| Objective: To observe the therapeutic effects of Nicorandil on coronary microcirculation dysfunction(CMD)in patients with exercise tolerance,microcirculation function,to evaluate the mechanism of Nicorandil on coronary microcirculation dysfunction.Methods:1 Experiment methods: This is a randomized,controlled prospective clinical trial.2 Inclusion criteria:(1)From April 2015 to August 2016,with coro nary microcirculation dysfunction were admitted for Coronary angiograph y(CAG)confirmed coronary stenosis < 50% or there was no restenosis after percutaneouscoronary intervention(PCI);(2)Treadmill exercise test positive;(3)Diagnosis of CMD patients,the diagnostic standard of CM D to meet one of the following conditions: A: Gated myocardial perfusi on ECT in patientswith abnormal myocardial perfusion,Positron emissio n tomography/computed tomography(PET/CT)suggested that myocardial metabolic imaging is normal;B: CAG: Corrected TIMI frame count(CT FC)>27.A total of80 patients were enrolled in this study,all of the p atients were selectedaccording to the draw method is divided into trial g roup(n=40)and control group(n=40).3 Methods of administration: Two groups of patients were treated with routine drugs treatment: Aspirin,beta blockers,statins,nitrates.In t he trial group,the routine drugs treatment combined with Nicorandil(5m g,three times/d),total of three months.4 Main outcome measures: Compared between the two groups befo re and after treatment for three months:(1)Changes of treadmill exercis e test parameters;(2)Changes of corrected TIMI frame count(CTFC);(3)PET/CT and ECT myocardial imageing;(4)Changes of serum C-reactive protein(CRP).Results:1 Basic clinical characteristics of two groups: There was no significant difference between the two groups in age,sex and other general clinical basic conditions,Similarly,there were no statistically significant differences in baselines such as fasting blood glucose,triglycerides,low-density lipoprotein,high-density lipoprotein,urea,creatinine and routine drugs;2 Treadmill exercise test parameters of the two groups: After three months,Nicorandil trial group compared with the control group:(1)STsegment begins to depress the time was delayed more than the control group,the difference was statistically significant[trial group and control group(210.97±52.36 S vs.179.83±73.94S),P=0.040];(2)ST-segment contin ued to depress the time was significantly shorter than the control group,the difference was statistically significant[trial group and control group(377.34±109.90 S vs.421.43±63.89S),P=0.038];(3)ST-segment maximum d epression was lower than the control group,the difference was statistical ly significant[trial group and control group(0.87±0.27 mm vs.1.02±0.26 m m),P=0.024];(4)Maximum METS was higher than the control group,t he difference was statistically significant[trial group and control group(8.20±1.9vs.7.22±2.21),P=0.042];(5)The total time of exercise was delaye d more than the control group,the difference was not statistically signif icant[trial group and control group(737.36±101.20 S vs.726.02±144.80S),P=0.695];(6)The exercise time was longer than the control group,the difference was statistically significant[trial group and control group(414.34±80.65 S vs.382.29±89.09S),P=0.037];3 Corrected TIMI frame count: After three months follow up,the c orrected TIMI frame count of the trial group was lower than the control group,the difference was statistically significant[trial group and control group(29.54±1.73 vs.31.23±2.79),P=0.036];4 PET/CT and ECT examination results: After three months followup,the wall motion index of the trial group was lower than the control group,the difference was statistically significant[trial group and control group(1.08±0.71 vs.1.18±0.55),P=0.028];After three months follow up,t he defects range of target image result of the trial group was lower tha n the control group,the difference was statistically significant[trial group and control group(17.0±4.30% vs.24.0±3.80%),P=0.020];5 The levels of C-reactive protein: After three months follow up,t he levels of C-reactive protein of the trial group was lower than the co ntrol group,the difference was statistically significant[trial group and co ntrol group(4.23±0.67mg/l vs.4.77±1.31mg/l),P=0.015].Conclusions:1 Nicorandil can significantly reduce CMD patients with CTFC,eff ectively increase the patient’s exercise tolerance,reduce the degree of m yocardial ischemia.2 Nicorandil can significantly reduce CMD patients with the defects range of target image result and the wall motion index,reduce the level of serum CRP. |
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