Falcone C, Specchia G, Rondanelli R, Guasti L, Corsico G, Codega S, Montemartini C
Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi, Pavia, Italy.
J Am Coll Cardiol. 1988 Apr;11(4):719-23. doi: 10.1016/0735-1097(88)90202-1.
To verify whether beta-endorphin plasma levels influence the presence of anginal symptoms, 74 consecutive male patients were studied. All patients had previously documented coronary artery disease and reproducible exercise-induced myocardial ischemia. Thirty-five patients (Group I) had a history of angina and reported anginal symptoms during exercise stress testing; 39 patients (Group II) were asymptomatic and had documented silent myocardial ischemia during exercise. Baseline beta-endorphin plasma levels were measured in blood samples taken before exercise stress testing and analyzed by beta-endorphin-I125-RIA Kit-NEN (a radioimmunoassay method). The mean baseline beta-endorphin plasma level was 22.5 +/- 19 pg/ml in patients with anginal symptoms compared with 43.7 +/- 28 pg/ml in asymptomatic patients (p less than 0.001). Baseline blood pressure and heart rate-systolic pressure (rate-pressure) product at baseline and at ischemia threshold (1 mm ST segment depression) were similar in the two groups. Group II patients had a longer exercise duration (p less than 0.01), more pronounced ST segment depression (p less than 0.001) and a higher peak rate-pressure product (p less than 0.01). The extent of coronary artery disease, ejection fraction and left ventricular end-diastolic pressure were similar in the two groups. These data suggest that higher baseline beta-endorphin plasma levels may play a role in the decreased sensitivity to pain in patients with silent myocardial ischemia. In addition, different beta-endorphin levels can be associated with a different sensitivity to pain.
为了验证β-内啡肽血浆水平是否会影响心绞痛症状的出现，对74例连续入选的男性患者进行了研究。所有患者既往均有冠状动脉疾病记录且存在可重复性运动诱发的心肌缺血。35例患者（第一组）有胸痛病史且在运动负荷试验期间报告有心绞痛症状；39例患者（第二组）无症状，且在运动期间记录到无症状性心肌缺血。在运动负荷试验前采集血样，用β-内啡肽-I125-RIA试剂盒（一种放射免疫分析法）测定基线β-内啡肽血浆水平。有胸痛症状的患者基线β-内啡肽血浆平均水平为22.5±19 pg/ml，无症状患者为43.7±28 pg/ml（p<0.001）。两组患者的基线血压、心率收缩压（率压）乘积在基线时和缺血阈值（ST段压低1 mm）时相似。第二组患者运动持续时间更长（p<0.01），ST段压低更明显（p<0.001），峰值率压乘积更高（p<0.01）。两组患者的冠状动脉疾病程度、射血分数和左心室舒张末期压力相似。这些数据表明，较高的基线β-内啡肽血浆水平可能在无症状性心肌缺血患者对疼痛的敏感性降低中起作用。此外，不同的β-内啡肽水平可能与不同的疼痛敏感性相关。
