Bilinska Maria, Potocka Joanna, Korzeniowska-Kubacka Iwona, Piotrowicz Ryszard
Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland.
Coron Artery Dis. 2007 Sep;18(6):455-62. doi: 10.1097/MCA.0b013e3282a30676.
Classic sulfonyloureas (SUs) are known to attenuate ischaemic preconditioning. Gliclazide is an SU agent believed to be more protective. We assessed the effects of diet, glibenclamide, or gliclazide on the warm-up effect in type 2 diabetic patients with stable angina.
The study group consisted of 64 men, aged 54+/-5 years: 17 patients without diabetes (G I) and 47 diabetic patients: 16 patients treated with glibenclamide (G II), 16 with gliclazide (G III) and 15 patients treated with diet (G IV). After the baseline positive exercise test (ET1), all patients reexercised after 30-min rest (ET2). We analysed exercise duration (ED, s), time to 1 mm ST depression (T-STD, s), max STD (mm), heart rate-systolic blood pressure product at 1 mm STD, or ischaemic threshold (mmHg/min x 100) and the total ischaemic time (s).
In G I, all analysed variables improved significantly during ET2 relative to ET1. Glibenclamide (G II) completely abolished the protective effect of exercise-induced ischaemia because only ED increased during ET2 (431 vs. 451, P<0.05). In G III, however, ED (486 vs. 537, P<0.001), T-STD (364 vs. 388, P<0.05) and max STD (2.5 vs. 2.0, P<0.05) improved significantly during ET2, whereas ischaemic threshold and total ischaemic time did not (PNS). In G IV, similar to G I, all variables improved significantly during ET2 relative to ET1.
Warm-up effect is preserved in diabetic patients with stable angina treated with diet, partially preserved in gliclazide-treated and abolished in glibenclamide-treated patients.
已知经典磺脲类药物（SUs）会减弱缺血预处理。格列齐特是一种被认为更具保护作用的磺脲类药物。我们评估了饮食、格列本脲或格列齐特对稳定型心绞痛2型糖尿病患者热身效应的影响。
研究组由64名年龄为54±5岁的男性组成：17名无糖尿病患者（G I）和47名糖尿病患者：16名接受格列本脲治疗的患者（G II），16名接受格列齐特治疗的患者（G III）和15名接受饮食治疗的患者（G IV）。在基线运动试验阳性（ET1）后，所有患者在休息30分钟后再次运动（ET2）。我们分析了运动持续时间（ED，秒）、出现1毫米ST段压低的时间（T-STD，秒）、最大ST段压低（毫米）、1毫米ST段压低时的心率-收缩压乘积或缺血阈值（毫米汞柱/分钟×100）以及总缺血时间（秒）。
在G I组中，与ET1相比，所有分析变量在ET2期间均有显著改善。格列本脲（G II）完全消除了运动诱导缺血的保护作用，因为在ET2期间只有ED增加（431对451，P<0.05）。然而，在G III组中，ED（486对537，P<0.001）、T-STD（364对388，P<0.05）和最大ST段压低（2.5对2.0，P<0.05）在ET2期间有显著改善，而缺血阈值和总缺血时间没有（PNS）。在G IV组中，与G I组相似，与ET1相比，所有变量在ET2期间均有显著改善。
接受饮食治疗的稳定型心绞痛糖尿病患者的热身效应得以保留，接受格列齐特治疗的患者部分保留，而接受格列本脲治疗的患者则被消除。
