDV最高,差异有统计学意义(P<0.05)。NS组左心室收缩末期容积(LVESV)、左室舒张末期内径(LVIDd)和左室收缩末期内径(LVIDs)高于NIC组和Sham组,差异有统计学意义(P<0.05)。Sham组大鼠心肌细胞排列规则,横纹清晰;NS组心肌细胞排列紊乱,形状不规则,同时还表现出明显的纤维组织增生。Sham组、NIC组的左心室/体重比值(LVW/BW)和肺脏重量指数(Lungw/Bw)均低于NS组,差异有统计学意义(P<0.05)。与Con组及Sham组相比,NS组p-Akt、Bcl-2及Bax蛋白相对表达量增加,差异有统计学意义(P<0.05)。NIC组p-Akt、Bcl-2蛋白相对表达量高于NS组,但Bax蛋白表达量下降,差异均有统计学意义(P<0.05)。结论尼可地尔可通过改善心功能和左室重塑对缺血性心力衰竭大鼠起到保护作用,这可能与抑制Bax蛋白表达有关。     

Impact of administration of nicorandil prior to percutaneous coronary intervention in treatment of acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:In order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy and safety of nicorandil prior to percutaneous coronary intervention in acute myocardial infarction (AMI) patients.Methods:This systematic review and meta-analysis will be performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently will search randomized controlled trials or observational studies about the treatment of nicorandil on AMI patients. Retrieved databases include Web of Science, ClinicalTrials.gov, Pubmed, Embase, and Cochrane Library. And retrieval time is limited from inception to June 2021. Key words are nicorandil, myocardial infarction, or similar expansion words without publication limitation. Biomechanical studies, in vitro studies, review articles, techniques, case reports, letters to the editor, and editorials are excluded.Results:The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/UEPKB.     

高效液相色谱法测定尼可地尔缓释片的含量

目的建立尼可地尔缓释片的含量测定方法。方法采用HPLC法,Agilent TC-C18(4.6mm×250mm,5μm)色谱柱,甲醇-水(48∶52)为流动相,流速1.0m L/min,检测波长254nm。结果尼可地尔的线性范围为3.008μ/m L-18.048μ/m L,线性关系良好(r=0.9998);平均加样回收率为98.37%(n=5),RSD=0.72%。结论该方法简便、结果准确,适用于制剂中尼可地尔的含量测定与质量控制。     

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。     

缬沙坦联合尼可地尔治疗高血压早期肾损害临床评价

目的探讨缬沙坦联合尼可地尔治疗高血压早期肾损害的临床疗效及对患者β2微球蛋白(β2-MG)、胱抑素C(Cys C)、同型半胱氨酸(HCY)和尿微量白蛋白(mALB)水平的影响。方法选取医院2016年2月至2018年2月收治的高血压早期肾损害患者86例,随机分为观察组和对照组,各43例。在常规降压治疗基础上,两组患者均予缬沙坦胶囊,观察组患者加服尼可地尔片,均治疗2个月。结果观察组总有效率为97. 67%,明显高于对照组的86. 05%(P <0. 05)。治疗后,两组患者的β2-MG,Cys C,HCY,mALB及血浆纤维蛋白原(Fib)、D-二聚体(D-D)、血小板平均容积(MPV)水平均明显下降,且观察组均明显低于对照组(P <0. 05);抗凝血酶Ⅲ(ATⅢ)水平明显升高,且观察组明显高于对照组(P <0. 05)。观察组不良反应发生率为4. 66%,与对照组的11. 64%相当(P> 0. 05)。结论缬沙坦联合尼地尔可治疗高血压早期肾损害疗效较好,可显著降低血压,改善肾功能和凝血功能。