尼可地尔联合曲美他嗪治疗多支血管病变合并不稳定型心绞痛患者的临床效果

Clinical effect of nicorandil combined with trimetazidine on mnitivessel coronary artery disease with unstable angina pectoris

目的评价尼可地尔联合曲美他嗪治疗多支血管病变合并不稳定型心绞痛的临床效果。方法选取2015年1月至2017年1月首都医科大学附属北京安贞医院收治的多支血管病变合并不稳定型心绞痛患者98例，按随机数字表法分为观察组及对照组，各49例。对照组给予常规药物治疗；观察组在对照组基础上加用尼可地尔5mg／次，3次／d和曲美他嗪20mg／次，3次／d口服；2组均连续服药6个月。检测治疗前及治疗6个月后氨基末端脑钠肽前体（NT—proBNP）、心肌肌钙蛋白I（cTnI）、高敏c反应蛋白（hs—CRP）浓度和左心室射血分数（LVEF）；记录患者每日心绞痛发作次数、持续时间及硝酸甘油用量；记录心肌梗死、脑梗死等心脑血管事件以及治疗期间不良反应的发生情况。结果治疗6个月后，2组NT—proBNP、cTnI、hs—CRP浓度均较治疗前明显降低，LVEF明显升高；观察组NT—proBNP、cTnI、hs—CRP浓度明显低于对照组，LVEF明显高于对照组[（826±14）μg／L比（973±19）μg／L、（0．031±0．004）μg/L比（0．044±0．006）μg/L、（0．58±0．11）mg／L比（1．12±0．25）mg／L、（55±6）％比（50±6）％]；差异均有统计学意义（均P〈0．05）。治疗6个月后，2组患者心绞痛发作次数、持续时间以及硝酸甘油用量均较治疗前减少（缩短）；观察组心绞痛发作次数、持续时间及硝酸甘油用量均少于（短于）对照组[（0．8±0．4）次／d比（1．3±0．4）次／d、（2．3±1．1）min／次比（6．3±1．7）min／次、（0．20±0．12）片／d比（0．50±0．31）片／d]；差异均有统计学意义（均P〈0．05）。治疗期间观察组心脑血管事件及不良反应发生率均低于对照组[4．1％（2／49）比10．2％（5／49）、6．1％（3／49）比10．2％（5／49）]（均P〈0．05）。结论尼可地尔联合曲美他嗪治疗多支血管病变合并不稳定型心绞痛具有较好效果，可明显缓解患者的临床症状并改善心功能。

Objective To analyze the therapeutic effect of nicorandil combined with trimetazidine on muhivessel coronary artery disease with unstable angina pectoris. Methods Totally 98 patients with multivessel coronary artery disease and unstable angina pectoris were enrolled from January 2015 to January 2017 in Beijing Anzhen Hospital, Capital Medical University; they were randomly divided into observation group and control group, with 49 cases in each group. The control group had conventional drug treatment; the observation group took nicorandil 5 mg/time, 3 times/d and trimetazidine 20 rag/time, 3 times/d based on control group; both groups were treated for 6 months. N-terminal pro-brain natriuretic peptide （ NT-proBNP）, cardiac troponin I （ cTNI）, high-sensitivity C-reactive protein（hs-CRP） and left ventricular ejection fraction （LVEF） were tested before and after treatment ; daily frequency, duration of angina pectoris and dose of nitroglycerin were recorded; incidences of cardio-cerebrovascular events and adverse reactions were analyzed. Results After 6 months of treatment, levels of NT-proBNP, cTnI and hs-CRP significantly decreased and LVEF significantly increased compared to those before treatment in both groups（P 〈0. 05 ）; levels of NT-proBNP, cTnI and hs-CRP in observation group were significantly lower and LVEF was significantly higher than those in control group [ （826 ± 14） μg/L vs （973 ± 19 ） μg/L, （0. 031 ±0. 004）μg/L vs （0. 044 ±0. 006）μg/L, （0. 58 ±0. 11）mg/L vs （1.12 ±0. 25）mg/L, （55 ±6）% vs （50± 6）% ] （P 〈 0. 05 ）. After treatment, daily frequency and duration of angina pectoris and dose of nitroglycerin significantly decreased （shortened） compared to those before treatment in both groups （P 〈 0. 05 ） ; daily frequency, duration of angina pectoris and dose of nitroglycerin in observation group were significantly less （shorter） than those in control group[ （0. 8 ±0.4）times/d vs （1.3 ±0.4）times/d, （2.3 ± 1.1） min/time vs （6.3 ± 1.7） min/time, （0. 20 ± 0. 12） pills/d vs （ 0. 50 ± 0. 31 ） pills/d ] （ P 〈 0.05 ）. Incidences of cardio-cerebrovascular events and adverse reactions in observation group were significantly lower than those in control group [4. 1% （2/49） vs 10. 2% （5/49）, 6. 1% （3/49） vs 10. 2% （5/49） ] （P 〈 0. 05 ）. Conclusion Nicorandil combined with trimetaz- idine has a satisfactory therapeutic effect on muhivessel coronary disease with unstable angina pectoris, which can significantly relieve clinical symptoms and improve heart function.