van Rijn T, Rabkin S W
Life Sci. 1986 Feb 17;38(7):609-15. doi: 10.1016/0024-3205(86)90054-8.
To determine whether endogenous opioids play a role in modulating the appreciation of chest pain in angina pectoris, the specific opioid antagonist, Naloxone, was used. The hypothesis was that the appearance time of ischemic myocardial pain should decrease after Naloxone if centrally mediated pain perception is significantly influenced by the endorphin system in angina pectoris. A randomized double blind clinical trial was conducted in 5 men with effort-induced angina pectoris associated with ST segment changes. Three multi-stage exercise tests, using the Bruce protocol were performed on the same day and time, on three successive weeks. Chest pain was reported 4.3 +/- 0.3 (SEM) minutes after starting exercise on the first or baseline test. On subsequent tests patients received either Naloxone 2 mg IV or a similar volume of saline placebo. Angina pectoris occurred significantly (p. less than 0.05) earlier (1.6 +/- 0.2 minutes) after Naloxone compared to placebo. There were no significant differences in myocardial ischemia indicated by ST segment changes and no significant differences in resting or exercise blood pressure and heart rate between Naloxone and placebo. Thus, these data focus attention on a neglected area of myocardial ischemic pain and suggest that endogenous opioids play a significant role in the recognition of the pain of effort-related angina pectoris.
为了确定内源性阿片类物质是否在调节心绞痛患者胸痛的感知中起作用，使用了特异性阿片类拮抗剂纳洛酮。假设是，如果心绞痛中内啡肽系统对中枢介导的疼痛感知有显著影响，那么纳洛酮使用后缺血性心肌疼痛的出现时间应该缩短。对5名患有劳力性心绞痛且伴有ST段改变的男性患者进行了一项随机双盲临床试验。在连续三周的同一天同一时间，按照布鲁斯方案进行了三次多阶段运动试验。在第一次或基线试验中，运动开始后4.3±0.3（标准误）分钟报告胸痛。在随后的试验中，患者接受静脉注射2毫克纳洛酮或等量的生理盐水安慰剂。与安慰剂相比，纳洛酮使用后心绞痛发作明显提前（1.6±0.2分钟）（p＜0.05）。ST段改变所提示的心肌缺血无显著差异，纳洛酮组与安慰剂组在静息或运动时的血压和心率也无显著差异。因此，这些数据将注意力集中在心肌缺血性疼痛这一被忽视的领域，并表明内源性阿片类物质在与劳力性心绞痛相关的疼痛识别中起重要作用。
