Abstract: Objective　To investigate the clinical effect of enalapril combined with external counter pulsation（ECP） on the inflammatory factors and vascular endothelial function in patients with coronary slow flow（CSF），providing a reference for the treatment of this disease.Methods　A total of 90 cases of CSF were enrolled from the Second Affiliated Hospital of Zhengzhou University from December 2013 to June 2017，and divided into the control group（n=30），enalapril group（n=30） and enalapril combined with ECP group（n=30） by block randomization method，treated by basic drug treatment　and symptomatic treatment，basic drug treatment，symptomatic treatment combined with enalapril（5 mg/d） treatment，basic drug treatment，symptomatic treatment，enalapril（5 mg/d） treatment combined with ECP，respectively.We collected their baseline characteristics，measurement results of levels of hypersensitive C-reactive protein（hs-CRP），interleukin-6 （IL-6），lipoprotein-associated phospholipase A2（Lp-PLA2），brachial flow-mediated dilation（FMD），endothelin-1（ET-1） and NO measured before treatment and on the 15th day after treatment，as well as corrected TIMI frame count （cTFC），Seattle Angina Questionnaire （SAQ） score，and duration of treadmill exercise testing（TET） before treatment and 6 months after treatment.Results　The Lp-PLA2，ET-1 decreased significantly but NO increased significantly in enalapril group on the 15th day after treatment，the cTFC decreased significantly in enalapril group 6 months after treatment（P<0.05），the IL-6，Lp-PLA2 ，ET-1 decreased obviously，but FMD，NO increasedand significantly in enalapril combined with ECP group on the 15th day after treatment（P<0.05），the cTFC decreased obviously ，SAQ score increased and the duration of TET prolonged substantially in enalapril combined with ECP group 6 months after treatment（P<0.05）．On the 15th day after treatment compared with the control group，the Lp-PLA2，ET-1 and cTFC increased significantly but FMD，NO decreased significantly in the enalapril group（P<0.05），6 months after treatment the cTFC increased significantly in the enalapril group（P<0.05）．On the 15th day after treatment，the IL-6，Lp-PLA2，ET-1 decreased significantly but NO significantly in the enalapril combined with ECP group than in other two groups （P<0.05）．6 months after treatment，the cTFC decreased significantly but SAQ score，duration of TET increased significantly in the enalapril combined with ECP group than in other two groups （P<0.05）．Conclusion　As the good clinical response achieved in SCF patients showed，enalapril combined with ECP significantly improved SCF，which might be related to the improvement of inflammation and vascular endothelial function.

Key words: Coronary slow flow；Enalapril；Counterpulsation, external；Endothelium；Treatment outcome

摘要：

目的　观察依那普利联合体外反搏（ECP）治疗冠状动脉慢血流（CSF）患者的临床疗效及对炎性因子和血管内皮功能的影响，为治疗CSF提供更多理论依据。方法　选取2013年12月—2017年6月于郑州大学第二附属医院就诊的CSF患者90例为研究对象，按随机数字表法分为对照组、药物组和药物联合反搏组，每组30例。对照组给予基础药物及对症治疗，药物组在对照组基础上加用依那普利5 mg/d。药物联合反搏组在药物组的基础上联合ECP治疗。收集患者一般资料，观察治疗前和治疗15 d后超敏C反应蛋白（hs-CRP）、白介素6（IL-6）及血浆脂蛋白相关磷脂酶A2（Lp-PLA2）、肱动脉血流介导性舒张功能（FMD）、内皮素1（ET-1）、一氧化氮（NO）和治疗前、治疗6个月后的校正心肌梗死溶栓治疗（TIMI）血流帧数（cTFC）、西雅图心绞痛量表（SAQ）评分、踏车运动试验总时间。结果　药物组治疗15 d后Lp-PLA2、ET-1低于治疗前，NO高于治疗前，药物组治疗6个月后cTFC低于治疗前（P<0.05）；药物组联合反搏组治疗15 d后IL-6、Lp-PLA2、ET-1低于治疗前，FMD、NO高于治疗前，药物联合反搏组治疗6个月后cTFC低于治疗前，SAQ评分、踏车运动试验踏车运动试验总时间高于治疗前（P<0.05）。治疗15 d后药物组Lp-PLA2、ET-1低于对照组，FMD、NO高于对照组，治疗6个月后药物组cTFC低于对照组（P<0.05）；治疗15 d后药物联合反搏组IL-6、Lp-PLA2、ET-1低于对照组、药物组，FMD、NO高于对照组、药物组，治疗6个月后药物联合反搏组cTFC低于对照组、药物组，SAQ评分、踏车运动试验踏车运动试验总时间高于对照组、药物组（P<0.05）。结论　依那普利联合ECP能够改善CSF，并取得较好的临床疗效，其作用机制可能与减少炎性程度、保护血管内皮功能有关。

关键词: 冠状动脉慢血流；依那普利；反搏动术, 体外；内皮功能；治疗结果