体外冲击波治疗难治性心绞痛的有效性和安全性研究

Efficacy and Safety of Extracorporeal Shock Wave on the Treatment of Refractory Angina of Coronary Heart Disease

目的评价体外冲击波用于难治性心绞痛治疗的有效性和安全性。方法入选2015年4月~2016年12月于上海交通大学医学院附属新华医院心血管内科就诊的无法行经皮冠状动脉介入治疗或冠状动脉旁路移植术的难治性心绞痛患者,随机分为体外冲击波治疗组和药物治疗组,观察两组治疗前后加拿大心绞痛分级(CCS分级)、纽约心脏病协会(NYHA)分级、左心室容积和核素心肌显像血流灌注情况等。结果42例完成治疗后6个月随访。治疗6个月后,体外冲击波治疗组患者CCS分级(2.3±0.9vs3.4±0.5)和NYHA分级(1.4±0.7vs1.9±0.8)均较治疗前好转,舒张末期容积(50.0±9.4mlvs52.1±7.3ml)和收缩末期容积(33.6±9.5mlvs35.1±10.9ml)均较治疗前有缩小趋势,左心室射血分数有升高趋势(63.2%±10.1%vs62.8%±16.1%)。治疗6个月后,核素心肌显像显示体外冲击波治疗组患者的心肌缺血区域血流灌注增加,缺血节段减少。药物治疗组相关指标也有改善,但改善幅度小于体外冲击波治疗组。结论对于不能或不愿行冠状动脉血运重建治疗,且有难治性心绞痛的冠心病患者,体外冲击波治疗可能是一种安全可行的新的辅助治疗手段。

Objective To evaluate the efficacy and safety of extracorporeal shock wave on the treatment of refractory angina.Methods From April 2015 to December 2016,patients with refractory angina not amenable for revascularization were enrolled in this study.They were randomly assigned to either extracorporeal shock wave treatment group or drug therapy group by block randomization.The angina class scores (CCS class score),NYAA class,left ventricular volume and myocardial perfusion imaging were observed before and after treatment.Results 42 patients were followed up for 6 months.In the extracorporeal shock wave treatment group,the CCS class decreased to 2.3±0.9 and New York Heart Association (NYHA) class decreased to 1.4±0.7.The end-diastolic volume (LVEDV) and the end-systolic volume (LVESV) decreased,and the LVEF increased in the shock wave treatment group after 6 months of treatment.Myocardial perfusion imaging showed that after 6 months of treatment in the extracorporeal shock wave treatment group,myocardial perfusion increased and ischemic segment reduced.The parameters of the drug treatment group also improved,but the improvement was less than the extracorporeal shock wave treatment group.Conclusion The extracorporeal shock wave may be a safe and feasible new treatment for patients with refractory angina not amenable for revascularization.