Dewey M, Hoffmann H, Hamm B
Institut für Radiologie, Charité, Berlin.
Rofo. 2006 Jun;178(6):600-4. doi: 10.1055/s-2006-926755. Epub 2006 May 15.
To investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N Spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography.
Out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements.
The proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 +/- 1.1 vs. 4.8 +/- 0.9 mm (12 % increase, p < 0.005), 3.0 +/- 0.6 vs. 3.5 +/- 0.5 mm (17 % increase, p < 0.001), 2.7 +/- 0.6 vs. 3.2 +/- 0.7 mm (19 % increase, p < 0.005), and 2.9 +/- 0.9 vs. 3.5 +/- 0.7 mm (21 % increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four main coronary vessels was observed.
Sublingual administration of Nitrate results in significantly larger proximal coronary artery diameters on MSCT coronary angiography and might thus be recommended for routine examinations.
探讨舌下含服硝酸甘油（1.2毫克，硝酸酯类[硝酸甘油]，Nitrolingual N喷雾剂）对多层螺旋计算机断层扫描（MSCT）冠状动脉造影中冠状动脉直径的影响。
在我们2003年7月至2005年11月期间接受MSCT（层厚0.5毫米，东芝Aquilion）冠状动脉造影的患者数据库（950例患者）中，我们回顾性地确定了接受随访检查的患者，这些患者在一次检查中接受了硝酸酯类药物，而另一次检查未使用硝酸酯类药物（10例患者）。从该数据库中随机选取另外10例接受两次舌下含服硝酸酯类药物的MSCT检查的患者作为对照组。对于这40次MSCT检查，制备了盲法MSCT数据集，由对患者信息以及是否使用硝酸酯类药物不知情的阅片者进行随机评估。在所有40个数据集中测量左主干冠状动脉（LMA）、左前降支冠状动脉（LAD）、左回旋支冠状动脉（LCX）和右冠状动脉（RCA）的近端冠状动脉直径，共进行了160次测量。
与同一10例未使用硝酸酯类药物的患者的检查相比，舌下含服硝酸酯类药物后获得的MSCT冠状动脉造影上所有四条冠状动脉的近端直径均显著增大（p < 0.001）。LMA、LAD、LCX和RCA在未使用和使用硝酸酯类药物时的平均直径分别为4.3±1.1毫米对4.8±0.9毫米（增加12%，p < 0.005）、3.0±0.6毫米对3.5±0.5毫米（增加17%，p < 0.001）、2.7±0.6毫米对3.2±0.7毫米（增加19%，p < 0.005）以及2.9±0.9毫米对3.5±0.7毫米（增加21%，p < 0.005）。在10例舌下含服硝酸酯类药物后接受两次MSCT冠状动脉造影的对照组患者中，未观察到所有四条主要冠状动脉近端直径的显著差异。
舌下含服硝酸酯类药物可使MSCT冠状动脉造影上的近端冠状动脉直径显著增大，因此可能推荐用于常规检查。
