Double-blind comparison of tolamolol,propranolol, practolol,and placebo in the treatment of angina pectoris.

Forty-two patients with angina pectoris have completed a randomized, double-blind trial comparing tolamolol 100 mg and 200 mg with propranolol 80 mg, practolol 100 mg, and placebo, all given three times a day. Tolamolol 200 mg thrice daily was found to be equivalent to propranolol 80 mg thrice daily in anti-anginal efficacy. Anginal attack rates and trinitrin consumption were significantly reduced by all active treatments as compared with the placebo but tolamolol and propranolol were the most effective. Tolamolol 200 mg thrice daily was most effective in reducing blood pressure, while propranolol was most effective in reducing the resting heart rate. All treatments except the placebo significantly increased the amount of exercise which could be performed before angina appeared (exercise work), while tolamolol 200 mg thrice daily significantly reduced Robinson''s index when compared with all other active agents. The degree of S-T segment depression induced by exercise was significantly lessened by both tolamolol and propranolol but not by practolol or placebo. There was no difference in patient preference between tolamolol and propranolol but tolamolol at both dose levels was preferred to practolol. Both tolamolol and propranolol are potent adrenergic beta-receptor antagonists and equal in anti-anginal efficacy but tolamolol has the advantage of being cardioselective. It is superior to practolol.     

心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛的临床研究

摘要 目的：探讨心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛的临床疗效。方法：按照随机数字表法将湖北民族大学附属民大医院和武汉市江夏区第一人民医院2019年4月-2021年9月间收治的98例老年冠心病心绞痛患者分为对照组（盐酸地尔硫卓片治疗,n=49）和观察组（心可舒片联合盐酸地尔硫卓片治疗,n=49）。观察两组疗效、心绞痛缓解情况、血脂指标、血管内皮功能指标、心功能指标、血液流变学指标和不良反应发生情况。结果：观察组的临床总有效率高于对照组（P<0.05）。治疗4周后,与对照组相比,观察组的心绞痛发作频率减少,全血黏度、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、内皮素-1（ET-1）、血浆比黏度、左室收缩末期内径（LVESD）、红细胞压积更低,一氧化氮（NO）、高密度脂蛋白胆固醇（HDL-C）、左心室射血分数（LVEF）、心排血量（CO）更高,心绞痛发作持续时间缩短（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛,可缓解心绞痛症状,改善血液流变学、心功能、血脂和血管内皮功能。     

Effect of partial agonist activity in beta blockers in severe angina pectoris: a double blind comparison of pindolol and atenolol.

The use of beta adrenoceptor blockade in the treatment of rest angina is controversial, and the effects on severe angina of partial agonist activity in beta blockers are unknown. Eight patients with effort angina and seven with effort and nocturnal angina and severe coronary artery disease were studied initially when they were not taking any antianginal drugs. Pindolol 5 mg thrice daily (with partial agonist activity) and atenolol 100 mg daily (without partial agonist activity) were given for five days each in a double blind randomised manner. Diaries of angina were kept and treadmill exercise testing and ambulatory ST monitoring performed during the last 48 hours of each period of treatment. Daytime and nocturnal resting heart rates and the frequency of angina were significantly reduced by atenolol compared with pindolol (p less than 0.01). The duration of exercise was significantly increased and the frequency, duration, and magnitude of daytime and nocturnal episodes of ST segment depression on ambulatory monitoring were reduced by atenolol. Reduction in resting heart rate is important in the treatment of both effort and nocturnal angina. Partial agonist activity in beta adrenoceptor antagonists may be deleterious in patients with severe angina pectoris.     

硝酸异山梨酯片联合美托洛尔治疗老年冠心病心绞痛的疗效及对IL-18及hs-CRP水平的影响．

目的：观察硝酸异山梨酯片联合美托洛尔治疗老年冠心病心绞痛的临床效果,观察联合用药对患者血浆白介素．18（Inter．1eukin,IL-18）、超敏C反应蛋白（HighsensitivityCreactiveprotein,hs—CRP）的影响。方法：选择本院收治的老年冠心病心绞痛患者84例,随机分为研究组和对照组,各42例,研究组给予硝酸异山梨酯片20mg,3次／d,口服,美托洛尔12．5mg,1次／d,口服;对照组仅给予硝酸异山梨酯片20mg,3次／d,口服,疗程均为28d。观察两组用药后心绞痛改善情况,并观察两组治疗前后血清IL-8、hs-CRP变化。结果：治疗后,研究组总有效率为90．5％;对照组总有效率为69．0％,研究组总有效率明显高于对照组（P〈0．01）。治疗后两组心率、心绞痛发作频率明显降低,持续时间明显缩短（P〈0．05）;研究组心率、心绞痛发作频率明显低于对照组,持续时间也较对照组短（P〈0．05）。治疗前两组血浆IL-18、hs-CRP水平比较无统计学差异（P〉0．05）;治疗后研究组IL．18、hs．CRP水平明显低于对照组（P〈O．05）。结论：硝酸异山梨酯片联合美托洛尔治疗老年冠心病心绞痛能够进一步减轻患者IL．18、hs．CRP水平,对心绞痛治疗效果较单独应用酸异山梨酯片更佳。     

心可舒胶囊联合氯吡格雷对冠心病心绞痛患者血管内皮功能、血液流变学及炎症因子的影响

摘要 目的：观察心可舒胶囊联合氯吡格雷对冠心病心绞痛患者血管内皮功能、血液流变学及炎症因子的影响。方法：选取2020年3月~2021年10月期间中国人民解放军东部战区总医院收治的92例冠心病心绞痛患者。按照信封抽签法分为对照组（46例）和观察组（46例）。对照组患者接受氯吡格雷治疗,观察组接受心可舒胶囊联合氯吡格雷治疗,对比两组疗效、血管内皮功能、血液流变学、炎症因子、心绞痛发作频率、硝酸甘油用量、心绞痛发作持续时间及不良反应。结果：与对照组相比,观察组治疗1个月后的临床总有效率更高（P<0.05）。与对照组相比,观察组治疗1个月后全血黏度、血浆比黏度、红细胞聚集指数更低（P<0.05）。与对照组相比,观察组治疗1个月后内皮素-1（ET-1）更低,一氧化氮（NO）更高（P<0.05）。与对照组相比,观察组治疗1个月后白介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、单核细胞趋化蛋白-1（MCP-1）更低（P<0.05）。与对照组相比,观察组治疗1个月后心绞痛发作频率、硝酸甘油用量更少,心绞痛发作持续时间更短（P<0.05）。两组不良反应发生率组间对比无统计学差异（P>0.05）。结论：心可舒胶囊联合氯吡格雷可改善冠心病心绞痛患者临床症状,改善血管内皮功能和血液流变学,降低炎症因子水平,效果显著。     

运动康复训练对冠心病多支病变患者运动耐量及血脂的影响

目的:探讨运动康复训练对冠心病多支病变患者活动耐量及血脂的影响。方法:选取冠心病多支病变患者,所有患者均进行不完全血运重建术,分为运动康复训练组及对照组,运动康复训练组自术后第三日起治疗组进行运动康复训练,对照组对运动量无要求。3月后,测量两组患者血脂水平及6分钟步行试验,比较两组患者步行距离、心绞痛发作次数、运动至心绞痛出现时间、6分钟内累积运动时间及血脂水平。结果:经运动康复训练治疗3月后,治疗组6分钟步行距离、运动至心绞痛出现时间及运动累积时间较对照组均明显增加,发生心绞痛次数较对照组明显减少。运动康复训练组治疗后甘油三酯、总胆固醇及低密度脂蛋白水平较治疗前明显降低,对照组仅总胆固醇有所降低,甘油三酯及低密度脂蛋白水平较治疗前无统计学差异。结论:运动康复训练可减少冠心病多支病变患者心绞痛发作次数,增加患者运动耐量并调节血脂代谢。     

Lipoproteins and diet in coronary heart disease; a five-year study

In a follow-up study for a five-year period of 351 patients with myocardial infarction and 119 patients with angina pectoris, the following observations were made:(a) The previously reported lipoprotein atherogenic index elevation in coronary heart disease was confirmed.(b) The prognosis in angina pectoris is strikingly and significantly worse when the lipoprotein atherogenic index is high.(c) Patients who died in the follow-up period showed significantly higher atherogenic index values than those who survived.(d) The lipoprotein atherogenic index measure is much superior to the serum cholesterol measurement as an indicator of the lipid disorder in coronary disease.(e) The low fat, low cholesterol diet is effective in maintaining chronically lowered lipoprotein atherogenic index values.(f) In patients who said they did not adhere to a low fat, low cholesterol diet, the recurrence and death rate was four times as high as in patients who stated they adhered to the diet.     

LIPOPROTEINS AND DIET IN CORONARY HEART DISEASE—A Five-Year Study

In a follow-up study for a five-year period of 351 patients with myocardial infarction and 119 patients with angina pectoris, the following observations were made:(a) The previously reported lipoprotein atherogenic index elevation in coronary heart disease was confirmed.(b) The prognosis in angina pectoris is strikingly and significantly worse when the lipoprotein atherogenic index is high.(c) Patients who died in the follow-up period showed significantly higher atherogenic index values than those who survived.(d) The lipoprotein atherogenic index measure is much superior to the serum cholesterol measurement as an indicator of the lipid disorder in coronary disease.(e) The low fat, low cholesterol diet is effective in maintaining chronically lowered lipoprotein atherogenic index values.(f) In patients who said they did not adhere to a low fat, low cholesterol diet, the recurrence and death rate was four times as high as in patients who stated they adhered to the diet.     

川芎嗪注射液对冠心病心绞痛患者临床症状及血液流变学的影响

目的:探讨川芎嗪注射液对冠心病(CHD)心绞痛患者临床症状及血液流变学的影响。方法:选择2014年3月至2016年3月在我院进行治疗的CHD心绞痛患者60例,按随机数字表法分为实验组和对照组各30例,对照组患者给予常规治疗,实验组患者在常规治疗基础上加用川芎嗪注射液治疗,两组患者均治疗20 d,比较两组患者临床疗效及治疗前后心绞痛症状、血液流变学指标和血脂指标。结果:实验组治疗后的总有效率高于对照组(P0.05)。两组治疗后心绞痛发作次数、发作时长均减少,且实验组少于对照组(P0.05)。治疗后,两组的全血黏度、血浆黏度、红细胞聚集指数、纤维蛋白原(Fib)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均低于治疗前,且实验组低于对照组,(P0.05)。结论:川芎嗪在治疗CHD心绞痛方面具有显著的疗效,不仅能够有效改善患者心绞痛症状,还能改善血液流变学异常情况,因此值得临床推广使用。     

心通口服液联合美托洛尔对冠心病心绞痛患者血管内皮功能、心肌损伤指标和血清MMP-2、MMP-7、MMP-8、MMP-9的影响

摘要 目的：观察心通口服液联合美托洛尔对冠心病心绞痛患者血管内皮功能、心肌损伤指标和血清基质金属蛋白酶（MMP）-2、MMP-7、MMP-8、MMP-9的影响。方法：按照随机数字表法,将我院2021年1月~2022年5月期间收治的72例冠心病心绞痛患者分为对照组（n=36）和研究组（n=36）。在常规治疗的基础上,对照组患者接受美托洛尔治疗,研究组患者接受心通口服液联合美托洛尔治疗。对比两组疗效、不良反应发生率、心功能指标[左室射血分数（LVEF）、心输出量（CO）]、临床指标（心绞痛发作次数、每次发作持续时间、含服硝酸异山梨酯片剂量）、血管内皮功能指标[一氧化氮（NO）、血管内皮生长因子（VEGF）、6-酮前列素 F1a（6-keto-PGF1a）]、心肌损伤指标[心肌肌钙蛋白I（cTnI）、脑钠肽（BNP）、肌酸激酶同工酶（CK-MB）]和血清MMP-2、MMP-7、MMP-8、MMP-9水平。结果：研究组的临床治疗总有效率（94.44%）高于对照组（75.00%）（P<0.05）。治疗2周后,研究组LVEF、CO高于对照组（P<0.05）。治疗2周后,研究组含服硝酸异山梨酯片剂量、心绞痛发作次数少于对照组,每次发作持续时间短于对照组（P<0.05）。治疗2周后,研究组NO、VEGF、6-keto-PGF1a高于对照组（P<0.05）。治疗2周后,研究组血清MMP-2、MMP-7、MMP-8、MMP-9水平低于对照组（P<0.05）。治疗2周后,研究组CK-MB、BNP、cTnI低于对照组（P<0.05）。两组不良反应发生率对比未见明显差异（P>0.05）。结论：心通口服液联合美托洛尔治疗冠心病心绞痛患者,可改善临床症状,改善机体血管内皮功能、心肌损伤指标、心功能和血清MMP-2、MMP-7、MMP-8、MMP-9水平。     

经桡动脉心导管术诊断和治疗冠状动脉疾病的临床研究

目的:观察经桡动脉介入诊治冠心病的安全性和有效性。方法:对1503例患者进行了经桡动脉途径介入诊治,其中包括心绞痛患者1218例,心梗患者268例,二尖瓣和/或动脉瓣手术前对冠状动脉进行解剖学评估17例,观察患者手术安全性、成功率以及与经桡动脉手术相关的并发症发病率。结果:介入治疗成功率为93.1%(1400/1503),手术失败的主要原因为桡动脉穿刺失败(39例),严重桡动脉痉挛(42例),右锁骨下动脉不同程度的弯曲(18例),近端严重狭窄(14例)。术后有14例患者出现严重并发症(瞬时缺血性病变),60例出现有症状的窦性心动过缓,43例出现静脉血栓,77例出现血肿,88例出现桡动脉梗阻。结论:经桡动脉途径是一种安全、有效、患者更容易接受的冠心病介入诊治方法。     

Availability of glucose given orally during exercise

The present study was designed to determine whether daily exercise alters adrenergic and muscarinic neural control of coronary blood flow during resting and exercising conditions in the conscious dog. Mean left circumflex artery blood flow (CBF), mean coronary blood pressure, and heart rate were measured during resting conditions (55 +/- 9 ml/min, 108 +/- 6 mmHg, and 93 +/- 2 beats/min, respectively) and during submaximal exercise (85 +/- 9 ml/min, 108 +/- 7 mmHg, and 210 +/- 15 beats/min). Injection of phentolamine into the left circumflex coronary artery during treadmill exercise resulted in a 10 +/- 1% increase in CBF before training (untrained, UT) and a 21 +/- 6% increase after 4-5 wk of daily exercise (partially trained, PT) (P less than 0.02 UT vs. PT). Intracoronary atenolol or propranolol caused a 15 +/- 6% reduction in CBF during exercise in dogs before and after PT. While the dogs were lying quietly at rest intracoronary injections of norepinephrine initially increased CBF 85%, followed by a prolonged 19 +/- 9% decrease in CBF. CBF decreased 16 +/- 3% after intracoronary injection of phenylephrine. After PT the coronary vasoconstriction following norepinephrine and phenylephrine injections was significantly potentiated (31 +/- 6 and 35 +/- 4%, respectively). These data suggest that exercise training caused significant changes in the coronary vascular response to alpha-receptor stimulation so that an alteration in the neural control of the coronary circulation occurred.     

芪红汤联合美托洛尔对冠心病心绞痛气虚血瘀型患者血浆ET、hs-CRP、NT-proBNP水平的影响

目的:探讨芪红汤联合美托洛尔对冠心病心绞痛气虚血瘀型患者血浆内皮素(ET)、超敏C反应蛋白(hs-CRP)、氨基末端B型脑利钠肽原(NT-proBNP)水平的影响。方法:选择我院2014年6月~2016年6月收治的98例冠心病心绞痛气虚血瘀型患者,按治疗方式分为对照组与研究组,每组49例。对照组选用美托络尔治疗,研究组在美托络尔基础上联合芪红汤治疗,两组均持续治疗1个月。观察和比较两组的临床疗效,治疗前后症状积分、血浆ET、hs-CRP、NT-proBNP、左室射血分数(LVEF)、6 min步行试验、心绞痛持续时间、发作频率及心脏不良事件的发生情况。结果:治疗后,研究组总有效率显著高于对照组(P0.05),两组症状积分、ET、hs-CRP、NT-proBNP、心绞痛持续时间、发作频率均较治疗前显著降低(P0.05),且研究组以上指标均显著低于对照组(P0.05);两组LVEF、6-WMT均较治疗前上升(P0.05),且研究组以上指标均明显高于对照组(P0.05)。研究组心脏不良事件发生率显著低于对照组(P0.05)。结论:芪红汤联合美托络尔治疗冠心病心绞痛气虚血瘀型患者的临床效果肯定,能够有效降低患者血浆ET、hs-CRP、NT-proBNP水平。     

参芍片联合酒石酸美托洛尔片对冠心病心绞痛患者氧化应激、血管内皮功能和心肌损伤标志物的影响

摘要 目的：探讨参芍片联合酒石酸美托洛尔片对冠心病心绞痛患者氧化应激、血管内皮功能和心肌损伤标志物的影响。方法：病例选取自我院2018年9月~2021年7月期间收治的110例冠心病心绞痛患者,按照入院的奇偶顺序将患者分为对照组（55例）和观察组（55例）,对照组患者接受酒石酸美托洛尔片治疗,观察组患者接受参芍片联合酒石酸美托洛尔片治疗,观察两组临床总有效率、心电图总有效率,对比两组临床症状、氧化应激[超氧化物歧化酶（SOD）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-PX）]、血管内皮功能[内皮素（ET）、血管内皮生长因子（VEGF）、一氧化氮（NO）]和心肌损伤标志物[心肌肌钙蛋白（cTn）、肌酸激酶同工酶（CK-MB）、脑钠肽（BNP）]水平变化,记录两组用药的不良反应发生率。结果：与对照组相比,观察组的临床总有效率、心电图总有效率进一步升高（P<0.05）。观察组治疗12周后心绞痛发作次数较对照组少,心绞痛持续时间较对照组短,6 min步行试验距离长于对照组（P<0.05）。治疗12周后,观察组VEGF、ET水平低于对照组,NO水平高于对照组（P<0.05）。治疗12周后,观察组CK-MB、cTn、BNP水平低于对照组（P<0.05）。治疗12周后,观察组MDA水平低于对照组,SOD、GSH-PX水平高于对照组（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。结论：参芍片联合酒石酸美托洛尔片治疗冠心病心绞痛患者,可促进症状改善,减轻机体氧化应激和血管内皮损伤,发挥较好的心肌保护作用。     

冠心病患者血清尿酸、高敏C 反应蛋白、纤维蛋白原水平变化 的临床研究

目的:观察冠心病患者血清中尿酸、高敏C反应蛋白、纤维蛋白原水平的变化.方法:选取2010年11月至2011年11月于我院就诊的68例冠心病患者(稳定型心绞痛21例,不稳定型心绞痛24例,急性心肌梗死13例)作为研究对象,并选取同期于我院体检中心体检的62例健康人为对照组,检测受试者血清中尿酸、高敏C反应蛋白、纤维蛋白原的水平.结果:研究组患者血清中UA、CRP和FBG水平显著高于对照组(P＜0.05).与稳定型心绞痛组比,不稳定型心绞痛的CRP水平增高(5.34±1.98 mg/L vs.11.36±2.73 mg/L,P＜0.05),急性心肌梗死组的UA (345.63±86.4 μmol/L vs.493.76±101.2 μmol/L,P＜0.05)、CRP (5.34±1.98mg/L vs.21.3±2.24 mg/L,P＜0.05)和FBG(3.86±1.34 g/L vs.6.85±2.36 g/L,P＜0.05)水平显著增高,与不稳定型心绞痛组比,急性心肌梗死组的UA(378.91±89.7 μmol/L vs.493.76±101.2 μmol/L,P＜0.05)、CRP(11.36±2.73 mg/L vs.21.3±2.24 mg/L,P＜0.05)和FBG(4.27±2.08 g/L vs.6.85±2.36 g/L,P＜0.05)水平显著增高(P＜0.05).结论:冠心病患者血清中尿酸、高敏C反应蛋白和纤维蛋白原的水平升高,3个指标可用于评估治疗效果和预后.     

Comparison of Adrenergic Beta-blocking Drugs in Angina Pectoris

The symptomatic, electrocardiographic, and haemodynamic effects of two adrenergic beta-blocking drugs, oxprenolol and propranolol, have been compared in equipotent intravenous doses in six patients with uncomplicated angina pectoris during treadmill exercise. The method of comparison included double-blind assessment and analysis with placebo control and randomized serial comparison in each patient. Both drugs produced an equal amelioration in symptoms in most of the patients. This was closely correlated with improvement in the electrocardiographic changes and a significant reduction in the exercising heart rate and systemic arterial pressure. This method of double-blind combined subjective and objective assessment carries distinct advantages in the comparative assessment of drug treatments in angina pectoris.     

Preoperative prediction of significant coronary artery disease in patients with valvular heart disease.

A prognostic index for predicting significant coronary artery disease was established using multiple logistic regression analysis of clinical data from 643 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement. The index or equation obtained incorporated the presence of angina, a family history of ischaemic heart disease, age, cigarette smoking habits, mitral valve disease, sex, and electrocardiographic evidence of myocardial infarction. The equation was validated using prospective data from 387 patients with valvular disease and shown to enable almost a third of routine coronary arteriograms to be omitted while maintaining 95% sensitivity for patients with coronary artery disease. Similar analysis of the more detailed prospective data produced a second discriminant function incorporating diastolic blood pressure, total cigarettes smoked in life, the severity of angina, family history of ischaemic heart disease, age, current cigarette smoking habits, and the ratio of total to high density lipoprotein cholesterol. This method improved the discrimination between patients with and without coronary artery disease, allowing omission of 30% of routine coronary arteriograms with 100% sensitivity for patients with coronary disease and omission of 41% with a 96% sensitivity level.     

辅酶Q10联合替格瑞洛治疗冠心病不稳定型心绞痛疗效及对冠脉血流参数的影响

摘要 目的：探讨辅酶Q10联合替格瑞洛治疗冠心病不稳定型心绞痛疗效及对冠脉血流参数的影响。方法：选取我院2020年10月到2022年10月收治的128例冠心病不稳定型心绞痛患者作为研究对象,分为观察组与对照组,每组64例,对照组患者采取常规西医治疗,观察组在对照组基础上增加辅酶Q10联合替格瑞洛治疗,对比两组患者临床治疗效果,并应用视觉模拟疼痛量表（VAS）评定两组患者心绞痛疼痛情况,并对比其每日发作频率、每次持续时间、每日硝酸甘油用量,分别对两组患者治疗前与治疗后的心功能指标和冠脉血流参数。结果：观察组治疗总有效率高于对照组（P<0.05）;观察组疼痛评分、每日发作频率、每次持续时间、每日硝酸甘油用量均明显低于对照组（P＜0.05）;治疗前两组患者6分钟步行距离、LVEF、BNP对比无差异（P＞0.05）,治疗后两组患者6分钟步行距离、LVEF均升高,且观察组较对照组高,BNP水平降低,观察组低于对照组（P＜0.05）;治疗前两组患者舒张期时间速度积分、左前降支收缩期峰值流速、左前降支舒张期峰值流速、冠脉血流速度储备值对比无明显差异（P＞0.05）,治疗后两组患者舒张期时间速度积分、左前降支收缩期峰值流速、左前降支舒张期峰值流速、冠脉血流速度储备值均升高,且观察组高于对照组（P＜0.05）。结论：辅酶Q10联合替格瑞洛治疗冠心病不稳定型心绞痛疗效显著,可减少患者心绞痛疼痛程度,减少发作频率、持续时间和硝酸甘油用量,提升患者心功能水平,改善冠脉血流参数,值得临床应用推广。     

氯吡格雷联合阿司匹林对冠心病心绞痛患者血清hs-CRP, TNF-alpha 及IL-6 水平的影响

目的：探讨氯吡格雷与阿司匹林对冠心病心绞痛患者血清炎症因子水平的影响及其临床疗效。方法：选择2014 年3月-2016 年3 月在我院确诊为冠心病心绞痛患者69 例作为研究对象,根据治疗方法不同,将患者随机分成研究组（39 例）和对照组（30 例）。对照组患者采用阿司匹林治疗,研究组患者在此基础上联合使用氯吡格雷治疗。观察并比较两组患者治疗前后血清高敏C- 反应蛋白(high-sensitivity C-reactive protein, hs-CRP)、肿瘤坏死因子-alpha（tumor necrosis factor-alpha, TNF-alpha）及白细胞介素-6 (interleukin-6, IL-6)水平的变化情况,以及临床疗效。结果：治疗前两组患者血清hs-CRP,IL-6 及TNF-alpha水平比较,差异无统计学 意义（P>0.05）;治疗后两组患者血清hs-CRP,IL-6 及TNF-alpha水平均低于治疗前,且研究组低于对照组,差异具有统计学意义（P<0. 05）。研究组患者临床总有效率（94.7%）高于对照组（88.9%）,差异具有统计学意义（P<0.05）。结论：氯吡格雷联合阿司匹林治疗冠 心病心绞痛的临床效果显著,能够降低患者血清hs-CRP,IL-6 及TNF-alpha炎症因子水平,值得临床推广应用。     

New Trends in the Treatment of Angina Pectoris

Traditionally when considering the pharmacologic basis of therapy in angina pectoris, attention is focussed on alterations of coronary blood flow. Yet the diseased coronary arteries in these patients often do not appear to be capable of responding to vasodilatory drugs. Since the pain of myocardial ischemia is relieved by a number of interventions without an increase in coronary blood flow, the concept herein considered is that angina pector is best viewed as an unfavorable relation between myocardial oxygen requirements and availability. Thus, the clinical value of the major antianginal agents is thought to be based importantly upon their actions to reduce myocardial oxygen consumption rather than to increase coronary blood flow.Sublingual nitroglycerin possesses a powerful dilator effect on veins which reduces venous return and thereby the size of the heart and intra-myocardial tension; thus myocardial oxygen requirements are diminished.The beta-adrenergic receptor blocking drug, propranolol (Inderal®), inhibits sympathetic stimulation of the heart at rest and during exercise. Thus, myocardial oxygen requirements are diminished by the reduction in heart rate and diminished contractility. As a result of this latter action, cardiac output is reduced and thereby arterial pressure and intramyocardial tension is lowered. In patients with advanced heart disease and borderline cardiac compensation, propranolol is hazardous because it removes the availability of one of the important reserve mechanisms for maintaining cardiac compensation—the sympathetic support of the failing heart.The introduction of electrical stimulation of the carotid sinus nerves as a means of therapy in patients with angina pectoris has provided a powerful tool for the treatment of patients with refractory ischemic pain.