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目的观察应用依那普利与地尔硫卓治疗心脏X综合征(CSX)患者的疗效。方法将43例心脏X综合征患者随机接受依那普利(21例,依那普利组)或地尔硫卓(22例,地尔硫卓组)治疗,随访治疗3个月后的临床情况并复查平板运动试验、冠状动脉血流储备(CFR)及一氧化氮(NO)、血浆内皮素-1(ET-1)的含量。结果与本组治疗前比较,用药3个月后两组胸痛例数及最大ST段压低幅度明显减少,ET-1水平明显下降,CFR及NO的水平明显升高,运动总时间、ST段压低1mm时间明显延长(P<0.01或P<0.05)。与地尔硫卓组相比,依那普利组胸痛例数及最大ST段压低幅度明显减少(均为P<0.05),ET-1水平明显下降(P<0.01),CFR及NO的水平明显升高(均为P<0.05),运动总时间、ST段压低1mm时间明显延长(P<0·01,P<0.05)。结论依那普利与地尔硫卓均能改善CSX患者的内皮细胞功能提高患者的运动耐量及CFR,且依那普利较地尔硫卓更为有效。
Objective To observe the efficacy of enalapril and diltiazem in the treatment of patients with cardiac X syndrome. Methods Forty-three patients with cardiac X syndrome were randomized to receive enalapril (21 enalapril) or diltiazem (22 diltiazem) and were followed up for 3 months. The treadmill test , Coronary blood flow reserve (CFR), nitric oxide (NO), and plasma endothelin-1 (ET-1) levels. Results Compared with those before treatment, the number of chest pain and the maximal ST segment depression in both groups decreased significantly after 3 months of treatment, the level of ET-1 was significantly decreased, the levels of CFR and NO were significantly increased, the total exercise time and ST segment depression 1mm time was significantly longer (P <0.01 or P <0.05). Compared with diltiazem group, the number of chest pain and the maximal ST segment depression in enalapril group were significantly decreased (all P <0.05), the ET-1 level was significantly decreased (P <0.01) and the levels of CFR and NO were significantly increased (All P <0.05). The total exercise time and ST segment depressing 1mm time were significantly longer (P <0.01, P <0.05). CONCLUSION Both enalapril and diltiazem improve endothelial function in CSX patients and improve exercise tolerance and CFR. Enalapril is more effective than diltiazem.