Cohn P F, Maddox D, Holman B L, Markis J E, Adams D F, See J R, Idoine J
Am J Cardiol. 1977 May 4;39(5):672-8. doi: 10.1016/s0002-9149(77)80127-6.
The effect of sublingually administered nitroglycerin on regional myocardial specific blood flow (in ml/min per 100 g tissue) was evaluated with a xenon-133 washout technique in 31 patients in a resting nonstressed state. Eight patients had normal coronary arteriograms (Group 1), 12 had coronary artery disease without collateral vessels (Group 2) and 11 had coronary artery disease with collateral vessels (Group 3). Although nitroglycerin caused a similar decrease in mean arterial blood pressure and blood pressure-heart rate product in all three groups, the decrease in regional myocardial blood flow was significantly less in Group 3 (-8+/-6% [mean+/-standard error of the mean]) than in Group 1 (-31+/-5%), P less than 0.05); an intermediary decrease occurred in Group 2 (-23+/-5%). Within Group 3, there was a mean increase in regional myocardial blood flow after nitroglycerin in the five patients whose collateral vessels were of a higher angiographic grade and arose from non-stenosed coronary arteries, whereas a reduction was observed in the six patients with none or only one of these findings (+10+/-7% versus -23+/-3%, P less than 0.001). This study suggests that even in the resting state, in some patients with coronary artery disease enhancement of regional myocardial blood flow can occur after sublingual administration of nitroglycerin and is probably mediated through well functioning collateral vessels. It is possible that the drug's effects on both the coronary and systemic circulation may relieve angina in some patients with coronary artery disease.
在31例处于静息非应激状态的患者中，采用氙-133洗脱技术评估了舌下含服硝酸甘油对局部心肌特异性血流量（每100 g组织每分钟的毫升数）的影响。8例患者冠状动脉造影正常（第1组），12例有冠状动脉疾病但无侧支血管（第2组），11例有冠状动脉疾病且有侧支血管（第3组）。尽管硝酸甘油在所有三组中均使平均动脉血压和血压-心率乘积出现类似程度的下降，但第3组局部心肌血流量的下降（-8±6%[平均值±平均值的标准误]）明显小于第1组（-31±5%），P<0.05；第2组出现中间程度的下降（-23±5%）。在第3组中，5例侧支血管造影分级较高且起源于无狭窄冠状动脉的患者在使用硝酸甘油后局部心肌血流量平均增加，而6例无上述表现或仅有其中一项表现的患者局部心肌血流量减少（分别为+10±7%和-23±3%，P<0.001）。本研究提示，即使在静息状态下，一些冠状动脉疾病患者舌下含服硝酸甘油后局部心肌血流量也可能增加，这可能是通过功能良好的侧支血管介导的。药物对冠状动脉和体循环的作用可能在某些冠状动脉疾病患者中缓解心绞痛。
