不同给药周期对硝酸酯类药物耐药性的影响

Effects of Different Drug Delivery Cycles on the Drug Tolerance of Nitrates

关键词:  硝酸酯类药物  冠状动脉造影  用药周期  耐药性

Key words:  nitrates  coronary arteriography  drug delivery cycle  drug tolerance

摘要:

目的 通过观察冠脉血管的扩张程度来研究不同的给药周期对耐药性产生的影响。方法 将120例冠心病并拟进行冠状动脉造影术的患者分为4组：间断给药组、短程持续给药组、长程持续给药组、空白对照组。进行冠状动脉造影术时冠脉内注射硝酸异山梨酯1 mg，测量给药前及给药2 min后前降支(left anterior descending coronary artery，LAD)近端及回旋支(left circumflex branch of coronary artery，LCX)近端管径，计算平均扩张程度，进而评价患者硝酸酯药物的耐药程度。结果 单因素方差分析显示各组LAD和LCX及平均扩张度不完全相同，长程持续用药组扩张度明显低于间断给药组及空白对照组(P<0.05或0.01)，短程持续用药组扩张度与其他3组均无明显差异，空白对照组与间断用药组无明显差异。结论 硝酸酯类药物长期使用(>72 h)会产生一定的耐药性，短时程持续使用也可出现不显著的耐药性，间断使用(每天8~10 h空白期)可避免耐药的发生。

Abstract:

OBJECTIVE To explore the effects of different drug delivery cycles on the drug tolerance of nitrates by measuring the degree of coronary vascular expansion. METHODS One hundred and twenty patients having coronary heart disease and would get the operation of coronary angiography were divided into 4 groups: intermittent administration group, short-range continued administration group, long-range continued administration group, blank control group. The 1 mg isosorbide dinitrate was injected into coronary artry during coronary arteriography. The proximal diameter of left anterior descending coronary artery(LAD) and left circumflex branch of coronary artery(LCX) were measured before and 2 min after the injection. The expansion degree was calculated to evaluate the drug resistance of the nitrates. RESULTS One-way analysis of variance showed that the expansion degree of LAD and LCX and the average degree in 4 groups were not exactly the same. The expansion degree of long-range continued administration group was obviously lower than those of the intermittent administration group and blank control group(P<0.05 or 0.01). The expansion degree of short-range continued administration group had no obvious difference with the other 3 groups. There was no obvious difference between the blank control group and intermittent administration group. CONCLUSION Long-term use of nitrates (>72 h) will produce a certain amount of drug resistance; short-term continuous use of nitrates may cause the non-significant resistance; intermittent use of nitrates(8-10 h blank a day) can avoid the occurrence of drug resistance significantly.