尼可地尔治疗原发性微血管心绞痛患者的疗效分析

Curative effect of nicorandil on primary microvascular angina

目的基于13N-氨水正电子发射计算机断层成像(PET)定量测量冠状动脉(冠脉)血流储备(CFR)的方法,探讨原发性微血管心绞痛患者应用尼可地尔治疗后冠脉微循环的改善状况。方法纳入2018年1月至2019年9月于山西医科大学第一医院心血管内科确诊为原发性微血管心绞痛的患者60例,随机分为尼可地尔组及常规治疗组,每组各30例。常规治疗组予以包括阿司匹林、硝酸酯类、他汀类等心内科常规药物,尼可地尔组在常规治疗组的用药基础上给予尼可地尔(5 mg 3/d),随访3个月。比较两组患者治疗前后CFR改善情况、治疗总有效率及不良反应发生率。结果尼可地尔组患者CFR改善情况(2.96±0.28)优于常规治疗组患者CFR改善情况(2.63±0.30),差异有统计学意义(P<0.05)。尼克地尔组治疗总有效率(83.3%)高于常规治疗组患者治疗总有效率(53.3%,P<0.05)。两组患者间不良反应发生率比较,差异无统计学意义(P>0.05)。结论原发性微血管心绞痛患者应用尼可地尔可显著改善PET定量测量的CFR,提高冠脉微血管血流量,为尼可地尔治疗原发性微血管心绞痛的疗效评价提供客观准确的理论依据。

Objective To investigate the improvement of coronary microcirculation in patients with primary microvascular angina(MVA)treated with nicorandil based on the method of quantitative measurement of coronary flow reserve(CFR)with 13N-ammonia positron emission tomography(PET).Methods MVA patients(n=60)were chosen from Department of Cardiovascular Medicine in the First Hospital of Shanxi Medical University from Jan.2018 to Sept.2019,and divided randomly into nicorandil group and routine treatment group(each n=30).The routine treatment group was given basic medicinal including aspirin,nitrates,statins,etc.,and nicorandil group was given additionally nicorandil(5 mg/time,3 times/d).All groups were followed up for 3 months after treatment.The improvement of CFR,the total effective rate and incidence rates of adverse reactions were compared between 2 groups before and after treatment.Results The improvement of CFR was superior in nicorandil group(2.96±0.28)to that in routine treatment group(2.63±0.30,P<0.05).The total effective rate was higher in nicorandil group(83.3%)than that in routine treatment group(53.3%,P<0.05).The comparison in incidence rates of adverse reactions showed that the difference had no statistical significance between 2 groups(P>0.05).Conclusion The administration of nicorandil can significantly improve CFR measured with PET and increase coronary microvascular blood flow in MVA patients,which provides objective and accurate theoretical basis for clinical efficacy reviewing of nicorandil MVA treatment.