Effect of ultra short-acting β1-adrenergic receptor blocker on cardiac muscle as an immunomodulation therapy under excessive stress.

科学研究費補助金研究成果報告書研究種目: 基盤研究(C)研究期間: 2008～2010課題番号: 20592119研究代表者: 辻田 靖之（滋賀医科大学・医学部・講師）連携研究者: 江口 豊（滋賀医科大学・医学部・教授）連携研究者: 五月女 隆男（滋賀医科大学・医学部・准教授）連携研究者: 浜本 徹（滋賀医科大学・医学部・助教）連携研究者: 山根 哲信（滋賀医科大学・医学部・助教）連携研究者: 早藤 清行（滋賀医科大学・医学部・助教）全身性炎症反応症候群(SIRS)による頻脈性の発作性心房細動に対してランジオロールを投与した症例で心拍数と血圧、血行動態、投与前後の炎症性サイトカイン濃度の変化を調べ、他剤(ジゴキシン、シベンゾリン、ベラパミル)と効果を比較した。ランジオロール投与により心拍数は大きく低下、血圧は軽度低下、心係数は低下、一回拍出係数は増加、IL-6濃度が低下した。他剤より心拍数低下作用が強く、血圧低下作用は同等であった。除細動効果はジゴキシン、ベラパミルより高く、シベンゾリンに匹敵した。Patients of paroxysmal atrial fibrillation with a rapid ventricular response caused by SIRS were injected with landiolol, a short-acting selective β1-adrenergic receptor blocker and the changes in heart rate and blood pressure were recorded, hemodynamic parameters including cardiac index were measured, and the serum levels of inflammatory cytokines were measured. Next, we compared the effects of landiolol, digoxin, cibenzoline, and verapamil for patients with paroxysmal atrial fibrillation and a rapid ventricular response caused by SIRS. Landiolol certainly decreased the heart rate without inducing a massive decline in blood pressure. Landiolol decreased cardiac index, but increased the stroke volume index. Landiolol decreased the serum levels of interleukin-6. Landiolol decreased the heart rate more than the other drugs. The blood pressure lowering effect of landiolol was comparable to those of cibenzoline and verapamil. The success rate of pharmacological cardioversion using landiolol was higher than that using digoxin or verapamil, and was nearly equal to that using cibenzoline