|
埼玉医科大学雑誌 第30巻 第1号 (2003年1月) 19-28頁 ◇論文(図表を含む全文)は，PDFファイルとなっています． PDF (1.2 MB) 原 著 レニン-アンジオテンシン系抑制薬は透析療法を受けている糖尿病性腎症患者の左室肥大を抑制する 金子 敬子 入間台クリニック（〒358-0031 埼玉県入間市新久816）〔平成14年12月9日 受付〕 Left Ventricular Hypertrophy (LVH) and Inhibition of Renin-Angiotensin System with ACE Inhibitor (ACEi) or Angiotensin Receptor Antagonist (AIIA) in Diabetic Patients on Dialysis Therapy Keiko Kaneko ( Irumadai Clinic, Iruma-shi, Saitama 358-0031, Japan ) Background: LVH is frequently found in diabetic and hypertensive patients at the initiation of dialysis therapy and is highly predictive of future cardiac morbidity and mortality. However, it is unknown whether the blockage of renin-angiotensin system will regress LVH or not in these patients using ACEi or AIIA or both of them in combination. Method: Twenty four diabetic patients (62±3 years old; F/M: 8/16) with end-stage renal disease who had just entered into hemodialysis therapy and were diagnosed as having LVH evaluated by echocardiography were selected from 5 dialysis units staffed by the faculty of Saitama Medical School, Saitama, Japan between 1996 and 1998. The study was carried out for 2 years. An ACEi, enalapril 5 mg daily or an AIIA, losartan 50 mg daily was assigned at random. These drugs were administered 30 min after the cessation of dialysis therapy and usually given after lunch when dialysis therapy was not received. The doses of these drugs were adjusted up to 10 mg or 100 mg daily respectively according to the levels of blood pressure. One year after the start of the study, if LVH was not regressed in spite of treatments with enalapril or losartan, add-on each other drug was done. Results: Using repeated measures analysis of variance, applied to those with four echocardiograms, there were progressive decreases over time in LV mass index (LVMi: g/m2), posterior wall thickness, left ventricle end-diastolic diameter, interventricular thickness. The biggest changes in LVMi and other parameters found between the baseline and year 1 (147±14 vs. 138±12 g/m2). Combination therapy of enalapril and losartan for 7 patients who did not respond the initial therapy produced a significant reduction of LVH at the end of study. There was no significant difference in regression of LVH as well as blood pressure control and other variables between enalapril and losartan. Furthermore, there were significant correlations between the variables obtained from the repeated echocardiography related with LVH and systolic blood pressure in all patients. Conclusion: Antihypertensive treatment with either ACEi or AIIA is beneficial in the regression of LVH in diabetic patients who started dialysis therapy. Moreover, a combination therapy with ACEi and AIIA would provide a favorable effect on LVH in those patients unless a single administration of ACEi or AIIA is effective. Keywords: Left ventricular hypertrophy, Renin angiotensin system, combination therapy J Saitama Med School 2003;30:19-28 (Received December 9, 2002)
|