作者：边亚1，刘广阔2，郭洁1，陈晋波1，吕小棉1

单位：

1.050051河北省石家庄市第二医院心血管内科　2.050051河北省石家庄市，河北省人民医院消化内科

Units：

1.Department of Cardiology, Shijiazhuang Second Hospital, Shijiazhuang 050051, China2.Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050051, China

关键词：

糖尿病，2型；冠状动脉疾病；冠状动脉多支病变；心绞痛；尼可地尔；治疗效果；炎症

Keywords：

Diabetes mellitus, type 2; Coronary artery disease; Multiple coronary artery lesions; Angnia pectoris;Nicorandil; Treatment outcome; Inflammation

CLC：

R 587.1　R 541.4

DOI：

10.12114/j.issn.1008-5971.2022.00.245

Funds：

河北省卫生和计划生育委员会科研基金（20201345）

摘要：

目的　探究尼可地尔对老年2型糖尿病（T2DM）合并冠状动脉多支病变患者心绞痛的治疗效果和炎症因子的影响。方法　选取2017年6月至2020年9月石家庄市第二医院收治的老年T2DM合并冠状动脉多支病变患者84例，采用简单随机方法分为对照组和试验组，每组42例。两组入院后均接受糖尿病健康教育，采用统一降糖方案，在上述治疗方案基础上对照组采取常规治疗，试验组在对照组基础上口服尼可地尔。两组连续治疗6个月。比较两组心绞痛疗效、治疗前及治疗3、6个月后心绞痛相关指标（心绞痛发作次数、心绞痛持续时间、硝酸甘油用量）、心功能指标〔左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、脑钠肽（BNP）〕、炎症因子〔超敏C反应蛋白（hs-CRP）、可溶性细胞间黏附分子1（sICAM-1）、人软骨糖蛋白-39（YKL-40）〕及不良反应、主要不良心血管事件（MACE）发生率。结果　试验组心绞痛疗效优于对照组（P ＜0.05）。治疗方法与时间在心绞痛发作次数、心绞痛持续时间、硝酸甘油用量、LVEF、LVEDD、LVESD、BNP、hs-CRP、sICAM-1、YKL-40上存在交互作用（P ＜0.05）；治疗方法、时间在心绞痛发作次数、心绞痛持续时间、硝酸甘油用量、LVEF、LVEDD、LVESD、BNP、hs-CRP、sICAM-1、YKL-40上主效应均显著（P ＜0.05）；两组治疗3、6个月后心绞痛发作次数、硝酸甘油用量、LVEDD、LVESD、BNP、hs-CRP、sICAM-1、YKL-40分别小于本组治疗前，心绞痛持续时间分别短于本组治疗前，LVEF分别大于本组治疗前，治疗6个月后心绞痛发作次数、硝酸甘油用量、LVEDD、LVESD、BNP、hs-CRP、sICAM-1、YKL-40分别小于本组治疗3个月后，心绞痛持续时间分别短于本组治疗3个月后，LVEF分别大于本组治疗3个月后，且试验组治疗3、6个月后心绞痛发作次数、硝酸甘油用量、LVEDD、LVESD、BNP、hs-CRP、sICAM-1、YKL-40小于对照组，心绞痛持续时间短于对照组，LVEF大于对照组（P ＜0.05）。两组不良反应、MACE总发生率比较，差异无统计学意义（P ＞0.05）。结论　尼可地尔可提高老年T2DM合并冠状动脉多支病变患者心绞痛治疗效果，改善心功能，下调炎症因子表达，且安全性高。

Abstract：

Objective　To investigate the effect of nicorandil on efficacy of angina pectoris and inflammatory factorsin elderly patients with type 2 diabetes mellitus (T2DM) combined with multiple coronary artery lesions. Methods　A total of 84elderly patients with T2DM combined with multiple coronary artery lesions admitted to the Shijiazhuang Second Hospital fromJune 2017 to September 2020 were selected and divided into control group and experimental group by simple random method, with42 cases in each group. After admission, both groups received diabetes education and adopted a unified hypoglycemic plan. Underthe above treatment plan, the control group received routine treatment, while the experimental group received oral nicorandil onthe basis of the control group. Both groups were continuously treated for 6 months. Angina pectoris efficacy, related indexes ofangina pectoris (number and duration of angina pectoris attacks, dosage of nitroglycerin) , cardiac function indexes [left ventricularejection fraction (LVEF) , left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic dimension (LVESD) ,brain natriuretic peptide (BNP) ] , inflammatory factors [hypersensitive C-reactive protein (hs-CRP) , soluble intercellular adhesionmolecule-1 (sICAM-1) , human cartilage glycoprotein 39 (YKL-40) ] before treatment and after 3 and 6 months of treatmentand incidence of adverse reactions and major adverse cardiovascular events (MACE) were compared between the two groups.Results　The curative effect of angina pectoris of the experimental group was better than that of the control group (P < 0.05) .There was an interaction between treatment method and time on the number of angina pectoris attacks, the duration of anginapectoris attacks, the dosage of nitroglycerin, LVEF, LVEDD, LVESD, BNP, hs-CRP, sICAM-1 and YKL-40 (P < 0.05) . The maineffects of treatment method and time on the number of angina pectoris attacks, the duration of angina pectoris attacks, the dosageof nitroglycerin, LVEF, LVEDD, LVESD, BNP, hs-CRP, sICAM-1 and YKL-40 were all significant (P < 0.05) . After 3 and 6months of treatment in the two groups, the number of angina pectoris attacks, the dosage of nitroglycerin, LVEDD, LVESD, BNP,hs-CRP, sICAM-1 and YKL-40 were less than those before treatment, the duration of angina pectoris attacks was shorter thanthat before treatment, and LVEF was greater than that before treatment, respectively (P < 0.05) . In the two groups, the numberof angina pectoris attacks, the dosage of nitroglycerin, LVEDD, LVESD, BNP, hs-CRP, sICAM-1 and YKL-40 after 6 monthsof treatment were less than those after 3 months of treatment, the duration of angina pectoris attacks was shorter than that after 3months of treatment, and LVEF was greater than that after 3 months of treatment, respectively (P < 0.05) . The number of anginapectoris attacks, the dosage of nitroglycerin, LVEDD, LVESD, BNP, hs-CRP, sICAM-1 and YKL-40 in the experimental groupafter 3 and 6 months of treatment were lower than those in the control group, the duration of angina pectoris attacks was shorterthan that in the control group, and LVEF was greater than that in the control group (P < 0.05) . There was no significant differencein the incidence of adverse reactions and MACE between the two groups (P > 0.05) . Conclusion　Nicorandil can improve thetreatment effect of angina pectoris, improve cardiac function, down-regulate the expression of inflammatory factors in elderlypatients with T2DM complicated with coronary multivessel disease, and has high safety.

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