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Kokyu to Junkan Volume 34, Issue 2 （February 1986）

呼吸と循環 34巻2号（1986年2月発行）

Japanese English

研究

原発性肺高血圧症におけるNifedipineの効果 Hemodynamic evaluation of nifedipine in primary pulmonary hypertension:Short and long term effects 山口清司 ¹ , 立木楷 ¹ , 早坂真喜雄 ¹ , 小熊正樹 ¹ , 太田郁郎 ¹ , 上西徹二 ¹ , 祐川博康 ¹ , 金谷透 ¹ , 安井昭二 ¹ Seiji Yamaguchi ¹ , Kai Tsuiki ¹ , Makio Hayasaka ¹ , Masaki Oguma ¹ , Ikuro Ohta ¹ , Tetsuji Kaminishi ¹ , Hiroyasu Sukekawa ¹ , Tohru Kanaya ¹ , Shoji Yasui ¹ ¹山形大学第一内科 ¹The First Department of Internal Medicine, Yamagata University School of Medicine pp.171-176

発行日 1986年2月15日 Published Date 1986/2/15

DOI https://doi.org/10.11477/mf.1404204821

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Abstract 文献概要
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　原発性肺高血圧症（PPH）は，心臓および肺実質に原因となる疾患がなく．前毛細血管性の著しい肺高血圧をきたす疾患と定義されるが，病勢の進行の程度とそれに伴う病理組織学的変化は一様ではない。予後や薬物に対する反応は．この疾病の病勢のvariabilityによって大きく影響をうけると考えられる^1）。このことが，α-受容体遮断剤^2〜4），β-受容体激剤^5,6），hydralazine^7〜10），cap—topril^11〜13），arachidone酸代謝物質^14〜16），Ca^＋＋拮抗剤^17〜21）といった血管拡張療法の効果の是非に論議をよぶ大きな原因になっていると思われる。

　PPHに対する，Ca^＋＋拮抗剤であるnifedipineによる治療の検討は不十分であり，殊に慢性投与の報告は数少なく，本邦では．本論文が初めての報告と思われる。今回著者らは，PPH 4例に対してnifedipineの急性効果を検討し，その際TPRの著減を示した2例については，経口投与し，2ヵ月後に再度その効果を検討した。また3例については，亜硝酸剤（isosorbide dinitrate：ISDN）の急性効果も併せて検討し，若干の知見を得たので報告する。

The reported efficacy of vasodilators in primary pulmonary hypertension (PPH) has been contro-versial. We assessed the acute hemodynamic effects of nifedipine (nif) in 4 female patients with PPH (age: 40 years in average). The effects were compared with those of isosorbide dinitrate (ISDN). In addi-tion, chronic (2 months) hemodynamic effects of nif were evaluated.

Cardiac catheterization was performed and car-diac index (CI), heart rate (HR), mean systemic and pulmonary arterial pressures (Aom and PAPm), total systemic and pulmonary resistances (TSR and TPR), PaO₂, PaCO₂ and A-aDO₂ were determined before the administration of drugs and at the peak effects of sublingual nif (10mg) or ISDN (5mg).

After nif sublingually, CI increased from 2.4 to 3.0l/min/m² (ΔCI=25%), PAPm decreased from 57 to 53 mmHg (ΔPAPm= -7%) and TPR decreased from 1502 to 1205 dyne･sec･cm^-5 (ΔTPR = -23%). These favorable effects were marked in 2 patients with short symptomatic history. A-aDO₂ was enhanced in 3 patients (mean; 36.6 to 40.6 mmHg), probably due to the deterioration of ven-tilation/perfusion relationship. ISDN decreased PAP slightly, but aggravated low CO and high TPR in contrast with nif.

The long-term (2 months) effects of internal use of nif (40~60mg, daily) were evaluated in 2 pa-tients who had good response in short-term hemo-dynamic effects of nif. They had improved clinical symptom, although the hemodynamic reexamination showed favorable effect in one patient after 2 hours and no change in the other after 12 hours from the last administration of nif (10mg). It was sug-gested that the hemodynamic effects of nif in PPH can be dependent upon the time course after the administration, and therefore nif should be given at least more than three times a day. Thus, nif may be a useful drug in selected patients with PPH.