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目的 :探讨血管紧张素转换酶抑制剂 ( ACEI)对硝酸甘油 ( NTG)耐药的影响及机制。方法 :将 65例不稳定型心绞痛 ( UAP)患者分为 NTG组 ( 组 )、NTG+Captopril组 ( 组 )、NTG+非巯基 ACEI组 ( 组 ) ,观察耐药比例、收缩压 ( SBP)、血小板环磷酸鸟苷 ( c GMP)、血浆血管紧张素 ( Ang )、内皮素 ( ET)、缓激肽 ( BK)变化。结果 :1 组和 组耐药比例均较 组低 ( P <0 .0 5 ) ;2加用 Captopril和非巯基 ACEI能使 NTG滴注过程后期的 SBP回升及血小板 c GMP下降得到抑制 ;3血小板 c GMP能反映 NTG耐药 ;4ACEI能在 NTG滴注过程中使缩血管物质 ( Ang 、ET)减少、舒血管物质 ( BK)增多。结论 :在克服硝酸甘油耐药方面 ,含巯基的 Captopril与非巯基 ACEI作用类似。BK途径可能是 ACEI对抗 NTG耐药的重要环节
Objective: To investigate the effect and mechanism of angiotensin converting enzyme inhibitor (ACEI) on the drug resistance of nitroglycerin (NTG). Methods: Sixty-five patients with unstable angina pectoris (UAP) were divided into two groups: NTG group, NTG + Captopril group and NTG + non-sulfanilic ACEI group. The drug resistance ratio, SBP, Changes of cGMP, Ang, ET and BK were observed. Results: The drug resistance rates in group 1 and group were lower than those in group 1 (P <0. 05). Captopril and non-sulfhydryl ACEI could inhibit the rebound of SBP and decrease of cGMP in platelets during the course of NTG instillation. 3 Platelets c GMP can reflect NTG resistance; 4ACEI in the NTG infusion of vasoconstrictor substances (Ang, ET) decreased, vasodilators (BK) increased. CONCLUSIONS: Captopril containing thiol groups have similar effects as non-sulfhydryl ACEIs in overcoming resistance to nitroglycerin. BK pathway may be an important part of ACEI against NTG resistance