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目的:探讨不稳定型心绞痛(UA)发病中内皮素(ET)的作用及低分子量肝素(LMWH)对其影响,进而明确LMWH治疗UA的机理。方法:采用放免法测定44例UA病人及20例健康人(对照组)血浆ET含量,将44例UA病人随机分为常规治疗组(常规组)、低分子量肝素组(LMWH组)。常规组23例(男15例,女8例;年龄64岁±7岁),口服硝酸异山梨醇酯10mg tid、阿斯匹林肠溶片50mg qd,5％葡萄糖注射液250ml+能量合剂1支加门冬氨酸钾镁30ml,静脉点滴qd;LMWH组21例(男16例,女5例,年龄65岁±8岁),在上述治疗基础上加用低分子量肝素(商品名:法安明)5000IU腹部皮下注射,q12h。治疗1周后再测定血浆ET含量。结果:UA病人血浆ET含量高于对照组(P<0.001),常规组、LMWH组治疗1周后,病人血浆ET含量均下降(与治疗前比较P<0.001),其中LMWH组尤为显著,ET水平趋于正常(与对照组比P>0.05),常规组ET水平仍高于正常组和LMWH组。结论:ET在UA发病中起重要作用,LMWH可降低UA病人血浆ET水平,因而可有效地控制不稳定型心绞痛。
Objective: To investigate the effect of endothelin (ET) and the effect of low molecular weight heparin (LMWH) on the pathogenesis of unstable angina pectoris (UA), and to clarify the mechanism of LMWH in the treatment of UA. Methods: 44 patients with UA and 20 healthy people (control group) were randomly divided into routine treatment group (conventional group) and low molecular weight heparin group (LMWH group) by radioimmunoassay. The conventional group of 23 patients (15 males and 8 females; aged 64 years ± 7 years), oral administration of isosorbide dinitrate 10mg tid, aspirin enteric-coated tablets 50mg qd, 5% glucose injection 250ml + energy mixture 1 Plus magnesium aspartate 30mg, intravenous qd; LMWH group of 21 patients (16 males and 5 females, aged 65 ± 8 years old), in addition to the above treatment with low molecular weight heparin (trade name: Ming) 5000IU abdominal subcutaneous injection, q12h. One week after the treatment, the plasma ET level was measured again. Results: The ET level in UA patients was significantly higher than that in control group (P <0.001). The ET level of patients in routine group and LMWH group decreased after 1 week (P <0.001 compared with before treatment), especially in LMWH group The levels tended to be normal (P <0.05 compared with the control group). The levels of ET in the routine group were still higher than those in the normal group and the LMWH group. Conclusion: ET plays an important role in the pathogenesis of UA. LMWH can reduce the level of plasma ET in patients with UA, so it can effectively control unstable angina pectoris.