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陕西医学杂志 2008年第7期37卷 865-867页

作者：薛振怀黄伯梯广州市黄埔区中医院广州510700

目的:观察单硝酸异山梨酯联合通心络胶囊对不稳定型心绞痛的疗效。方法:将64例不稳定型心绞痛患者随机分为治疗组和对照组,治疗组给予单硝酸异山梨酯片和通心络胶囊口服,对照组给予阿斯匹林片口服。疗程4周。观察用药前后患者症状、心... 详细信息

目的:观察单硝酸异山梨酯联合通心络胶囊对不稳定型心绞痛的疗效。方法:将64例不稳定型心绞痛患者随机分为治疗组和对照组,治疗组给予单硝酸异山梨酯片和通心络胶囊口服,对照组给予阿斯匹林片口服。疗程4周。观察用药前后患者症状、心电图的改变,检测心功能指标,并予治疗后随访,记录药物的不良反应。结果:治疗组总有效率93.9%,对照组总有效率71.0%。治疗组疗效明显高于对照组。两组病人的每搏量(SV)、心排血量(CO)、左室射血分数(LEVF)值均较治疗前提高,治疗组SV、CO提高更为明显。两组均无明显不良反应,且随访2月后治疗组发生不良事件低。结论:单硝酸异山梨酯联合通心络胶囊治疗不稳定心绞痛疗效显著。

关键词：心绞痛不稳定型/药物疗法 @单硝酸异山梨酯 @通心络胶囊

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曲美他嗪对不稳定型心绞痛患者临床疗效及胰岛素抵抗的影响

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陕西医学杂志 2008年第8期37卷 1050-1051页

作者：吴帆河南省许昌市中心医院心内科许昌461000

目的:探讨曲美他嗪对不稳定型心绞痛患者临床疗效及胰岛素抵抗的影响。方法:将76例不稳定型心绞痛患者随机分成两组,治疗组38例,除用常规传统药物治疗外,加用曲美他嗪;对照组38例用传统药物治疗。8周后,观察两组患者心绞痛发作次数,心... 详细信息

目的:探讨曲美他嗪对不稳定型心绞痛患者临床疗效及胰岛素抵抗的影响。方法:将76例不稳定型心绞痛患者随机分成两组,治疗组38例,除用常规传统药物治疗外,加用曲美他嗪;对照组38例用传统药物治疗。8周后,观察两组患者心绞痛发作次数,心肌缺血情况,心电图的变化,检测空腹血糖、胰岛素,计算胰岛素敏感指数。结果:治疗组心绞痛发作次数减少、ST段最大下降幅度、总缺血情况明显改善(P<0.05),治疗组治疗后空腹胰岛素水平有所下降(P<0.05)、胰岛素敏感指数较治疗前明显升高(P<0.05),与对照组相比胰岛素敏感指数也有显著性差异(P<0.05)。结论:在传统治疗基础上加用曲美他嗪治疗不稳定型心绞痛疗效明显,并且还可以改善胰岛素抵抗。

关键词：心绞痛不稳定型/诊断不稳定型/药物疗法血糖/血液胰岛素/血液曲美他嗪/治疗应用

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坎地沙坦对不稳定心绞痛患者脑钠肽、白介素-6和C-反应蛋白水平的影响

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陕西医学杂志 2008年第4期37卷 420-422,435页

作者：兰超李莉刘秋慧郑州大学第一附属医院急救中心EICU 河南省高等学校临床医学重点学科开放实验室郑州450052

目的:探讨Ang受体拮抗剂-坎地沙坦对不稳定心绞痛(UAP)患者血浆脑钠肽(BNP)、白介素-6(IL-6)和C-反应蛋白(CRP)水平的影响,并了解BNP是否与炎症反应有关。方法:选取UAP患者90例随机分为常规治疗组和坎地沙坦治疗组。常规治疗组(n=40)采... 详细信息

目的:探讨Ang受体拮抗剂-坎地沙坦对不稳定心绞痛(UAP)患者血浆脑钠肽(BNP)、白介素-6(IL-6)和C-反应蛋白(CRP)水平的影响,并了解BNP是否与炎症反应有关。方法:选取UAP患者90例随机分为常规治疗组和坎地沙坦治疗组。常规治疗组(n=40)采用不稳定心绞痛常规治疗,坎地沙坦治疗组(n=50)在常规治疗基础上加用坎地沙坦酯片治疗8周。观察入院即刻、1周及8周血清BNP、IL-6、CRP水平、心脏超声指标的变化。结果:UAP组患者BNP、IL-6及CRP水平明显高于正常对照组(P<0.01)。常规治疗组和坎地沙坦治疗组治疗1周后,上述指标与治疗前相比均有下降(P<0.05),治疗8周后坎地沙坦组这种改变更加显著(P<0.01)。两组之间治疗8周的比较,上述指标以及LVED、E/A、LVPWT、IVST均有显著性差异。BNP与IL-6、CRP及LVED存在正相关。结论:UAP患者坎地沙坦组治疗后BNP早期的下降与IL-6、CRP的下降有关,而后期的下降还与LVED有关。在常规治疗的基础上加用坎地沙坦可明显降低UAP及ACS血清炎症因子水平,稳定AS斑块。

关键词：心绞痛不稳定型/药物疗法 @坎地沙坦利钠肽,脑/血液白细胞介素6/血液 C反应蛋白/血液

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比索洛尔与培哚普利治疗不稳定性心绞痛30例

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陕西医学杂志 2008年第12期37卷 1661-1662页

作者：李文斌苗英张月琴杨淑云宁夏固原市原州区人民医院固原756000 固原市原州区三营中心卫生医院

目的:探讨比索洛尔与培哚普利联合应用治疗不稳定型心绞痛的疗效。方法:将60例不稳定型心绞痛患者分为治疗组及对照组进行临床比较。结果:治疗组完全缓解率为93.3%对照组完全缓解率为66.7%,两组完全缓解率(P<0.05)有显著差异。治疗... 详细信息

目的:探讨比索洛尔与培哚普利联合应用治疗不稳定型心绞痛的疗效。方法:将60例不稳定型心绞痛患者分为治疗组及对照组进行临床比较。结果:治疗组完全缓解率为93.3%对照组完全缓解率为66.7%,两组完全缓解率(P<0.05)有显著差异。治疗组优于对照组。结论:比索洛尔与培哚普利联合其它药物治疗不稳定型心绞痛疗效满意。

关键词：心绞痛不稳定型/药物疗法比索洛尔/治疗应用培垛普利/治疗应用

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Improvement of endothelial function and insulin sensitivity with vitamin C in patients with coronary spastic angina - Possible role of reactive oxygen species

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第7期35卷 1860-1866页

作者： Hirashima, O Kawano, H Motoyama, T Hirai, N Ohgushi, M Kugiyama, K Ogawa, H Yasue, H Kumamoto Univ Sch Med Dept Cardiovasc Med Kumamoto 8608556 Japan

OBJECTIVES This study was designed to examine the effect of antioxidant supplementation on the endothelial function and insulin sensitivity in patients with coronary spastic angina (CSA). BACKGROUND Insulin resistance may play a key role in coronary heart disease, and there is a possible link between acetylcholine-induced coronary vasoconstriction and hyperinsulinemia in patients with CSA. Endothelial dysfunction is present in the systemic arteries in CSA patients, and reactive oxygen species may cause inactivation of nitric oxide in these patients. METHODS We measured flow-mediated dilation of the brachial artery using ultrasound technique in 22 patients with CSA and 20 control subjects. We also evaluated glucose tolerance using a 75-g oral glucose tolerance test and insulin sensitivity using steady-state plasma glucose (SSPG) methods in the same patients. RESULTS The incidence of impaired glucose tolerance was higher in the CSA group than in the control group. Vitamin C infusion augmented flow-mediated dilation and decreased SSPG levels in the CSA group (from 3.27 +/- 0.77% to 7.00 +/- 0.59% [p < 0.001 by analysis of variance (ANOVA)] and from 177.3 +/- 13.3 to 143.1 +/- 14.9 mg/dl [p = 0.047 by ANOVA], respectively) but not in the control group (from 6.47 +/- 0.66% to 6.80 +/- 0.60% and from 119.8 +/- 11.7 mg/dl to 118.1 +/- 11.3 mg/dl, respectively). The steady-state plasma insulin levels were not affected by vitamin C infusion in either group. CONCLUSIONS Vitamin C improves both endothelial function and insulin sensitivity in patients with CSA. Thus, reactive oxygen species and/or decreased nitric oxide bioactivity may play an important role in the genesis of both endothelial dysfunction and insulin resistance in patients with CSA. (J Am Coll Cardiol 2000;35:1860-6) (C) 2000 by the American College of Cardiology.

关键词：心绞痛不稳定型/血液心绞痛不稳定型/药物疗法心绞痛不稳定型/病理生理学抗坏血酸/治疗应用血糖内皮血管/药物作用内皮血管/病理生理学葡糖耐量试验胰岛素/代谢女(雌)性人类男(雄)性中年人

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Anticoagulants in acute coronary syndromes

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第5A期84卷 2M-6M页

作者： Turpie, AGG McMaster Univ Hamilton ON Canada

Antithrombotic and antiplatelet agents, particularly unfractionated heparin and aspirin, are longstanding therapeutic mainstays for acute coronary syndromes such as unstable angina and non-Q-wave myocardial infarction (MI). Early studies demonstrated that aspirin reduces the risk of mortality or nonfatal MI by 50-70% in patients presenting with unstable angina or non-Q-wave MI. Added to aspirin, heparin regimens further diminish the incidence of these myocardial ischemic events in the acute setting. Three major clinical studies demonstrated that such enhanced risk reductions can be achieved without significant increases in bleeding complications. The low-molecular-weight (LMW) heparin, dalteparin, proved superior to placebo but not unfractionated heparin in diminishing the incidence of (1) death or Ml;(2) death, MI, or recurrence of angina;or (3) frequency of revascularization procedures. On the other hand, another LMW heparin, enoxaparin, did reduce these events at 14 and 30 days, as well as 1 year after treatment. The principal biophysical limitation of heparins, however, is that they cannot inactivate clot-bound thrombin, which probably contributes to morbidity and mortality in acute coronary syndromes. The natural leech-derived polypeptide hirudin and its derivatives (e.g., lepirudin) inactivate both fibrin-bound and free thrombin. Lepirudin has been approved in certain countries for the treatment of heparin-induced thrombocytopenia and is now being evaluated in the clinical management of acute myocardial ischemic syndromes. The well-documented pathophysiologic foundation for acute coronary syndromes is partial or intermittent thrombotic occlusion of a coronary artery as the result of atherosclerosis. Although a stable atherosclerotic plaque may not be clinically problematic, plaque rupture, which occurs under a variety of stimuli, touches off a cascade of enzymatic and cellular responses that frequently culminate in thrombotic occlusion. In the coronary circula

关键词：急性病心绞痛不稳定型/药物疗法抗凝药/治疗应用阿司匹林/治疗应用冠心病/药物疗法达肝素/治疗应用依诺肝素/治疗应用纤维蛋白溶解药/治疗应用肝素低分子量/治疗应用水蛭素疗法水蛭素类/类似物和衍生物心肌梗死/药物疗法重组蛋白质类/治疗应用人类

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Prior aspirin users with acute non-ST-elevation coronary syndromes are at increased risk of cardiac events and benefit from enoxaparin

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AMERICAN HEART JOURNAL 2001年第4期141卷 566-572页

作者： Santopinto, J Gurfinkel, EP Torres, V Marcos, E Bozovich, GE Mautner, B McCabe, CH Antman, EM Leonidas Lucero Hosp Coronary Care Unit RA-8000 Bahia Blanca Buenos Aires Argentina Favaloro Fdn Buenos Aires DF Argentina Brigham & Womens Hosp Boston MA 02115 USA

Background The aim of this article was to investigate whether prior aspirin use in patients with acute coronary syndromes affects clinical outcome. The Efficacy Safety Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study (ESSENCE) and Thrombolysis in Myocardial Infarction (TIMI) 11B trials have shown superiority of enoxaparin over unfractionated heparin (UFH) in patients with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI). However, the treatment effect of enoxaparin in the subset of patients reporting prior aspirin use has not been determined. Methods The rate of death, myocardial infarction, and urgent revascularization at days 8 and 43 after randomization was compared among patients who received aspirin within the week before randomization with those who did not receive aspirin in the TIMI 11B trial. A total of 3275 patients (84%) were prior aspirin users. Results The admission diagnosis was similar for prior and nonprior aspirin users. At both day 8 and day 43 the event rate was higher for prior aspirin users than for nonprior aspirin users (odds ratio 1.6 [1.24-2.08], P = .0004 at day 43), even after correction for baseline characteristics. Compared with those prior aspirin users taking UFH, enoxaparin-treated prior aspirin users had a reduced rate of the composite end point of death, myocardial infarction, and urgent revascularization at day 8 (odds ratio 0.82 [0.67-1.00], P = .046) and day 43 (odds ratio 0.83 [0.70-0.98], P = .032). Conclusion Patients with UA/NSTEMI and prior aspirin use had a 60% higher risk of death and cardiac ischemic events compared with nonprior aspirin users. On the basis of this subanalysis, enoxaparin is superior to UFH in all patients. In prior aspirin users the benefit is more clearly demonstrated.

关键词：心绞痛不稳定型/药物疗法抗凝药/治疗应用阿司匹林/治疗应用双盲法依诺肝素/治疗应用肝素/治疗应用 Logistic模型心肌梗死/药物疗法血小板聚集抑制剂/治疗应用预后危险性评估综合征女(雌)性人类男(雄)性中年人

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Subgroups, treatment effects, and baseline risks: Some lessons from major cardiovascular trials

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AMERICAN HEART JOURNAL 2000年第6期139卷 952-961页

作者： Parker, AB Naylor, CD Univ Toronto Fac Med Inst Med Sci Toronto ON M5S 1A8 Canada SOCAR Cardiac Res Ltd Toronto ON Canada Univ Toronto Dept Med Toronto ON M5S 1A8 Canada Univ Toronto Clin Epidemiol & Hlth Serv Res Program Sunnybrook & Womens Coll Unit Toronto ON M5S 1A8 Canada Inst Clin Evaluat Sci Toronto ON Canada

Background The objective of this study was to determine how subgroup analyses are performed in large randomized trials of cardiovascular pharmacotherapy. Methods and Results We reviewed 67 randomized, double-blind, controlled trials involving pharmacotherapy in at least 1000 patients with unstable angina, myocardial infarction, left ventricular dysfunction, or heart failure with clinical outcomes as primary end points, published between 1980 and 1997. Nine had no subgroup analyses but 43 reported on 5 or more subgroups and 31 reported subgroups without formal statistical tests for treatment-subgroup interactions. In most trials, a rationale for subgroup selection was missing. All but 6 focused on single-factor subgroups. Conclusions Trial subgroups should ideally be defined a priori on 2 bases: single-factor subgroups with a strong rationale for biological response modification and multifactorial prognostic subgroups defined from baseline risks. However, single-factor subgroup analyses are often reported without a supporting rationale or formal statistical tests for interactions. We suggest that clinicians should interpret published subgroup-specific variations in treatment effects skeptically unless there is a prespecified rationale and a significant treatment-subgroup interaction.

关键词：心绞痛不稳定型/药物疗法心血管药物/治疗应用数据说明统计双盲法心肌梗死/药物疗法回顾性研究危险性评估治疗结果心室功能障碍左/药物疗法人类

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The Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry in patients with unstable angina

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第5A期84卷 7M-12M页

作者： Piegas, LS Flather, M Pogue, J Hunt, D Varigos, J Avezum, A Anderson, J Keltai, M Budaj, A Fox, K Ceremuzynski, L Yusuf, S Inst Dante Pazzanese Cardiol BR-04012180 Sao Paulo Brazil

Clinical approaches to the prevention of the potentially catastrophic consequences of coronary ischemic phenomena such as unstable angina and suspected non-Q-wave myocardial infarction (MI) differ across the world. in addition to prevailing physician beliefs in different societies, the level of access to catheterization laboratories largely determines whether an interventionist or conservative strategy is adopted. The Organization to Assess Strategies for Ischemic Syndromes (OASIS)-a prospective registry of approximately 8,000 patients with acute myocardial ischemia with no ST elevation, treated in 95 hospitals across 6 countries-furnished a unique window into regional differences in clinical management and the frequency and timing of invasive procedures (i.e., angiography, percutaneous transluminal coronary angioplasty [PTCA], and coronary artery bypass graft [CABG] surgery), as well as the outcomes of these trends. At 6 months after symptom onset, patients in the United States and Brazil, where the catheterization laboratory facilities are more accessible, underwent significantly (p <0.001) more angiography (69.4%), PTCA (23.6%), and CABG (25.2%) than in Canada and Australia, where the corresponding rates were 48.4%, 17.0%, and 16.8% (p <0.001), respectively;and in Hungary and Poland, where the respective rates were 23.5%, 5.8%, and 10.9% (p <0.001). This relatively aggressive approach led at 6 months to a more substantial decrease in refractory angina in the United States and Brazil than in Canada and Australia (20.4% vs 13.9%;p <0.001), but no improvement in rates of cardiovascular mortality and MI (10.5% versus 10.5%;p = 0.36). There was a significant (p less than or equal to 0.012) increase in stroke, (1.9% vs 1.3%;p = 0.010) and major bleeding (1.9% vs 1.1%;p = 0.009) events. Furthermore, an inverse correlation emerged between baseline cardiovascular risk status and frequency of angiography and PTCA interventions preferentially for low-risk compared with high

关键词：肾上腺素能β受体拮抗剂/治疗应用心绞痛不稳定型/诊断心绞痛不稳定型/药物疗法心绞痛不稳定型/放射摄影术心绞痛不稳定型/外科学心绞痛不稳定型/治疗抗凝药/治疗应用澳大利亚巴西钙通道阻滞药/治疗应用加拿大脑血管障碍/病因学冠状血管造影术猝死心脏/病因学匈牙利国际合作住院时间心肌梗死/病因学比值比波兰前瞻性研究登记危险治疗结果美国血管舒张药/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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Evidence of platelet activation during treatment with a GPIIb/IIIa antagonist in patients presenting with acute coronary syndromes

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第5期36卷 1514-1519页

作者： Cox, D Smith, R Quinn, M Theroux, P Crean, P Fitzgerald, DJ Royal Coll Surg Ireland Dept Clin Pharmacol Ctr Cardiovasc Sci Dublin 2 Ireland Montreal Heart Inst Montreal PQ H1T 1C8 Canada St James Hosp Dept Cardiol Dublin 8 Ireland

OBJECTIVES The study was done to determine the rule of partial agonist activity in the lack of effectiveness of the oral GPIIb/IIIa antagonist orbofiban. BACKGROUND Orbofiban, an oral GPIIb/IIIa antagonist, was found to increase the mortality of patients with acute coronary syndromes (ACS) in the OPUS-TIMI-16 trial, despite the fact that it is a very potent anti-platelet agent and that IV agents have proven very effective. METHODS Patients (n = 520) with ACS were randomized to orbofiban 30 mg, 40 mg or 50 mg twice daily or 50 mg once daily or placebo. Platelet activity was assessed in 175 patients by examining GPIIb/IIIa receptor conformation, expression of CD63 antigen, and platelet aggregation. RESULTS Plasma concentrations of orbofiban at the highest dose (74 +/- 6 ng/ml peak, 61 +/- 5 ng/ml trough) exceeded the ICS, for platelet aggregation to adenosine diphosphate (ADP) (29 +/- 6 ng/ml) and thrombin-activating peptide (61 +/- 18 ng/ml). Orbofiban induced a conformational change in GPIIb/IIIa detected as the displacement of the monoclonal antibody mAb2;such conformational changes have been linked to partial agonist activity. Consistent with this, platelet expression of CD63 ex vivo was significantly increased at five time points during the study. In vitro, orbofiban increased platelet aggregation to a submaximal concentration of epinephrine (67 +/- 19% vs. 27 +/- 9%, n = 5) and increased thromboxane formation when the platelet GPIIb/IIIa were clustered using monoclonal antibodies to the receptor. CONCLUSIONS Orbofiban is both an antagonist and a partial agonist of platelet GPIIb/IIIa. At low concentrations of the drug, this partial agonist activity may enhance platelet aggregation. Along with suboptimal plasma drug levels, these findings may help explain the lack of efficacy seen with orbofiban in patients with ACS. (C) 2000 by the American College of Cardiology.

关键词：急性病丙氨酸/药理学心绞痛不稳定型/血液心绞痛不稳定型/药物疗法心肌梗死/血液心肌梗死/药物疗法血小板活化/药物作用血小板聚集抑制剂/药理学血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂吡咯烷类/药理学老年人女(雌)性人类男(雄)性

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