Montorsi P, Cozzi S, Loaldi A, Fabbiocchi F, Polese A, De Cesare N, Guazzi M D
Istituto di Cardiologia, Università di Milano, Italy.
Am J Cardiol. 1990 Aug 1;66(3):302-7. doi: 10.1016/0002-9149(90)90840-w.
In 18 patients (12 women) 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 decreased 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; coronary flow was unchanged or decreased and norepinephrine plasma levels were modestly or greatly increased, respectively. After 4 weeks of treatment with nifedipine (10 to 20 mg 4 times daily), the effort ST-segment shift was further decreased to 4.4 +/- 3.5 mm (p less than 0.03) despite a slightly increased double product. Plasma norepinephrine values, as compared to those after acute nifedipine, were decreased by 40% in patients with further improvement and were unchanged in patients whose exercise performance did not vary.(ABSTRACT TRUNCATED AT 250 WORDS)
在18例（12名女性）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毫克硝苯地平可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），并使运动负荷试验期间的整体ST段偏移在可比的最大工作量和不变的双倍乘积情况下从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（反向）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。在少数情况下，硝苯地平并未改善甚至恶化运动反应；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升高或大幅升高。在用硝苯地平（每日4次，每次10至20毫克）治疗4周后，尽管双倍乘积略有增加，但运动时ST段偏移进一步降至4.4±3.5毫米（p<0.03）。与急性服用硝苯地平后相比，血浆去甲肾上腺素值在病情进一步改善的患者中降低了40%，而在运动表现无变化的患者中则无变化。（摘要截选至250字）
