【摘要】 目的 探讨替格瑞洛联合增强型体外反搏治疗微血管性心绞痛患者的临床疗效及对血管内皮功能、冠状动脉微循环和生活质量的影响。方法 采用前瞻性随机对照试验方法，选取2024年3月至2025年3月于沧州市人民医院心内科就诊的300例微血管性心绞痛患者，按随机数字表法分为观察组（n=150）和对照组（n=150）。对照组接受基础治疗+替格瑞洛治疗，观察组接受基础治疗+替格瑞洛+增强型体外反搏治疗，观察组和对照组均持续治疗6周。比较观察组和对照组临床疗效、心绞痛症状情况、血管内皮功能指标、冠状动脉微循环指标、运动耐力及疼痛程度，并分析比较不良事件发生率。结果 治疗后，观察组患者的总有效率为90.00%(135/150)，高于对照组77.33%(116/150)（χ~2=8.806,P<0.05）；治疗后，观察组和对照组患者心绞痛症状均较治疗前改善，且观察组心绞痛发作频率、持续时间[分别为（2.13±1.15）次/周、（2.85±0.65）min/次]均低于对照组[分别为（4.35±1.42）次/周、（4.52±0.96）min/次，t=14.879、17.642，均P<0.05]，间隔时间[（16.95±3.44）h/次]长于对照组[（10.86±2.01）h/次，t=18.721,P<0.05]；治疗后，观察组和对照组患者血管内皮功能均较治疗前改善，且观察组一氧化氮水平[（76.58±8.92）μmol/L]高于对照组[（63.45±7.75）μmol/L,t=13.609,P<0.05]，内皮素1水平[（84.33±10.38）ng/m L]低于对照组[（95.35±12.40）ng/m L,t=8.346，均P<0.05]；治疗后，观察组和对照组患者冠状动脉微循环指标较治疗前改善，且观察组冠状动脉血流储备、心肌平台期强度、再充盈平均速度[分别为（3.56±0.42）、（1.45±0.18）dB、（3.67±0.42）1/s]高于对照组[分别为（3.01±0.38）、（1.24±0.16）dB、（3.11±0.38）1/s,t=11.893、10.680、12.109，均P<0.05]；治疗后，观察组和对照组患者生活质量均较治疗前改善，且观察组6分钟步行距离[（445.49±26.82）m]远于对照组[（408.88±25.01）m,t=12.227，均P<0.05]，视觉模拟量表评分[（2.38±0.33）分]低于对照组[（3.14±0.62）分，t=13.253，均P<0.05]；观察组患者的不良反应发生率为12.00%(18/150)，对照组为6.00%(9/150)，差异无统计学意义（χ~2=3.297,P=0.069）。结论 替格瑞洛联合增强型体外反搏治疗微血管性心绞痛可提升临床疗效，有效减轻心绞痛症状，改善血管内皮功能与冠状动脉微循环，提高患者运动耐力和生活质量，且安全性良好。更多还原

【Abstract】 Objective To explore the clinical efficacy of ticagrelor combined with enhanced external counterpulsation in patients with microvascular angina and its impact on vascular endothelial function, coronary microcirculation, and quality of life. Methods A prospective controlled trial was conducted. A total of 300 patients with microvascular angina who visited the Department of the Cardiology, Cangzhou People’s Hospital from March 2024 to March 2025 were selected and randomly divided into an observation group(n=150) and a control group(n=150) using a random number table method. The control group received standard treatment plus ticagrelor, while the observation group received standard treatment plus ticagrelor combined with enhanced external counterpulsation. Both groups were treated continuously for 6 weeks. Clinical efficacy, angina symptoms, vascular endothelial function indicators, coronary microcirculation parameters, exercise tolerance, pain levels, and the incidence of adverse events were compared between the two groups. Results After treatment, the total effective rate in the observation group was 90.00%(135/150), higher than that in the control group(77.33%(116/150))(χ~2=8.806, P<0.05). After treatment, angina symptoms improved in both groups compared with before treatment. The frequency and duration of angina attacks in the observation group((2.13±1.15) episodes/week,(2.85±0.65) min/episode, respectively) were lower than those in the control group((4.35±1.42) episodes/week,(4.52±0.96) min/episode, respectively)(t=14.879, 17.642, both P<0.05), while the interval between attacks((16.95±3.44) h/episode) was longer than that in the control group((10.86±2.01) h/episode)(t=18.721, P<0.05). After treatment, vascular endothelial function improved in both groups compared to before treatment. The nitric oxide level in the observation group((76.58±8.92) μmol/L) was higher than that in the control group((63.45±7.75) μmol/L)(t=13.609, P<0.05), while the endothelin-1 level((84.33±10.38) ng/mL) was lower than that in the control group((95.35±12.40) ng/mL)(t=8.346, both P<0.05). After treatment, coronary microcirculation parameters improved in both groups compared with before treatment. The coronary flow reserve, myocardial plateau intensity, and mean refill velocity in the observation group((3.56±0.42),(1.45±0.18) dB,(3.67±0.42)1/s, respectively) were higher than those in the control group((3.01±0.38),(1.24±0.16) dB,(3.11±0.38)1/s, respectively)(t=11.893, 10.680, 12.109, all P<0.05). After treatment, quality of life improved in both groups compared with before treatment. The 6-minute walking distance in the observation group((445.49±26.82) m) was longer than that in the control group((408.88±25.01) m)(t=12.227, P<0.05), while the VAS score((2.38±0.33) points) was lower than that in the control group((3.14±0.62) points)(t=13.253, P<0.05). The incidence of adverse reactions was 12.00%(18/150) in the observation group and 6.00%(9/150) in the control group, with no statistically significant difference between the two groups(χ~2=3.297, P=0.069). Conclusion The combination of ticagrelor and enhanced external counterpulsation in the treatment of microvascular angina can improve clinical efficacy, effectively alleviate angina symptoms, enhance vascular endothelial function and coronary microcirculation, increase exercise tolerance and quality of life, with a favorable safety profile.更多还原