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Kokyu to Junkan Volume 37, Issue 7 （July 1989）

呼吸と循環 37巻7号（1989年7月発行）

Japanese English

研究

血中遊離脂肪酸による運動誘発心筋虚血の早期検出 Early recognition of exercise-induced myocardial ischemia by plasma free fatty acid 上原晋 ¹ , 横田充弘 ² , 岩瀬三紀 ³ , 宮原隆志 ³ , 小出正文 ³ , 林博史 ³ , 杉山理 ⁴ , 小澤高将 ⁴ Susumu Kamihara ¹ , Mitsuhiro Yokota ² , Mitsunori Iwase ³ , Takashi Miyahara ³ , Masafumi Koide ³ , Hiroshi Hayashi ³ , Satoru Sugiyama ⁴ , Takayuki Ozawa ⁴ ¹トヨタ記念病院循環器科 ²名古屋大学医学部臨床検査医学 ³名古屋大学医学部第1内科 ⁴名古屋大学医学部第2生化学 ¹Toyota Memorial Hospital ²Department of Laboratory Medicine, Nagoya University School of Medicine ³First Department of Internal Medicine, Nagoya University School of Medicine ⁴Department of Biomedical Chemistry, Nagoya University School of Medicine pp.779-784

発行日 1989年7月15日 Published Date 1989/7/15

DOI https://doi.org/10.11477/mf.1404205512

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Abstract 文献概要
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　血中遊離脂肪酸は心筋の熱源として重要な役割を果たしており，空腹時，好気的状態では心筋熱源の50〜70％は脂肪酸代謝によるとされている^1）。しかし，心筋虚血時には，脂肪酸代謝は抑制され嫌気的糖代謝の亢進がおこる^2）。

　従来，脂肪酸分析にはガスクロマトグラフィーが用いられていたが，最近，高速液体クロマトグラフィー（HPLC）を用いた，より感度の優れた脂肪酸分析法が報告されている^3）。本研究では，HPLCによる脂肪酸分析法を用い，1）運動誘発心筋虚血の早期検出に血中遊離脂肪酸の測定が有用であるか否か，2）心筋虚血時に血中遊離脂肪酸構成に変化が見られるか否かについて検討した。

To investigate whether or not myocardial free fatty acid (FFA) uptake is useful for early recog-nition of exercise-induced myocardial ischemia com-pared with myocardial lactate uptake, we studied in 8 patients with stable effort angina pectoris bymeasuring hemodynamic and metabolic parameters during supine multistage bicycle ergometer exercise (BEx). Analysis of FFA composition was performed by high performance liquid chromatography. The exercise endpoint in the control study was moderate chest pain in all cases. In all cases, BEx testing us-ing the same method, duration and workload was repeated 1. 5 hours after the oral administration of 6 mg of nilvadipine (a new calcium antagonist). Exercise time of the subjects studied was 463=40 sec (mean±SE, 180-540 sec). After administration of nilvadipine, chest pain was not induced in 6 patients and was lessened in severity in 2 patients. Mean ST segment depression was 0. 21±0. 05 mV in the cont-rol period and it was significantly reduced to 0. 08± 0. 03 mV after nilvadipine administration (p< 0. 05). Myocardial FFA uptake decreased from 21. 1±4. 4% at rest to 8. 1±2. 1% at peak exercise in the control study (p < 0. 05). Myocardial lactate uptake was unchanged at rest and peak exercise in the control study (21.6±2. 7 vs 22. 2± 3. 3%). After administra-tion of nilvadipine, myocardial FFA uptake did not change during BEx (25. 3±2. 7 at rest and 21.3± 3. 6% at peak exercise). At peak exercise, myocar-dial FFA uptake increased significantly after admini-stration of nilvadipine (21. 3± 3. 6 vs 8. 1=2. 1%, p<0. 05). In FFA composition, the percentage of each of 12 FFA did not change during myocardial passage at rest and peak exercise.

Therefore, it is suggested that myocardial FFA up-take would be useful for early recognition of exer-cise-induced myocardial ischemia compared with myocardial lactate uptake.