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目的探讨体外心脏震波治疗系统(CSWT)治疗冠心病的安全性及疗效。方法将45例冠心病患者随机分为震波治疗组(予CSWT治疗,n=25)及对照组(不予震波治疗,n=20)。3个月为1个震波治疗周期,共行9次震波治疗。震波治疗组患者检测时间点为震波治疗前(0个月)、9次震波治疗结束时(3个月)、随访6个月时(6个月),对照组的相应检测时间点分别为入选时、随访3个月时、随访6个月时。两组患者分别在上述时间点行99 Tcm-甲氧基异丁基异腈(99 Tcm-MIBI)及18 F-氟脱氧葡萄糖(18F-FDG)双核素单光子发射型计算机断层成像(SPECT)心肌显像检查及微伏级T波电交替(MTWA)检查,评估加拿大心血管学会(CCS)心绞痛分级、纽约心脏协会(NYHA)心功能分级、西雅图心绞痛量表(SAQ)评分、6min步行距离(6MWT)、左心室射血分数(LVEF)。临床随访不少于6个月,比较两组患者的病死率、心肌再梗死率、再住院率、心肌灌注、心肌代谢及心功能的变化。结果 45例患者均完成随访。震波治疗组患者在3个月、6个月时的心肌灌注及代谢、NYHA心功能分级、CCS心绞痛分级、硝酸甘油用量、SAQ评分、6MWT、LVEF、MTWA均比0个月时明显改善(P<0.05),且上述指标均比同期对照组明显改善(P<0.05)。震波治疗组患者治疗后无死亡、无心肌再梗死发生。结论 CSWT是一项无创、安全、有效的新型血管再生疗法,可作为冠心病治疗的选择。
Objective To investigate the safety and efficacy of extracorporeal cardiac shock therapy (CSWT) in the treatment of coronary heart disease. Methods 45 patients with coronary heart disease were randomly divided into shock wave treatment group (CSWT treatment, n = 25) and control group (no shock wave treatment, n = 20). 3 months for a shock treatment cycle, a total of 9 shock wave treatment. The time points of the patients in the shock wave treatment group were before the shock wave treatment (0 months), the end of the 9 shock waves (3 months), the follow-up 6 months (6 months), the corresponding detection time point of the control group At 3 months follow-up, 6 months follow-up. Two groups of patients underwent 99 Tcm-99 Tcm-MIBI and 18 F-FDG-FDG single photon emission computed tomography (SPECT) myocardial perfusion at the above time points (CCWA) angina grading, New York Heart Association (NYHA) cardiac function classification, Seattle angina pectoris scale (SAQ) score, 6min walking distance (6MWT) ), Left ventricular ejection fraction (LVEF). Clinical follow-up of not less than 6 months, compared two groups of patients mortality, myocardial infarction rate, rehospitalization rate, myocardial perfusion, myocardial metabolism and cardiac function changes. Results All the 45 patients were followed up. At 3 months and 6 months, the myocardial perfusion and metabolism, NYHA functional class, CCS angina grade, nitroglycerin dosage, SAQ score, 6MWT, LVEF and MTWA in sham-treated group were significantly improved than those in 0-month <0.05), and the above indicators were significantly improved over the same period control group (P <0.05). Shock wave treatment group patients without death after treatment, no myocardial infarction occurred. Conclusion CSWT is a noninvasive, safe and effective new revascularization therapy, which can be used as the treatment of coronary heart disease.