体外心脏冲击波治疗难治性心绞痛的初步疗效及安全性

Extracorporeal cardiac shock wave therapy in treatment of patients with refractory coronary artery disease:efficacy and safety

目的初步评价体外心脏冲击波治疗(CSWT)在难治性心绞痛治疗中的临床疗效和安全性。方法诊断明确的难治性心绞痛患者28例,男22例,女6例,平均年龄为(68.2±12.0)岁,接受CSWT,指定治疗仪(100击/点,能量为0.09 mJ/mm2,每次3～6点,3次/周),3次治疗为1组,间隔3周进行1组治疗,共治疗9周。观察治疗前后加拿大心绞痛分级(CCS分级)、西雅图心绞痛量表(SAQ积分)、核素心肌血流灌注情况、左心室射血分数(LVEF)变化、6 min步行距离、心电图、血和尿常规以及心肌损伤标志物等。结果入组患者中有27例完成治疗,17例完成治疗后6个月随访。治疗后6个月,患者的CCS分级为(2.0±0.0)级,显著低于治疗前的(2.5±0.5)级(P<0.01),纽约心脏病学会(NYHA)心功能分级为(1.8±0.6)级,显著低于治疗前的(2.0±0.7)级(P=0.03)。99mTc-核素心肌显像显示,治疗6个月后的心肌区域血液灌流明显增加,缺血节段减少(P值均<0.05)。治疗6个月后的左心室舒张末容积为(157.67±91.38)mL,低于治疗前的(172.11±102.01)mL;左心室收缩末容积为(99.44±86.44)mL,低于治疗前的(114.56±99.37)mL(P>0.05);LVEF为0.459±0.205,高于治疗前的0.422±0.188;但差异均无统计学意义(P值均>0.05)。所有患者在治疗中及治疗后均无心律失常、心绞痛发作等不适症状,也无心肌损伤标志物升高。结论对于晚期冠状动脉性心脏病、弥漫性血管病变以及不适用传统心肌再血管化治疗的患者,CSWT是一种安全、可行的选择。

Objective To evaluate the efficacy and safety of extracorporeal cardiac shock wave therapy （CSWT） in treatment of patients with refractory coronary artery disease （RCAD） . Methods A total of 28 cases/ times of confirmed RCAD patients （ 22 males and 6 females, mean age of E68.2 ± 12.01 years） received CSWT （ 100 shots/spot at 0.09 mJ/mm^2 for 3- 6 spots, 3 times a week/series） ; the treatment was given every 3 weeks for 9 weeks. The Canadian Cardiovascular Society functional class score （CCS）, Seattle angina questionnaire score （SAQ）, myocardial perfusion imaging （MPI）, left ventricular ejection fraction （LVEF）, 6-minute walking test, echocardiogram, blood routine, urine routine and myocardial injury markers were all observed before and after treatment. Results Twenty-seven patients completed the treatment, and 17 were followed up for 6 months. The CCS class and New York Heart Association （NYHA） class before CSWT and 6 months after treatment showed that CCS class decreased from 2.5 ± 0.5 to 2.0 ± 0.0 （ P〈 0.01 ） and NYHA class decreased from 2.0 ± 0.7 to 1.8± 0.6 （ P = 0.03 ）. Single-photon emission computed tomograph （SPECT） myocardial perfusion imaging revealed an increase in perfusion in treated myocardial segments and decrease in untreated segments. In addition, it demonstrated that after 6 months treatment the left ventricular end-diastolic volume （LVEDV） decreased from （172.11± 102.01） mL to （157.67±91.38） mL（P〉 0.05）, left ventricular end-systolic volume （LVESV） decreased from （ 114.56 ± 99.37） mL to（99.44 ± 86.44） mL（ P〉0.05）, and LVEF increased from 0. 422 ± 0. 188 to 0. 459± 0. 205（P〉0.05）. No cardiac arrhythmia or angina pectoris was noticed during treatment. Conclusion CSWT is a safe and feasible choice for patients with end-stage coronary artery disease, diffuse vascular lesions,and those who are not suitable for traditional myocardial revascularization treatment, （Shanghai Med J, 2009, 32.. 872-875）