心筋梗塞早期における血中ノルエピネフリン，エピネフリンの臨床的検討

Clinical significance of plasma norepinephrine and epinephrine early in the course of acute myocardial infarction

　循環器疾患の種々の病態におけるカテコールアミン（以下CA）の意義が最近注目されているが，急性心筋梗塞（以下AMI），とくに発症直後の早い時期の血中CAの動態および臨床的意義に関する報告はきわめて少ない。これまでに，実験的には冠状動脈結紮の直後から血中CAの上昇がみられ^14），虚血心の組織CAが著減する^15,20），また臨床的にもAMI後に血中CAが上昇する^1,8,12）などの報告がなされている。しかし臨床的に発症直後より経時的に血中CAを測定し，疾患の重症度，不整脈，梗塞部位との関係などを検討した報告は少なく，成績や見解も必ずしも一致をみていない。われわれは，発症の明らかなAMI 26例で，発症早期からの血中ノルエピネフリン（以下NE），エピネフリン（以下E）を経時的に測定し，若干の知見を得たので報告する。

Plasma norepinephrine (NE) and epinephrine (E) in the early phase of acute myocardial infarction were investigated. Plasma NE and E were determined serially in 26 patients with acute myocardial infarc-Lion admitted within 24 hours after the onset. Thret were 16 cases of anterior or anterolateral infarction. 7 cases of inferior or posteroinferior infarction and :1 cases of subendocardial infarction. Following result were obtained.

1) Plasma NE and E were elevated in most eases at the first time of sampling. In one case that was drawn blood as early as thirty minites after the onset, plasma NE and E showed already high level. Within 3 hours after the onset the rate of abnormal elevation reached to 100 per cent in NE, and 75 per cent in E respectively. Thereafter their levels were gradually decreased with mild fluctuation ; plasma NE normal-ized in 40 per cent of cases within 24 hours, on the other hand, plasma E showed the early normalization in 70 per cent of cases within 12 hours.

2) Clinical severity demonstrated by Killip's clas-sification showed significant correlation with plasma NE and E drown within 24 hours after the onset. Norepinephrine and epinephrine showed significant high levels (P<0.01) in Killip's III and IV groups compared with those of I and 11 groups. In addition to this, very early plasma NE levels drown within 4 hours also showed good correlation with peak CPK values.

3) The severity of arrhythmia during the first 24 hours was classified into four groups depending on the type and incidence. Norepinephrine showed sig-nificant elevation in severe ventricular arrhythmia group C and D. And epinephrine showed significant elevation only in the most severe group D.

4) In cases of anterior infarction, NE and E values during the first 24 hour, demonstrated significantly higher levels 0.01) as compared with case of inkrior or subendocardial infarctions.

The elevation of plasma NE and E levels early in the course of acute myocardial infarction might play the significant role of not only diagnostic implication but also severity and prognosis of acute myocardial infarction.