西咪替丁可诱发变异性心绞痛患者的冠状动脉痉挛。

Cimetidine induces coronary artery spasm in patients with vasospastic angina.

作者信息

Shimokawa H, Okamatsu S, Taira Y, Nakamura M

出版信息

Can J Cardiol. 1987 May;3(4):177-82.

Abstract

We have previously reported that cimetidine, a histamine H2-receptor blocker, augments the histamine-induced coronary vasoconstriction at the site of spastic segments in the atherosclerotic coronary arteries of swine. To elucidate whether cimetidine has a coronary vasoconstrictive effect in humans, 14 patients with vasospastic angina (group 1) and 14 controls with atypical chest pain (group 2) were examined angiographically. Nitroglycerin-effective spontaneous angina with electrocardiographic ST-T changes and ergonovine-induced coronary artery spasm were confirmed in group 1, but not in group 2. Cimetidine was administered intravenously in a dose of 200 mg. Cimetidine induced coronary artery spasm in 4 patients in group 1 but none in group 2(29% vs. 0%, p less than 0.01). The extent of coronary vasoconstriction induced by cimetidine was greater at the site of spastic coronary segments than that at the site of non-spastic segments in group 1 or all segments in group 2 [14% vs. 4%, (p less than 0.01) or 14% vs. 2%, (p less than 0.01)] as well as the extent of ergonovine-induced coronary vasoconstriction [46% vs. 14%, (p less than 0.01) or 46% vs. 14%, (p less than 0.01)] and nitroglycerin-induced coronary vasodilatation [58% vs. 25%, (p less than 0.01) or 58% vs. 17%, (p less than 0.01)]. As it was suggested that cimetidine has potential vasoconstrictive effects in patients with coronary artery spasm, it should be administered with caution in patients with the vasospastic angina pectoris.

摘要

我们之前曾报道，组胺H2受体阻滞剂西咪替丁可增强组胺诱导的猪动脉粥样硬化冠状动脉痉挛节段部位的冠状动脉收缩。为阐明西咪替丁在人类是否具有冠状动脉收缩作用，对14例血管痉挛性心绞痛患者（第1组）和14例非典型胸痛对照者（第2组）进行了血管造影检查。第1组确诊为伴有心电图ST-T改变的硝酸甘油有效的自发性心绞痛以及麦角新碱诱导的冠状动脉痉挛，而第2组未确诊。静脉注射西咪替丁，剂量为200mg。西咪替丁在第1组4例患者中诱发了冠状动脉痉挛，而第2组无1例诱发（29% 对0%，p<0.01）。第1组中，西咪替丁诱导的冠状动脉收缩程度在痉挛冠状动脉节段部位大于非痉挛节段部位，在第2组中则大于所有节段部位[14% 对4%，（p<0.01）或14% 对2%，（p<0.01）]，麦角新碱诱导的冠状动脉收缩程度[46% 对14%，（p<0.01）或46% 对14%，（p<0.01）]以及硝酸甘油诱导的冠状动脉扩张程度[58% 对25%，（p<0.01）或58% 对17%，（p<0.01）]也是如此。由于提示西咪替丁在冠状动脉痉挛患者中具有潜在的血管收缩作用，因此在血管痉挛性心绞痛患者中应谨慎使用。