Objective: To explore the different effects of chronic treatment with glibenclamide and gliclazide on the warm-up phenomenon in diabetes patients with coronary artery disease. Methods: A total of seventy-one patients with chronic stable angina and diabetes who were positive for exercise test and was proven that the stenosis degree was 70%-90% in at least one major branch through coronary angiogram were included into the study.They were divided into three groups, diet control group (DMD), glibenclamide group (DMG1) and gliclazide group (DMG2), according to the treatment of diabetes.All of the patients underwent two bicycle exercise tests (EX) at 15-minute interval.Parameters including ischaemic threshold (the rate-pressure product at 1-mm ST-segment depression, RPP), time to ischaemic (the time to 1 mm ST-segment depression, T-STD), the maximum ST-segment depression (STDmax) and exercise duration (ED) were recorded respectively. Results: In group DMD, T-STD and ED were prolonged [(360±83) s vs (409±80) s, P<0.001] and [(518±90) s vs (549±96) s, P=0.001], STDmax were shortened [(1.91±0.43) mm vs (1.60±0.36) mm, P<0.001], and RPP was increased [(180±27) beats·min(-1)·mmHg·10(2) vs (195±28) beats·min(-1)·mmHg·10(2), P<0.001] as the parameters during EX2 were compared with those during EX1. In group DMG1, there was no statistic difference in these indexes except that ED was prolonged [(458±70) s vs (472±66) s, P=0.045] when those of EX2 and EX1were compared. In the group DMG2, all the analyzed variables improved significantly during two sequential exercise tests as the results in the group DMD except that ischaemic threshold was not increased [(199±41) beats·min(-1)·mmHg·10(2) vs (211±39) beats·min(-1)·mmHg·10(2), P=0.071]. Conclutions: Warm-up phenomenon is abolished in diabetic patients with stable angina treated with glibenclamide, partially preserved in gliclazide-treated patients. and the KATP channel may be involved in those different effects. Gliclazide should be the safer choice for the patients with diabetes and chronic stable angina.
目的： 观察不同磺脲类药物对冠心病合并糖尿病患者发生warm-up现象的影响作用。 方法： 选择2013年7月至2015年10月入住石家庄市第一医院心内科，运动试验阳性以及符合冠脉造影提示至少单支冠脉狭窄度为70%~90％的慢性稳定型心绞痛合并糖尿病患者作为研究对象。根据其血糖控制方式分为节食对照(DMD)组25例、格列本脲组(DMG1)23例与格列齐特组(DMG2)23例，共71例入组。分别进行间隔15 min的连续两次踏车运动试验(EX(1)、EX(2))，观察缺血阈值(ST段压低0.1 mV时心率血压乘积即RPP值)、缺血发作时间(即出现ST段压低0.1 mV时间，T-STD)、ST段压低的最大值(STDmax)以及总运动时间(ED)等指标。 结果： DMD组两次运动相比T-STD和ED延长[(360±83) s比(409±80) s，P<0.001]和[(518±90) s比(549±96) s，P=0.001]；STDmax减轻[(1.91±0.43) mm比(1.60±0.36) mm，P<0.001]，RPP提高[(180±27)次·min(-1)· mmHg·10(2)比(195±28)次·min(-1)· mmHg·10(2)，P<0.001]；DMG1组两次运动相比除总的运动时间[(458±70) s比(472±66) s，P=0.045]有所后延外，余指标均未见明显缺血减轻的改变(P>0.05)；DMG2组除缺血阈值[(199±41)次·min(-1)· mmHg·10(2)比(211±39)次·min(-1)· mmHg·10(2)，P=0.071]外，其余指标均有不同程度的明显改善(P<0.05)。 结论： 格列本脲可以阻断warm-up现象的发生，而格列齐特却使这一心肌自我保护现象部分保留，钾通道可能作为重要机制参与其中；格列齐特将成为糖尿病合并冠心病人群更为安全的选择。.
Keywords: Exercise test; Gliclazide; Glyburide; Potassium channels; Warm-up phenomenon.