Kerensky R A, Kutcher M A, Braden G A, Applegate R J, Solis G A, Little W C
Section of Cardiology, Bowman Gray School of Medicine, Wake Forest University, North Carolina Baptist Hospital, Winston-Salem, USA.
Clin Cardiol. 1995 Feb;18(2):91-6. doi: 10.1002/clc.4960180211.
There is evidence that the first balloon inflation during coronary angioplasty provides a preconditioning stimulus leading to decreased ischemia during subsequent balloon inflations. Endogenous adenosine release may play a role in ischemic preconditioning. Therefore, intracoronary adenosine administration prior to the first balloon inflation during percutaneous transluminal coronary angioplasty (PTCA) might modify the preconditioning response to the first balloon inflation. Forty-one patients underwent double-blind randomization to treatment with 100 mcg of intracoronary adenosine or placebo prior to coronary angioplasty. Twenty patients (11 adenosine, 9 placebo) had complete resolution of ischemia between inflations allowing comparison between the first and second inflation. An angioplasty guidewire was used to obtain an intracoronary electrocardiogram. The mean reduction in ST elevation during the second inflation compared with the first was 4.8 mm in the placebo group and -0.8 in the adenosine group (p < 0.05 placebo vs. adenosine). Seven of 9 placebo patients had a decrease in ischemia during the second inflation compared with the first, while only 2 of 11 adenosine patients showed a reduction. It was concluded that (1) the first inflation during PTCA is a preconditioning stimulus leading to a decrease in ischemia during later inflations, and (2) intracoronary adenosine administration prior to PTCA modifies the preconditioning effect of the first inflation. These data suggest that adenosine plays a role in ischemic preconditioning in humans.
有证据表明，冠状动脉血管成形术中首次球囊扩张可提供一种预处理刺激，导致后续球囊扩张期间缺血减少。内源性腺苷释放可能在缺血预处理中起作用。因此，在经皮腔内冠状动脉血管成形术（PTCA）期间，首次球囊扩张前给予冠状动脉内腺苷可能会改变对首次球囊扩张的预处理反应。41例患者在冠状动脉血管成形术前接受了双盲随机分组，分别接受100 mcg冠状动脉内腺苷或安慰剂治疗。20例患者（11例腺苷组，9例安慰剂组）在两次扩张之间缺血完全缓解，从而可以比较首次和第二次扩张。使用血管成形术导丝获取冠状动脉内心电图。与首次扩张相比，安慰剂组第二次扩张期间ST段抬高的平均降低幅度为4.8 mm，腺苷组为-0.8 mm（安慰剂组与腺苷组比较，p<0.05）。9例安慰剂组患者中有7例第二次扩张时缺血较首次减少，而11例腺苷组患者中只有2例减少。得出的结论是：（1）PTCA期间的首次扩张是一种预处理刺激，导致后期扩张时缺血减少；（2）PTCA前给予冠状动脉内腺苷会改变首次扩张的预处理效果。这些数据表明腺苷在人类缺血预处理中起作用。
