目的 探讨冠心丹参滴丸联合维拉帕米治疗非阻塞性冠状动脉微血管型心绞痛（CMVD-AP）的临床疗效及对心血管预后的影响。方法 选取2024年6月—2024年12月沧州市人民医院确诊的CMVD-AP患者104例，随机分为对照组（52例）和治疗组（52例）。对照组口服盐酸维拉帕米片，80 mg/次，3次/d。治疗组在对照组基础上舌下含服冠心丹参滴丸，10粒/次，3次/d。两组患者均接受4周的治疗。观察两组患者临床疗效，比较治疗前后两组患者收缩压心率比值（PRQ）和冠状动脉血流储备（CFR）水平，ST段压低最大幅度、运动平板试验终止率和总运动时间，血清内皮素-1（ET-1）和一氧化氮（NO）水平，及不良反应情况。结果 治疗后，治疗组总有效率为94.23%，显著高于对照组的78.85%（P＜0.05）。治疗后，两组患者PRQ和CFR水平均明显高于治疗前，且治疗组患者上升幅度显著高于对照组（P＜0.05）。治疗后，两组患者ST段压低最大幅度和运动平板试验终止率较治疗前明显降低，而总运动时间明显增加（P＜0.05），且治疗组运动平板试验结果改善幅度显著高于对照组（P＜0.05）。治疗后，两组患者血清ET-1水平较治疗前明显下降，而NO水平明显升高（P＜0.05），且治疗组血清ET-1和NO水平改善幅度均明显优于对照组（P＜0.05）。治疗期间，治疗组与对照组不良反应发生率（3.85% vs 15.38%）比较差异具有统计学意义（P＜0.05）。结论 冠心丹参滴丸联合维拉帕米可有效改善CMVD-AP患者心肌耗氧量、冠状动脉血流储备及运动耐量，调节血管内皮功能并降低不良反应发生率风险。

Objective To investigate the clinical efficacy of Guanxin Danshen Dropping Pills combined with verapamil in treatment of non-obstructive coronary microvascular angina (CMVD-AP) and its impact on cardiovascular prognosis. Methods Patients (104 cases) with non-obstructive coronary microvascular angina in Cangzhou People’s Hospital from June 2024 to December 2024 were randomly divided into control (52 cases) and treatment (52 cases) group. Patients in the control group were po administered with Verapamil Hydrochloride Tablets, 80 mg/time, three times daily. Patients in the treatment group were po sublingually administered with Guanxin Danshen Dropping Pills on the basis of the control group, 10 pills/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical evaluations were evaluated, and the levels of PRQ and CFR, the maximum ST segment depression, treadmill test termination rate, and total exercise time, the levels of serum ET-1 and NO, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was 94.23%, which was significantly higher than 78.85% in the control group (P < 0.05). After treatment, the levels of PRQ and CFR in two groups were significantly higher than before treatment, and the increase in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the maximum ST-segment depression and the termination rate of treadmill test in two groups were significantly reduced compared with before treatment, while the total exercise time was significantly increased (P < 0.05), and the improvement in treadmill test results in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the serum ET-1 levels in two groups were significantly decreased compared with those before treatment, while the NO levels were significantly increased (P < 0.05). The improvement of serum ET-1 and NO levels in the treatment group was significantly better than that in the control group (P < 0.05). During the treatment period, there was a statistically significant difference in the incidence of adverse reactions between the treatment group and the control group (3.85% vs 15.38%, P < 0.05). Conclusion The combination of Guanxin Danshen Dripping Pills and verapamil can effectively improve myocardial oxygen consumption, coronary flow reserve, and exercise tolerance in patients with CMVD-AP, regulate endothelial function, and reduce the risk of adverse reactions.

R914

河北省卫生健康委员会医学科学研究计划项目（20251499）