Ogino K, Osaki S, Noguchi N, Kitamura H, Omodani H, Kato M, Hisatome I, Matsumoto T, Kinugawa T, Miyakoda H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Eur J Clin Pharmacol. 1995;48(3-4):189-94. doi: 10.1007/BF00198297.
To elucidate the effect of Nicorandil on myocardial energy metabolism and myocardial sympathetic activity, we administered Nicorandil orally to eight patients with angina pectoris prior to exercise testing. Arterial and coronary sinus levels of lactate, ammonia, hypoxanthine (HX), adrenaline and noradrenaline were measured during exercise in order to determine the irrespective myocardial extraction ratios (MER). Compared to placebo, Nicorandil increased the time to development of significant ST depression (322 vs 390 s) while decreasing the maximum amplitude of ST depression (0.244 vs 0.216 mV). Heart rate, systolic blood pressure, and the rate pressure product during exercise were not significantly affected. The MER of lactate, measured during exercise, was significantly higher after Nicorandil than placebo (13.6 vs 27.9). Similarly, the MERs of ammonia and HX were significantly higher after Nicorandil (-46.0 vs 7.4% and -47.0 vs 9.9% respectively). Nicorandil, had no apparent effect on myocardial sympathetic activity as the MERs of adrenaline and noradrenaline were essentially unaffected. We conclude that Nicorandil decreased myocardial ischaemia and suppressed myocardial accelerated purine metabolism (a marker of cellular energy metabolism) during exercise in patients with angina pectoris. This effect appears not to be related to myocardial sympathetic activity.
为阐明尼可地尔对心肌能量代谢及心肌交感神经活性的影响，我们在运动试验前对8例心绞痛患者口服尼可地尔。运动期间测量动脉血和冠状窦血中乳酸、氨、次黄嘌呤（HX）、肾上腺素及去甲肾上腺素水平，以确定各自的心肌摄取率（MER）。与安慰剂相比，尼可地尔延长了出现显著ST段压低的时间（322秒对390秒），同时降低了ST段压低的最大幅度（0.244毫伏对0.216毫伏）。运动期间的心率、收缩压及心率血压乘积未受到显著影响。运动期间测量的乳酸MER，尼可地尔治疗后显著高于安慰剂（13.6对27.9）。同样，尼可地尔治疗后氨和HX的MER也显著升高（分别为-46.0对7.4%和-47.0对9.9%）。由于肾上腺素和去甲肾上腺素的MER基本未受影响，尼可地尔对心肌交感神经活性无明显作用。我们得出结论，在心绞痛患者运动期间，尼可地尔可减轻心肌缺血并抑制心肌嘌呤代谢加速（细胞能量代谢的一个标志物）。这种作用似乎与心肌交感神经活性无关。
