Emanuelsson H, Hjalmarson A, Holmberg S, Waagstein F, Waldenström A
J Cardiovasc Pharmacol. 1984 Mar-Apr;6(2):224-32. doi: 10.1097/00005344-198403000-00003.
We studied nine patients with arteriosclerotic coronary heart disease (Group I) and 10 patients with normal coronary arteries (Group II) to elucidate mechanisms by which nifedipine affects catecholamine arterial levels and myocardial extraction at rest and during pacing. Nifedipine induced signs of general and coronary vasodilatation and improved myocardial lactate metabolism during pacing. Noradrenaline arterial concentration increased significantly after nifedipine in both groups (p less than 0.01). In Group I, the values were 40-50% higher compared with Group II. The net myocardial extraction of noradrenaline was not significantly affected by nifedipine, except during pacing in Group II, in which an increase in myocardial release was seen (p less than 0.05). In Group I, there was no correlation between arterial concentration of noradrenaline and myocardial release, while there was a significant negative correlation in Group II (p less than 0.0001). Adrenaline arterial concentration and myocardial extraction were not altered by nifedipine, but there was a positive significant correlation in Group I between arterial concentration and myocardial extraction of adrenaline (p less than 0.001). In conclusion, nifedipine increased noradrenaline levels in both groups of patients, probably reflecting a rise in sympathetic activity. Because myocardial lactate production turned into extraction in patients with coronary artery disease, the increased sympathetic tone evidently did not outweigh the beneficial antianginal effects of nifedipine.
我们研究了9例动脉硬化性冠心病患者（第一组）和10例冠状动脉正常的患者（第二组），以阐明硝苯地平影响静息和起搏时儿茶酚胺动脉水平及心肌摄取的机制。硝苯地平可诱发全身和冠状动脉扩张的体征，并在起搏时改善心肌乳酸代谢。两组患者在服用硝苯地平后去甲肾上腺素动脉浓度均显著升高（p<0.01）。在第一组中，该值比第二组高40%-50%。除了第二组起搏时心肌释放增加（p<0.05）外，硝苯地平对去甲肾上腺素的净心肌摄取没有显著影响。在第一组中，去甲肾上腺素的动脉浓度与心肌释放之间没有相关性，而在第二组中则存在显著的负相关（p<0.0001）。肾上腺素的动脉浓度和心肌摄取不受硝苯地平的影响，但在第一组中，肾上腺素的动脉浓度与心肌摄取之间存在显著的正相关（p<0.001）。总之，硝苯地平使两组患者的去甲肾上腺素水平升高，这可能反映了交感神经活性的增强。由于冠心病患者心肌乳酸生成转变为摄取，交感神经张力的增加显然并未超过硝苯地平有益的抗心绞痛作用。
