Conradson T B, Eklundh G, Olofsson B, Pahlm O, Persson G
Chest. 1987 Jan;91(1):5-9. doi: 10.1378/chest.91.1.5.
Twenty-four patients (five women) aged 53-72 yr with both ischemic heart disease and asthma or chronic bronchitis receiving oral beta 2-agonists also received additional bronchodilating therapy with theophylline (600 mg daily), enprofylline (600 mg daily) or placebo. The study was double-blind, randomized, triple-crossover with each regimen given for two weeks. Holter monitoring was used during 48 consecutive hours in each period. Compared with placebo, addition of theophylline and enprofylline were associated with an increased mean hourly heart rate of 6 bpm (p less than 0.001). A small, but statistically significant (p less than 0.05) increase in mean hourly frequency of premature ventricular beats (PVBs) occurred with enprofylline as compared with placebo. However, in only two patients with enprofylline (and one patient with theophylline) the increase in PVBs was such that a clinically relevant proarrhythmic effect seems possible. Furthermore, ventricular tachycardia was not more frequently observed with any xanthine than with placebo. Thus, combined oral bronchodilator therapy is not contraindicated in patients with obstructive lung disease and concomitant ischemic heart disease. Holter monitoring is recommended to assess the individual patient's response to such therapy.
24例年龄在53至72岁之间，同时患有缺血性心脏病和哮喘或慢性支气管炎且正在接受口服β2受体激动剂治疗的患者（5名女性），还接受了额外的支气管扩张治疗，分别使用氨茶碱（每日600毫克）、恩丙茶碱（每日600毫克）或安慰剂。该研究为双盲、随机、三交叉试验，每种治疗方案给药两周。在每个治疗阶段连续48小时进行动态心电图监测。与安慰剂相比，加用氨茶碱和恩丙茶碱后平均每小时心率增加6次/分钟（p<0.001）。与安慰剂相比，恩丙茶碱使室性早搏（PVB）平均每小时发生频率有小幅但具有统计学意义的增加（p<0.05）。然而，仅2例使用恩丙茶碱的患者（1例使用氨茶碱的患者）室性早搏增加幅度较大，似乎可能产生临床相关的促心律失常作用。此外，与安慰剂相比，使用任何一种黄嘌呤类药物时室性心动过速的观察频率均未增加。因此，阻塞性肺病合并缺血性心脏病患者并非禁忌联合口服支气管扩张剂治疗。建议进行动态心电图监测以评估个体患者对该治疗的反应。
