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Kokyu to Junkan Volume 50, Issue 10 （October 2002）

呼吸と循環 50巻10号（2002年10月発行）

Japanese English

研究

虚血性心疾患を合併したII型糖尿病患者におけるWarm-up現象に対するスルホニルウレアの作用 Effect of Sulfonylurea on the Warm-up Phenomenon in Type II Diabetic Patients with Ischemic Heart Disease 植田育子 ¹ , 久慈直光 ¹ , 内野和顕 ¹ , 南澤康介 ¹ , 海老名俊明 ¹ , 小林俊一 ¹ , 松下浩平 ¹ , 日比潔 ¹ , 梅村敏 ¹ Ikuko Ueda ¹ , Naomitsu Kuji ¹ , Kazuaki Uchino ¹ , Kousuke Minamisawa ¹ , Toshiaki Ebina ¹ , Shunichi Kobayashi ¹ , Kohei Matsushita ¹ , Kiyoshi Hibi ¹ , Satoshi Umemura ¹ ¹横浜市立大学医学部内科学第二 ¹Second Department of Internal Medicine, Yokohama City University School of Medicine キーワード：ウォームアップ現象 , II型糖尿病 , スルポニルウレア , warm-up phenomenon , type II diabetes mellitus , sulfonvlurea Keyword: ウォームアップ現象 , II型糖尿病 , スルポニルウレア , warm-up phenomenon , type II diabetes mellitus , sulfonvlurea pp.1057-1062

発行日 2002年10月15日 Published Date 2002/10/15

DOI https://doi.org/10.11477/mf.1404902552

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Abstract 文献概要
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要旨　本研究の目的は，虚血性心疾患患者におけるスルポニルウレア（SU）薬投与がウォームアップ現象を減弱するか否かを検討することである．II型糖尿病と診断され，安定狭心症を合併している患者12例を対象とした．SU薬服用者4例をSU群，SU薬非服用者8例をコントロール群（CT群）とした．トレッドミル運動負荷試験を同一日に二度施行した．心電図のST部分が1mm低下するまでにかかる時間とST部分が1mm低下した時点でのratepressure productについてTest1とTest2の差を検討したところ，SU群では特に変化は認められず，CT群では有意に延長または増加した．これよりSU薬は血糖コントロールを目的として現在臨床で用いられるSU薬投与量下において，連続して負荷を行ったときに観察されるウォームアップ現象を減弱させる傾向があることが示唆された．

　Objectives: Myocardial ischaemia and infarction are associated with substantially increased morbidity and mortality, in patients with diabetes mellitus. Although many factors contribute to the increased morbidity and mortality in patients with type II diabetes mellitus. one contributor may be the use of sulfonylurea. The increased tolerance to myocardial ischaemia observed during the second of two consecutives exercise tests, the warm-up phenomenon, has been proposed as a clinical model of ischaemic preconditioning. The aim of this study is to investigate whether sulfonylurea, a selective K_ATP channel blocker, abolishes the warm-up phenomenon.

　Methods: Twelve type II diabetic patients with chronic stable angina pectoris were divided into twodifferent groups of patients: the SU group (receiving SU), the CT group (not receiving SU). All patients underwent two consecutive treadmill exercise tests with a recovery time to establish baseline conditions.

　Results: There was no difference in characteristics of the subjects between the SU group and the CT group. In the SU group, the time to 1mm ST segment depression didn't change during the second test compared with the first (SU group: Test 1, 3.5±1.0 vs Test 2, 2.8±1.0min, p=NS), but it was significantly prolonged in the CT group (CT group: Test 1, 6.1±1.1 vs Test 2, 7.3±0.8 min, p＜0.02). In the SU group rate-pressure product at the time of the 1mm ST segment depression didn't change during the second test compared with the first (SU group: Test 1, 177.9±16.9 vs Test 2, 155.1±27.3 beats･min^-1･mmHg･10², p=NS), but it significantly increased in the CT group (CT group: Test 1, 186.2±14.3 vs Test 2, 216.7±17.3 beats･min^-1･mmHg･10², p＜0.05). The difference in time to 1mm ST segment between the first test and the second test in the SU group was significant compared to that in the CT group.

　Conclusions: Sulfonylurea, an oral hypoglycemic agent, used with an ordinary clinical dose led to a decrease in the warm-up phenomenon, which is a clinical manifestation of ischaemic preconditioning, on two consecutive exercise tests. Therefore, sulfonylurea should be prescribed carefully in diabetic patients with coronary heart disease.