陳旧性心筋梗塞の予後評価を²⁰¹Tl心筋シンチグラフィおよび^99mTc心シンチグラフィによって57例について発症後5年間follow upを行い, 検討した。
心筋梗塞発症時期を60歳以上の高年者群と60歳未満の比較的若年者群で比較すると心係数では経時的な変化はなく, 左室駆出率は比較的若年者群で有意な (p<0.05) 低下を示した。また, 右室駆出率については著変を認めなかった。冠動脈造影によるCAGスコアとhandgrip負荷での△LVEFの変化はy=-1.34x+3.61 (r=-0.400, n=44, p<0.01) と弱い逆相関を認めた。またT1欠損率の初回および最終検査を高年者, 若年者間で比較すると有意差はないが, 若年者群で欠損率の上昇傾向があった。
以上, 心機能・心筋血流の核医学的検査が心筋梗塞の予後の評価として有意な検査法であり, リハビリテーションおよび日常生活指導に役立つと考えられたので報告する。

抄録全体を表示

動脈硬化の進行度を表す臨床的指標として生理学的に算出された大動脈脈波速度 (PWV) と生化学的に求められた動脈硬化指数 (AI) が知られている. 前者は主として大動脈の硬化度を, 後者は主に細小動脈の硬化度を知る指標と考えられる. われわれは超高齢者, ことに百寿者におけるPWVおよびAIについて検討するため, 沖縄県在住の健康百寿者40名 (男7名, 女33名; 平均101.1歳: 100～105歳) を対象とし, 70歳以上90歳未満の健康老齢者92名 (男45名, 女47名; 70歳代74名うち男36名, 女38名; 80歳代18名うち男9名, 女9名; 平均75.8歳) を対照に比較検討した. PWVについては全百寿者の平均値 (10.15m/s) は全対照の平均値 (8.45m/s) に比べ有意に高かった (p<0.0001). AIでも全百寿者の平均値 (1.91) と全対照の平均値 (2.59) との間に有意差を認めた (p<0.0001). PWVとAIの間には百寿者と対照老人で, おのおのr=0.0049, r=0.094と双方とも相関は認められなかった. しかし分布の様相にはおのおの特徴が見られ, 対照老人と百寿者では動脈硬化の部位およびその進行状況が異なっている可能性があることが示唆された.

抄録全体を表示

HWA 285 expected to have an anti-arteriosclerotic activity for its inhibitory action on the cyclic AMP phosphodiesterase. The inhibitory activity on the enzyme resulted in improving vasodilative function and erythrocyte deformity as well as repressing platelet coagulation. We have investigated the anti-arteriosclerotic activity of HWA 285 on the following study using arteriosclerotic rabbits: histochemical examinations of six structural components from aorta and one biophysical characteristics of aorta, i. e., the pulse wave velocity (PWV).
Material and methods: twenty eight Japanese albino domesticated rabbits, 38 months old male, were divided into three groups; 13 rabbits for healthy group (H), 9 for arteriosclerosis (S) and 6 for HWA 285 treated (A). Lesions on both intima and media in aorta were made by nitrogen inhalation, intramuscular injection of norepinephrine and cholesterol peroral ingestion. Group A received one dose of HWA 285, 3mg/kg/day, through intravenous injection at the same time the load test was started. An external loop of carotid artery was made and used for measuring both PWV and blood pressure. All animals were sacrificed 16 weeks later and examined for the following items in their thoracic media by MSP method; smooth muscle cell (SMC), nuclear DNA (DNA), elastin (EL), collagen (CL), acid mucopolysacharides (AMPS), glycoprotein (GP) and calcium phosphate (CA). The differences in the six structural materials among three groups were evaluated with the principale component analysis.
Results: The H group showed PWV between 7 and 8m/sec and the S group exhibited it gradual increase to 9m/sec. Whereas, the A group had a declining trend in PWV and significantly lower values than that of the S group (p<0.001). The average regression coefficiencies for the H, S and A group were 0.0109, 0.0626, and -0.056m/sec/ wk, respectively. The S group clearly showed some lesions on SMC, reduction in the amount of EL and CL, increase in diseased connective tissues and deposition of CA under histochemical studies. Among the A group, however in both tissues and the amount of components were observed only in slight. Since HWA 285 has more than three times of efficacy than its analogue, pentoxifylline, further clinical evaluation on this drug should be forthcoming. Besides HWA 285 has the anti-arteriosclerotic function observed in this study, we believe that it has some activity which acts directly on metabolism in smooth muscle cells of aortic wall and connective tissues.

抄録全体を表示

On healthy normal Japanese living in principal cities of Japan, examination was made of the relationship between levels of 4 serum lipids, i.e. total cholesterol (TC), triglyceride (TG), β-lipoprotein (β-LP) and HDL-cholesterol (HDL), and ischemic ECG changes or aortic pulse wave velocity values (PWV) in recent (1984) epidemiological cases of 18, 873 males and 5, 471 females, 24, 344 in total, aged from the twenties to the seventies.
1) Incidence of ischemic ECG changes in each serum lipid value showed better and weaker positive correlations for TC from the thirties to the fifties of males and females, respectively. For TG, no definite tendency was seen except for the weak positive correlation observed for males from the thirties to the forties.
2) In terms of the relationship between each serum lipid value and PWV value indicative of organic changes in the aorta, no definite tendency was seen except for positive correlation for TC at each age-group of both sexes. Correlation coefficiency showed low values, and each serum lipid tended to show higher values for females than for males. However, mean PWV value in each serum lipid value was only a little higher for males than for females.
3) Change in PWV valve showed a significantly high value for each age-group of both sexes in the ischemic ECG change-positive group, with the difference by sex being only a little greater for males. Incidence of ischemic ECG changes in each PWV value showed an exponential function increase, suggesting a progress of PWV value preceded by some ischemic ECG changes.

抄録全体を表示

Effect of clinofibrate, a serum lipid reducing agent, upon prolonged administration was studied referring to rise and fall of aortic pulse wave velocity (PWV) that is one of the nonivasive evaluations of arteriosclerosis.
A total of 49 patients including 28 males and 21 females with arteriosclerotic diseases without administration of antiarteriosclerotic agent, their age ranging from 47 to 83 years, 68.5 years on an average, were used as the sclerotic group (S group), while a total of 41 patients including 24 males and females under administration of clinofibrate (Lipoclin^®) at 600-1, 200mg/day, their age ranging from 48 to 83 years, 62.9 years on an average, were used as the administration group (A group).
PWV was applied to all of the patients every 3 months, blood pressure was measured once a month, and blood chemical assay of serum lipid, etc., was carried every 4 months. The observation period ranged from 25 to 129 months (72.2 months on an average) for the S group and from 2 to 25 months (12.5 months on an average) for the A group. PWV was measured by simultaneous tracing of carotid pulse, femoral pulse and heart sound as well as distance in a straight line from the right sternal border connected with the second costa to the position whereat femoral pulse was traced, using the following formula:
PWV=[D×1.3/t+t_c]_p
wherein:
D: Distance in a straight line from the right sternal border connected with the second costa,
1.3: Anatomical smoothing value to the true length of aorta,
t: Starting time difference between carotid and femoral pulse tracings,
t_c: Starting time difference between aortic second sound and carotic notch, and
p: Minimum brachial pressure upon measurement.
As PWV depends on the minimum blood pressure, correct it to a PWV at minimum blood pressure of 80mmHg using a pressure calibration to have individuals comparable.
When changes of PWV (ΔPWV) on an average of both groups are compared every 5 months, it was 0.17m/sec by 5 months, 0.31m/sec by 10 months, 0.56m/sec by 15 months, 0.82m/sec by 20 months and 0.90m/sec by 25 months respectively in the S group, while in the A group it was 0.06m/sec by 5 months, 0.05m/sec by 10 months, 0.19m/sec by 15 months, 0.13m/sec by 20 months and 0.1m/sec by 25 months respectively. PWV varied within the low level, and after 20 and 25 months the A group showed the lower value at 5% and 1% levels of significance respectively.
It was suggested that upon prolonged administration of clinofibrate, organic arteriosclerotic lesion is inhibited.

抄録全体を表示

Effect of soysterol obtained from soybeans was studied referring to rise and fall of aortic pulse wave velocity (PWV) of rabbits with experimental arteriosclerosis, observation of arterial wall constituents and assay.
Twenty-seven male rabbits of 38 months were divided into the healthy group (H group) of 13 rabbits, the sclerotic group (S group) of 9, and the soysterol administration group (A group) of 5 respectively. For producing arteriosclerosis, N₂ gas inhalation, intramuscular injection of norepinephrin and oral administration of cholesterol were used combinedly. To the A group at the same time as loading 200 mg of soysterol (Moristerol^®) was given once a day. PWV and blood pressure were measured every two weeks to see their rise and fall. After 22 weeks all the rabbits were killed and 6 components in media of thoracic aorta, namely, smooth muscle cell (SMC), nuclear DNA (DNA), elastin (EL), collagen (CL), acid mucopolysaccharides (AMPS), and glycoprotein (GP) were observed histochemically by MSP and assayed. Furthermore, a series of principal component analysis was conducted to generally evaluate differences among those 3 groups as to changes of those 6 components. When rise and fall of PWV in those 3 groups were observed with average regression coefficient, it was 0.0109 m/sec/W with the H group, 0.0626 m/sec/W with the S group and-0.0326 m/sec/W with the A group, showing the lower value with the A group than that of the S group. An average PWV changes (ΔPWV) in every 3 months was hardly observed in the H group, but in the S group after 6 weeks, it increased by 0.9 m/sec on an average. On the other hand in the A group during the total course, an apparent decreasing trend was observed, and a significant decrease was noted 6 weeks after starting of administration onward. Upon histochemical observation, atrophy, disappearance and decrease of SMC, fragmentation and disappearance of EL and CL, uneven distribution and increase of AMPS and GP, and increase of calcium phosphate were noted in the S group, while in the A group either component received only mild disturbances, showing intermediary values between H group and S group. Amount of the components with the H group, S group and A group respectively were as follows
SMC: 40.6±6.6, 32.6±4.4, 40.6±8.0% E
DNA: 293.8±61.8, 283.1±51.2, 316.0±74.9% E
EL: 52.8±4.3, 42.3±2.6, 51.6±7.5% E
CL: 38.8±4.0, 33.3±3.7, 37.3±1.8% E
AMPS: 28.4±6.6, 35.7±5.4, 32.7±2.7% E
GP: 33.2±3.7, 39.7±5.3, 36.1±3.8% E
Upon principal component analysis and a study of their distribution on the quadratic coordinates in comparison of those 3 groups, it was suggested that distribution of the A group being near the region of the H group, soysterol has an antiarteriosclerotic effect.

抄録全体を表示

Studies show that arteriosclerosis advances first in the aorta and then proceeds to the cerebral and coronary arteries. Because the aortic pulse wave velocity (PWV) can be used to estimate the extent of arteriosclerosis in the aorta, the use of PWV may allow earlier detection of arteriosclerotic diseases.
This study examined the relationship between PWV and other arteriosclerotic indicators including (1) arteriolar sclerotic changes in the retina as evaluated by Scheie's method (≥grade II); (2) ischemic ECG changes (Minnesota code: 4-1, 4-2, 4-3, 4-4 and/or 5-1, 5-2, 5-3); and (3) hypertension determined as systolic pressure ≥160mmHg and/or diastolic pressure >95mmHg. Subjects were 221, 564 male urban workers, 20-69 years of age, who participated in cardiovascular disease screening in major cities in Japan. This study sample did not include patients with hypertension, diabetes, hyperlipidemia, or gout, or those having a history of cardio- and/or cerebrovascular diseases.
We examined the prevalence of each of the above three indicators at various PWV levels (<7.0, 7.0-7.9, 8.0-8.9, 9.0-9.9, ≥10.0m/sec.) in different age groups (20-29, 30-39, 40-49, 50-59, 60-69 years old).
The prevalence of each of the three indicators increased exponentially as the PWV became faster in all age groups examined with the exception of the prevalence of hypertension due to elevated diastolic pressure in patients 60-69 years old; the prevalence of each condition increased significantly at PWV scores of 8.0m/sec or greater among those under 60 years old and 9.0m/sec or greater among those 60-69 years old.
It is suggested that PWV advances prior to the appearance of the indicators examined and that the use of PWV in mass screenings can contribute significantly to the prevention of arteriosclerotic diseases.

抄録全体を表示

We have developed a method of pulse wave velocity (PWV) determination for an aid of noninvasive diagnosis of arteriosclerosis, and have studied the principle of pulse generation and theory of wave transfer, its relation to the quantitative histological findings, organ specific distribution of arteriosclerosis, and other basic, clinical and epidemiological problems on PWV,
In the present paper, features of the complicated arteriosclerosis with hypertension were examined using PWV based on the epidemiological interests. Subjects:
Epidemiological subjects: Among 128, 127 male subjects examined in the occasion of mass physical examinations for 30 to 60s of age without the of cerebral apoplexy and cardiac attack, 12, 231 cases with history of hypertension, 7, 253 cases without history of hypertension but hypertension with maximum blood pressure more than 180 and/or minimum blood pressure more than 100mmHg being found in the mass physical examination, and 108, 643 cases of the control with no hypertensive history, showing less than 158 and/or less than 88mmHg of blood pressure were the subjects of epidemiological examination.
Results:
The PWV values of the epidemiological subjects (having history of hypertension, and hypertensive subjects) were higher than those in the control subjects. However, the PWV values in the hypertensive history bearing and hypertensive patients in the epidemiological examination were not significantly different among various age group, and considering the fact that the hypertensive history bearing cases had recived some treatments, treatment of hypertension might not be directly and positively effective in the improvement of arteriosclerosis.

抄録全体を表示

大動脈壁の硬さの非観血的測定法として大動脈脈波速度法 (PWV) が用いられており, PWV値は動脈硬化の臨床的な指標の一つとして注目されている. そこで, 我々は, PWV値が冠動脈硬化の存在および重症度とどのように関連するかを検討するために, 冠動脈撮影 (CAG) を行った105例 (男性84例, 58±1歳; 女性21例, 59±0.2歳) につきCAG所見とPWV値とを対比した. CAGは, 狭窄病変を有する冠動脈分枝数により正常群 (N群), 一枝病変群 (1VD群), 二枝病変群 (2VD群), 三枝病変群 (3VD群) に分類し, また American Heart Association による冠動脈の15区域において, それぞれの狭窄の程度に応じて, 0～4の5段階に評価しその合計をCAGの重症度スコア (CAGスコア) としPWV値と比較した. N群 (n=18; 53±2歳) では, PWV値は8.0±0.34m/sec, 冠動脈に狭窄病変を有する群 (n=87; 60±0.9歳) では8.9±0.20m/secと両群に有意差を認めなかった. 1VD, 2VD, 3VD群の各々のPWV値をN群と比較すると3VD群 (n=10; 63±3.6歳) ではPWV値10.0±0.88m/secとN群に比し有意に高値を示したが他の群間には有意な差を認めなかった. PWV値とCAGスコアとの単相関をみると, r=0.267と有意の (p<0.01) の正の相関を認めたが, 年齢の因子を加え重回帰分析を行うと両者の間には有意の相関を認めなかった. PWV値と年齢の間には既に指摘されているような有意の正の相関 (p<0.05) を認めた. 以上の結果から, PWV値は大動脈の加齢変化とよく相関するが, 冠動脈狭窄病変の有無および重症度とは相関しないと考えられた.

抄録全体を表示