飲酒負荷後に末梢静脈血中エンドセリン-1濃度が上昇したアルコール誘発性異型狭心症の1例

A Case of Alcohol-induced Variant Angina Associated with High Level of Plasma Endothelin-1

　症例は70歳，男性．飲酒後の胸痛を訴えて来院．入院後に飲酒負荷を行ったところ，ST上昇発作を認めた．冠動脈造影では左右冠動脈に有意狭窄を認めなかった．飲酒約5時間後，右冠動脈ではコントロール造影に比し，③番〜④番にかけて，軽度ではあるがトーヌスのさらなる亢進を認めた．引き続きアセチルコリン15μgの冠注を行ったところ99％の冠攣縮が生じた．末梢静脈血中エンドセリン−1の濃度の測定（正常2.30pg/ml以下）を経時的に行ったところ，入院中飲酒（—）では3.15pg/ml，飲酒負荷後は4.09pg/mlまで上昇，禁酒2ヵ月後は2.88pg/mlであった．以上，飲酒負荷後に末梢静脈血中エンドセリン−1濃度が上昇した異型狭心症の1例を経験した．飲酒後に勃発する冠攣縮の一要因としてエンドセリン−1が関与している可能性もあると考え報告した．

A 70-year-old man was admitted to our hospital because of chest pain which occurred several hours after alcohol ingestion. In an attempt to provoke the attack by alcohol ingestion, we gave the patient alcoholicbeverage (sake containing 15% alcohol, 360 ml) at the hospital (alcohol test). Alcohol-induced variant angina was provoked 4.5 hours after alcohol ingestion and ST elevation was seen in II, III, aVF leads. The alcohol test was repeated during cardiac catheterization. Coronary angiography showed no organic stenoses in either coronary artery. Although variant angina did not occur spontaneously during cardiac catheterization, spasticity of the right coronary artery increased 5 hours after alcohol ingestion.

Later, subtotal spasm of the right coronary artery was induced by intracoronary injection of acetylcholine (15 μg). Plasma ethanol level had already returned to nillevel at this time.

We also measured the endothelin-1 level in the peripheral vein. The endothelin-1 level was 3.15 pg/ml with-out drinking and it increased to 4.09 pg/ml during alcohol test (normal range ; less than 2.30 pg/ml). Two months after abstaining from drinking, it decreased to 2.88 pg/ml.

Although this report is a case report of only one patient, there may be some relationship between alcohol-induced variant angina and plasma endothelin-1 level.