体外衝撃波結石破砕術に発生した心室性期外収縮と血中ホルモンの関係 - とくにヒト心房性ナトリウム利尿ペプチド(hANP)の意義について -

Abstract

昭和大学病院泌尿器科にて過去3年1ヵ月間にESWLを施行した61例について, ESWLの循環器への影響による不整脈の発生について検討した. 1)VPCの発生率は37.7%であった.結石部位及び患側別には有意差は認めなかった. 2)収縮期血圧は術直後有意に上昇したが, 1週間後には術前値に戻った. 3)エピネフリン値は術直後有意に増加した.hANP値は術直後有意に増加したが, 1週間後には術前値に戻った. 4)ESWL施行中のVPC発生について, 循環動態の変化が関与していることが示唆された. 5)術前にVPCの発生を予測する上でhANPは一つの指標になり得ると考えられた

Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for upper urinary tract stones. However, the mechanism by which this treatment may be involved in causing ventricular premature contractions (VPC) is unknown. We evaluated the relationship between VPC and plasma hormones in patients treated by ESWL. Holter monitoring was performed on 61 outpatients undergoing ESWL with electrocardiographic synchronization for upper urinary tract stones. The levels of cathecolamine, plasma renin activity (PRA), plasma aldosterone concentration (PAC), and human atrial natriuretic peptide (hANP) were measured before, immediately after, and 7 days after ESWL. Systolic blood pressure increased significantly immediately after, and decreased 7 days after ESWL. VPC occurred during 23 treatments (37.7%) but during ESWL no significant relationship was observed with the treatment side or location. Epinephrine increased significantly immediately after ESWL. hANP increased significantly immediately after ESWL, and decreased 7 days later. VPC occurred in all patients who had an hANP value above 40 pg/ml before ESWL. These results suggest that VPC is related to hemodynamic changes, and that hANP can predict VPC during ESWL.