5-FluorouracilおよびTegafurにより誘発された異型狭心症の1例

A case of variant angina induced by 5-Fluorouracil and Tegafur

　5-Fluorouracil（5-FU）およびTegafurは．ピリミジン拮抗性抗腫瘍剤であり，消化器癌，乳癌，肺癌など腺癌系の癌に広く有効性が認められている。Tegafurは生体内において徐々に5-FUに変換され抗腫瘍効果を発揮する。すなわち，Tegafurは5-FUのmaskedcompoundであり，易吸収性などの特性を有し副作用も5-FUに比して軽微であるといわれる^1）。

　今回我々は，5-FUおよびTegafur投与により誘発された冠動脈スパスムによる異型狭心症であると考えられる1例を経験したので報告する。

We report a case of variant angina induced by both 5-Fluorouracil (5-FU) and Tegafur. A 53 year old man was pointed out poorly differentiated ade. nocarcinoma of the stomach, which was treated with subtotal gastrectomy. He received 500 mg of 5-FU, 20 mg of Ara-C and 4 mg of Mitomycin C intra-venously. He complained of chest pain about 24 hours after first administration of the drug and electrocardiogram revealed ST segment elevation in aVF and V₂-V₆. He never had angina pec-toris. After he received daily doses of 120 mg of Diltiazem orally, his pain disappeared soon and electorocardiogram reverted to its previous pattern. Cardiac enzyme study showed no evidence of myo-cardial infarction. After 16 days from this episode, chemotherapy was begun again with daily doses of 600 mg of Tegafur orally. On the sixth day of this therapy, he again complained of chest pain and ambulatory electrocardiogram revealed ST segment elevation during the attack. Angina pectoris disap-peared by the discontinuance of the therapy of Tegafur and the increase of Diltiazem to the daily doses of 240 mg. Coronary angiography revealed significant spasm of the right coronary artery after injection of ergonovin malate, and it was believed that 5-FU and Tegafur induced coronary vasospasm.