多剤抵抗性の難治性冠攣縮性狭心症に対してRho-kinase阻害薬fasudilと長時間作用型Ca拮抗薬塩酸ベニジピンの併用が著効した1例

The Case that the Combination use of Fasudil, a Selective Rho-kinase Inhibitor, and Long Acting Ca Antagonist Benidipine Hydrochloride was Very Effective to the Efractory Vasospastic Angina Resistant to Multiple Kinds of Drugs

要旨

　冠攣縮性狭心症の多くはCa拮抗薬が著効し，発作を予防することが可能である．しかし，時に活動性が亢進し多剤抵抗性となる症例がある．今回われわれは，Ca拮抗薬(ニフェジピン，塩酸ジルチアゼム)，硝酸薬，Kチャネル開口薬の多剤併用が無効で発作が頻発し，心筋梗塞，不整脈(心室頻拍，房室ブロック)を合併した治療抵抗性の多枝冠攣縮性狭心症に，Rho-kinase阻害薬fasudilの静脈内投与を短期間併用することで発作が消失し，長時間作用型Ca拮抗薬塩酸ベニジピンを中心とした既存の治療で慢性期のコントロールが可能となった症例を経験した．本症例における冠動脈の過収縮，冠攣縮活動性の亢進にはRho/Rho-kinase系が大きく関与していた可能性が考えられ，文献的考察を加え報告する．

Summary

　It is well known that calcium antagonists are effective in almost vasospastic angina and can prevent anginal attacks. However, there are some cases that strongly enhance the vasospastic activity and become resistance to the multiple kinds of drugs. We experienced the precious case of refractory vasospastic angina with myocardial infarction and risky arrhythmia such as VT, AV block that anginal attacks were disappeared and could be kept good control by the combined administration of fasudil, a selective Rho kinase inhibitor, and benidipine hydrochloride, a long-acting Ca antagonist, while the therapy of other Ca antagonists, nitrate and nicorandil were ineffective in preventing anginal attacks. Considering the other studies, this report suggests that the Rho/Rho-kinase system may play an important role on the acceleration of coronary artery hypercontraction and the enhancement of coronary vasospasm activity.