Cantor A, Shapiro Y, Eyal A, Gueron M, Danon A
Heart Institute, Soroka Medical Center, Beer Sheva, Israel.
Isr J Med Sci. 1990 Feb;26(2):67-71.
The hypothesis that endogenous opioids may be involved in reduced exercise-induced ischemic pain or in silent ischemia was tested. Fifteen male patients with coronary artery disease were tested in a randomized, double-blind crossover study. After a preliminary screening effort test they were divided into two groups: the first group of nine patients received an i.m. injection of naloxone 0.4 mg, or saline as placebo, and the second group, comprising six patients, received 4 mg naloxone or saline i.v. Effort testing was performed at weekly intervals on an ergometric bicycle, following the Bruce protocol. ECG, heart rate, blood pressure and pain perception were monitored continually. Blood was sampled through an indwelling venous catheter for beta-endorphin determination before, at the peak of, and 10-20 min following exercise. ST depression, heart rate, blood pressure and the double product were similar after naloxone and following saline administration. Beta-endorphin concentrations in plasma were significantly increased following exercise in the second group of patients. The increase in beta-endorphin concentration was larger when the patients were pretreated with naloxone (4 mg) than with placebo. However, chest pain was not significantly altered by either dose of naloxone.
内源性阿片类物质可能参与减轻运动诱发的缺血性疼痛或隐匿性缺血的假说得到了验证。15名男性冠心病患者参与了一项随机、双盲交叉研究。经过初步筛选运动试验后，他们被分为两组：第一组9名患者肌肉注射0.4mg纳洛酮或生理盐水作为安慰剂，第二组6名患者静脉注射4mg纳洛酮或生理盐水。按照布鲁斯方案，每周在测力计自行车上进行一次运动试验。持续监测心电图、心率、血压和疼痛感知。在运动前、运动高峰时以及运动后10 - 20分钟，通过留置静脉导管采血测定β-内啡肽。纳洛酮给药后和生理盐水给药后的ST段压低、心率、血压和双乘积相似。第二组患者运动后血浆β-内啡肽浓度显著升高。与安慰剂相比，患者预先使用纳洛酮（4mg）时β-内啡肽浓度的升高更大。然而，两种剂量的纳洛酮均未显著改变胸痛情况。
