虚血性心疾患におけるα-human atrial natriuretic polypeptide（carperitide）による冠循環の改善

Effects of α-human Atrial Natriuretic Polypeptide (Carperitide) on the Systemic Hemodynamics and Coronary Circulation in Patients with Ischemic Heart Disease

　α-human atrial natriuretic polypeptide（carperitide）の常用量の点滴静注での虚血性心疾患における冠循環への影響を検討した．対象は冠動脈狭窄病変を持つ虚血性心疾患例群10例，正常例群7例の計17例である．測定は左前下行枝近位部にdoppler flow wireを留置し冠動脈血流速（CBFV）を，また冠状静脈洞内にopticatheterを留置し，冠状静脈洞酸素飽和度（ScsO₂）をそれぞれ同時記録した．carperitideは0.1μg／kg／min（γ）〜0.4γまで5分毎に漸増投与した．CBFVは，carperitide（前→0.2γ→0.4γ）投与で正常群（17.4±3.5→18.7±2.4→17.0±1.7cm／s），虚血群（17.2±2.7→16.3±1.5→20.4±3.6）とも有意な変化は認めなかった．ScsO₂は正常群（38.2±5.3→41.3士5.1^＊→41.9±5.4％）は0.2γで有意な増加を示し（^＊：p＜0.01），虚血群では（38.8±2.9→43.6±2.7^＊→43.8±2.9^＊）と0.2γ，0.4γで有意な増加を認めた．ScsO₂の増加は冠血流の増大による心筋酸素摂取率の減少を示し，常用量のcarperitideの投与で，虚血性心疾患においても冠血流量の増大，冠循環の改善が示唆された．

We investigated effects of α-human atrial natriuretic polypeptide (carperitide) infused intrtavenously in clinical dose on the coronary circulation in patients with ischemic heart disease (IHD). The subjects were 10 patients in the IHD group and 7 patients in the controlgroup. We measured coronary blood flow velocity (CBFD) by Doppler guide wire and coronary sinus oxygen saturation (ScsO₂) simultaneously. Carperitide was infused at the rate of 0.1μg/kg/min (γ)~0.4y increasingly every 5 minutes. CBFD showed no change in the control group (17.4±3.5→18.7±2.4→17.0 ±1.7cm/s) and the IHD group (17.2±2.7→16.3±1.5→20.4±3.6) during carperitide infusion (before→0.2γ→0.4γ). ScsO₂ increased in the control group (38.2±5.3→41.3±5.1^*→41.9±5.4)(^*:p＜0.01) and in the IHD group(38.8±2.9→43.6±2.7^*→43.8±2.9^*). The increase of ScsO₂ indicates a decrease in the myocardial oxygen extraction rate. The present study suggestes that a clinical dose of carperitide increses coronry blood flow and improves the coronary circulation.