Montorsi P, Cozzi S, Loaldi A, Fabbiocchi F, Annoni L, De Cesare N, Polese A, Guazzi M D
Istituto di Cardiologia, Università degli Studi, Milano.
Cardiologia. 1990 Oct;35(10):851-6.
In 18 patients (12 females) presenting with effort-induced chest pain and normal coronary angiograms (syndrome X), 10 mg sublingual nifedipine increased the lumen of major coronary arteries (quantitative angiography) by 13% +/- 10 (p less than 0.01), coronary blood flow (thermodilution) by 23% +/- 26 (p less than 0.05), norepinephrine plasma concentration by 60% +/- 42 (p less than 0.01), and reduced the global ST segment shift during the effort stress test from 8.8 +/- 4.1 to 7 +/- 6.8 mm (p less than 0.03) at comparable maximal workload and at unchanged double product. There was a correlation (positive) of changes in flow with changes in coronary lumen diameter (r = 0.65, p less than 0.01), with ST segment response to exercise (r = 0.83, p less than 0.001), and with (inverse) norepinephrine plasma concentration (r = -0.70, p less than 0.01); no correlation was found between ST segment response and changes in arterial lumen diameter. In a few cases nifedipine did not improve or even worsened the response to exercise; in them coronary flow was unchanged or reduced and norepinephrine plasma levels were modestly or greatly increased, respectively. After 4-week treatment with nifedipine (10-20 mg 4 times daily), the effort ST segment shift was further diminished to 4.4 +/- 3.5 mm (p less than 0.03) despite a slightly increased double product. Plasma norepinephrine values, as compared to those following acute nifedipine, were reduced by 40% in patients with further improvement and unchanged in patients whose exercise performance did not vary.(ABSTRACT TRUNCATED AT 250 WORDS)
在18例（12例女性）表现为劳力性胸痛且冠状动脉造影正常（X综合征）的患者中，舌下含服10毫克硝苯地平使主要冠状动脉管腔（定量血管造影）增大13%±10（p<0.01），冠状动脉血流量（热稀释法）增加23%±26（p<0.05），血浆去甲肾上腺素浓度升高60%±42（p<0.01），并使运动应激试验期间总的ST段移位在可比的最大工作量和不变的双倍乘积时从8.8±4.1毫米降至7±6.8毫米（p<0.03）。血流量变化与冠状动脉管腔直径变化呈正相关（r=0.65，p<0.01），与运动时ST段反应呈正相关（r=0.83，p<0.001），与（负）血浆去甲肾上腺素浓度呈负相关（r=-0.70，p<0.01）；未发现ST段反应与动脉管腔直径变化之间存在相关性。在少数病例中，硝苯地平并未改善甚至恶化运动反应；在这些病例中，冠状动脉血流量未变或减少，血浆去甲肾上腺素水平分别适度或大幅升高。在用硝苯地平（每日4次，每次10 - 20毫克）治疗4周后，尽管双倍乘积略有增加，但运动时ST段移位进一步降至4.4±3.5毫米（p<0.03）。与急性服用硝苯地平后相比，运动表现进一步改善的患者血浆去甲肾上腺素值降低了40%，运动表现未变的患者血浆去甲肾上腺素值未变。（摘要截短于250字）
