王永进. 伊伐布雷定对冠心病患者心率降低和内皮功能改善状况的影响[J]. 心脏杂志, 2019, 31(5): 534-538. DOI: 10.12125/j.chj.201905061
    引用本文: 王永进. 伊伐布雷定对冠心病患者心率降低和内皮功能改善状况的影响[J]. 心脏杂志, 2019, 31(5): 534-538. DOI: 10.12125/j.chj.201905061
    Yong-jin WANG. Effects of ivabrine on heart rate reduction and endothelial function improvement in patients with coronary heart disease[J]. Chinese Heart Journal, 2019, 31(5): 534-538. DOI: 10.12125/j.chj.201905061
    Citation: Yong-jin WANG. Effects of ivabrine on heart rate reduction and endothelial function improvement in patients with coronary heart disease[J]. Chinese Heart Journal, 2019, 31(5): 534-538. DOI: 10.12125/j.chj.201905061

    伊伐布雷定对冠心病患者心率降低和内皮功能改善状况的影响

    Effects of ivabrine on heart rate reduction and endothelial function improvement in patients with coronary heart disease

    • 摘要:
        目的  评估伊伐布雷定对冠状动脉疾病(CAD)患者经皮冠状动脉介入(PCI)术完整的血运重建后内皮功能和心率的影响。
        方法  将161例经PCI术30 d之后的患者随机分为伊伐布雷定组(试药组)和对照组(T0),试药组患者每天接受2次4 mg伊伐布雷定治疗,对照组服用标准药物,持续4周(T1),4周后针对静息心率(HR) > 60次/min的患者,伊伐布雷定剂量调整至每日两次每次7.5 mg,再继续4周(T2)。通过血流介导的内皮依赖性血管扩张值(FMD)和硝酸甘油介导的内皮非依赖性血管扩张值(NMD)测定以上试验过程中肱动脉反应性。
        结果  在T0时,伊伐布雷定试药组和对照组之间静息HR值(67 ± 6)次/min vs(68 ± 6)次/min,FMD(9 ± 4)% vs(8 ± 6)%和NMD(13 ± 7)% vs(13 ± 6)%,差异均无统计学意义。研究期间,试药组观察到HR显著降低T1时(65 ± 6)次/min,T2时为(62 ± 5)次/min; P < 0.01)、FMD值T1时(12 ± 6)%,T2为(15 ± 8)%;P < 0.01)和NMD(T1时为(16 ± 10)%,T2时(17 ± 9)%;P < 0.01)的改善,而对照组未观察到显著变化。试药组,从T1到T3时间段内观察,HR的变化和FMD的变化之间呈中度负相关(r = −0.426; P < 0.01)。
        结论  CAD患者通过PCI进行完整的血运重建后,在标准治疗药物中加入伊伐布雷定能显著改善内皮功能,这种改变可能与HR降低有关。

       

      Abstract:
        AIM  To evaluate the effect of ivabradine on endothelial functions in patients with coronary artery disease (CAD) after complete revascularization with percutaneous coronary angioplasty (PCI).
        METHODS  One hundred and sixty-one patients at least 30 days after PCI were randomized (T0) to receive ivabradine 4 mg twice daily (ivabradine group, n =81) or standard medical therapy (control group, n = 80). After 4 weeks (T1), ivabradine dose was adjusted up to 7.5 mg twice daily in patients with heart rate (HR) at rest 60 bpm and thereafter continued for additional 4 weeks (T2). At all times, brachial artery reactivity was assessed by flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD).
        RESULTS  No significant differences were observed at T0 between ivabradine group and control group in terms of HR (67 ± 6) vs. (68 ± 6) 1/min, FMD (9 ± 4) vs. (8 ± 6)% and NMD (13 ± 7) vs. (13 ± 6)%. Over the study period, a significant reduction of HR (65 ± 6) 1/min at T1, (62 ± 5) 1/min at T2; P < 0.01 and improvement of FMD (12 ± 6) % at T1, (15 ± 8) % at T2; P < 0.01 and NMD (16 ± 10) at T1, (17 ± 9) at T2; P < 0.01 were observed in ivabradine group, while no significant changes were observed in control group. In ivabradine group, a moderate negative correlation was observed between HR variation and FMD variation from T1 to T3 (r = −0.426; P = 0.003).
        CONCLUSIONS  In CAD patients undergoing complete revascularization with PCI, ivabradine added to the standard medical therapy produces a significant improvement in endothelial functions. This effect seems to be related to HR reduction.

       

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