冠攣縮性狭心症の薬物治療成績と予後に及ぼす因子の検討―愛媛県の一地方病院における後向き追跡調査

Investigation of the Influential Factor in Prognosis and the Result of Medical Therapy in Patients with Coronary Spastic Angina

要旨

　冠攣縮性狭心症患者の予後に影響を及ぼす背景因子と治療薬が予後に与える影響について後向きに検討を行った．当院にて，1998年7月から2005年9月末までに薬剤を用いた冠攣縮誘発負荷試験にて冠攣縮を証明し得た冠攣縮性狭心症患者161例を対象に，背景因子・治療薬・心血管イベントに関する予後調査を実施した．解析の結果，年齢と経口糖尿病薬服用と胸痛のコントロール状況が予後を有意に悪化させる因子であった．更に，糖尿病の合併と誘発冠攣縮枝数が予後を悪化させる傾向を示すことが明らかとなった．また，冠攣縮性狭心症患者の92%がカルシウム拮抗薬を服用しており，ベニジピンが32%，アムロジンが22%，ジルチアゼムが29%，その他のカルシウム拮抗薬が12%であった．糖尿病既往のない誘発冠攣縮枝数1，2枝の比較的重篤でない症例を対象に，カルシウム拮抗薬別に予後に及ぼす影響について検討したが，ベニジピン，ジルチアゼム，アムロジンの順に予後改善効果を認めた．本研究より，冠攣縮性狭心症の予後には年齢と糖尿病が大きな影響を及ぼしており，胸痛コントロールが重要であることが示された．また，カルシウム拮抗薬の種類によって冠攣縮性狭心症の予後に差異が認められる可能性も示唆された．

　We retrospectively investigated the patient's characteristics and selection of therapeutic drugs which might have affected the outcome in patients with coronary spastic angina. Patient's characteristics, therapeutic drugs and cardiovascular events were analyzed in 161 cases who had demonstrated drug-induced coronary spasm during provocative testing at our hospital from July, 1998 to end-September, 2005, The correlation of these parameters with the prognosis was studied. The analysis revealed that age, use of oral antidiabetics and uncontrolled chest pain proved to be significant poor prognostic factors. It was also shown that a diabetes complication and a greater number of affected branches tended to be correlated with poor prognosis. Ca antagonists were used to treat the disease in 92% of the patients; benidipine hydrochloride in 32%, amlodipine besilate in 22%, diltiazem hydrochloride in 29% and others in 12%. The correlation of Ca antagonists with the prognosis was studied in patients with moderate disease having no history of diabetes and having induced spasm in one or two branches. The outcome was better in the order of benidipine, diltiazem and amlodipine. In conclusion, this study showed that age, diabetes and chest pain control are significantly correlated with the prognosis in coronary spastic angina. Moreover, the possibility that selection of Ca antagonists may affect the outcome of the disease was also indicated.