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Increased plasma adenosine concentration in the subacute phase may contribute to attenuation of left ventricular dilation in the chronic phase in patients with acute myocardial infarction

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Title

Increased plasma adenosine concentration in the subacute phase

may contribute to attenuation of left ventricular dilation in the

chronic phase in patients with acute myocardial infarction( 内容

と審査の要旨(Summary) )

Author(s)

畑佐, 匡紀

Report No.(Doctoral

Degree)

博士(医学) 甲第1110号

Issue Date

2019-06-19

Type

博士論文

Version

ETD

URL

http://hdl.handle.net/20.500.12099/78510

※この資料の著作権は、各資料の著者・学協会・出版社等に帰属します。

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,8 ௨ୖ࡛᭷ពᕪࡣ࡞࠿ࡗࡓࠋ շ $0, ⩌࡟࠾࠸࡚㸪Ǽ()㸦៏ᛶᮇࡢ ()㸫ᛴᛶᮇࡢ ()㸧ࡣ 0D[ DGHQRVLQH ࡸǼDGHQRVLQH ࡜┦㛵㛵 ಀࡣ࡞࠿ࡗࡓࠋ ո 0D[DGHQRVLQH ࡣǼ/9'G㸦៏ᛶᮇ /9'G㸫ᛴᛶᮇ /9'G㸧࡜㏫┦㛵ࡢഴྥࡣ࠶ࡗࡓࡀ᭷ពᕪࡣ࡞࠿ ࡗࡓࠋ չ ǼDGHQRVLQH ࡶǼ/9'G ࡜㏫┦㛵ࡢഴྥࡣ࠶ࡗࡓࡀ᭷ពᕪࡣ࡞࠿ࡗࡓࠋ պ 0D[ DGHQRVLQH ࡣǼ/9'G ࡀ  ௨ୗࡢ⑕౛࡛㸪 ࡼࡾ኱ࡁ࠸⑕౛࡜ẚ㍑ࡋ㸪᭷ព࡟㧗್࡛࠶ࡗࡓ 㸦S 㸧ࠋ ջ ǼDGHQRVLQH ࡶǼ/9'G ࡀ  ௨ୗࡢ⑕౛࡛㸪 ࡼࡾ኱ࡁ࠸⑕౛࡜ẚ㍑ࡋ㸪᭷ព࡟㧗್࡛࠶ࡗࡓ 㸦S 㸧ࠋ ࠙⪃ᐹࠚ ࢔ࢹࣀࢩࣥࡣᚰಖㆤస⏝ࡀ࠶ࡿ࡜ࡉࢀ࡚࠸ࡿࡀ㸪ᛴᛶᚰ➽᱾ሰࡢᛴᛶᮇ࡟ࡣ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡣ ቑຍࡋ࡚࠾ࡽࡎ㸪 ᪥ᚋ࡟᭷ព࡟ቑຍࡋ࡚࠸ࡓࠋࡑࡢ᫂ࡽ࠿࡞ᶵᗎࡣ୙࡛᫂࠶ࡿࡀ㸪ᚰ➽⹫⾑⮬యࡼ ࡾࡶࡑࡢ௚ࡢせᅉࡢᙳ㡪ࢆᙉࡃཷࡅ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋᡃࠎࡣ㸪௨๓㸪ᕥᐊ཰⦰⬟పୗ࠾ࡼࡧᕥᐊ ᣑᙇࡢ⑕౛࡛ࡣ㸪௦ൾⓗ࡟⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡀቑຍࡋ࡚࠸ࡿࡇ࡜ࢆሗ࿌ࡋࡓࠋᮏ◊✲࡟࠾࠸࡚ࡶ㸪 ᕥᐊ཰⦰⬟పୗࡸᕥᐊᣑᙇࡀ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘቑຍࡢཎᅉ࡜࡞ࡗ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋ 0D[ DGHQRVLQH ࡜ǼDGHQRVLQH ࡀǼ/9'G  ௨ୗࡢ⑕౛࡛㸪 ࡼࡾ኱ࡁ࠸⑕౛࡜ẚ㍑ࡋ᭷ព࡟㧗್࡛ ࠶ࡿ࡜ࡢ⤖ᯝ࠿ࡽ㸪ᛴᛶᚰ➽᱾ሰࡢளᛴᛶᮇ࡟ቑຍࡋࡓ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡣ៏ᛶᮇࡢᕥᐊᣑᙇࢆῶ ᑡࡉࡏ࡚࠸ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋளᛴᛶᮇࡢ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡢቑຍ㔞ࢆ ᐃࡍࡿࡇ࡜࡛㸪៏ᛶ ᮇࡢᕥᐊᣑᙇࢆண ࡛ࡁࡿྍ⬟ᛶࡀ࠶ࡿࠋ0D[DGHQRVLQH ࡜ǼDGHQRVLQH ࡀǼ() ࡜┦㛵ࡋ࡚࠸࡞࠿ࡗ ࡓ⤖ᯝ࠿ࡽ㸪ᛴᛶᚰ➽᱾ሰᚋࡢෆᅉᛶ࢔ࢹࣀࢩࣥᨺฟࡣ៏ᛶᮇࡢᕥᐊᶵ⬟ࢆᨵၿࡍࡿ࡟ࡣ୙༑ศ࡛࠶ ࡿ࡜⪃࠼ࡽࢀࡓࠋ៏ᛶᮇࡢᕥᐊᶵ⬟ࢆᨵၿࡍࡿࡓࡵ࡟ࡣ㸪࢔ࢹࣀࢩࣥ࢔ࢦࢽࢫࢺࡸ࢔ࢹࣀࢩࣥ⏘⏕⸆ ࡀᚲせ࠿ࡶࡋࢀࡎ㸪ᐇ㝿࡟㸪ᛴᛶᚰ➽᱾ሰࡢ៏ᛶᮇ࡟ GLS\ULGDPROH ࢆᢞ୚ࡋ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࢆ ୖ᪼ࡉࡏࡿࡇ࡜࡛㸪ᕥᐊᶵ⬟ࢆᨵၿࡋ㸪ᕥᐊࣜࣔࢹࣜࣥࢢࡸ៏ᛶᚰ୙඲ࡢᛴᛶቑᝏࢆῶᑡࡉࡏࡓ࡜࠸ ࠺ሗ࿌ࡶ࠶ࡿࠋ ࠙⤖ㄽࠚ ᛴᛶᚰ➽᱾ሰᝈ⪅࡟࠾࠸࡚㸪⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡣளᛴᛶᮇ࡟ቑຍࡋࡓࠋෆᅉᛶ࢔ࢹࣀࢩࣥࡣᛴᛶ ᚰ➽᱾ሰ៏ᛶᮇࡢᕥᐊᣑᙇࢆᢚไࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ  ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ⏦ㄳ⪅ ⏿బ ໷⣖ࡣ㸪⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡀᚰ➽᱾ሰᛴᛶᮇ࠿ࡽளᛴᛶᮇ࡟࠿ࡅ࡚᭷ព࡟ୖ᪼ࡍ ࡿࡇ࡜ࢆ♧ࡋࡓࠋࡲࡓ៏ᛶᮇ࡟ᕥᐊᣑᙇᮎᮇᚄࡀ⦰ᑠࡋࡓ⑕౛࡜ᣑ኱ࡋࡓ⑕౛ࢆẚ㍑ࡍࡿ࡜㸪ᛴᛶᮇ ࠥளᛴᛶᮇ࡟࠿ࡅ࡚ࡢ⾑₢࢔ࢹࣀࢩࣥ⃰ᗘࡢ᭱㧗⃰ᗘ࠾ࡼࡧኚ໬㔞ࡣ㸪⦰ᑠࡋࡓ⑕౛࡛᭷ព࡟㧗ࡃ࡞ ࡿࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓࠋᮏ◊✲ࡣᚰ➽᱾ሰ៏ᛶᮇࡢᕥᐊᶵ⬟ࢆᨵၿࡍࡿ┠ⓗ࡛㸪࢔ࢹࣀࢩࣥ࢔ࢦࢽࢫ ࢺࡸ࢔ࢹࣀࢩࣥ⏘⏕⸆ࡀ᭷⏝࡛࠶ࡿྍ⬟ᛶࢆ♧၀ࡋ㸪ᚠ⎔ჾ⑓ᏛࡢⓎᒎ࡟㈉⊩ࡍࡿࡶࡢ࡜ㄆࡵࡿࠋ 㹙୺ㄽᩥබ⾲ㄅ㹛 0DVDQRUL +DWDVD  7RVKLNL 7DQDND  6KLQJR 0LQDWRJXFKL  <RVKLKLVD <DPDGD  +LURPLWVX .DQDPRUL0DVDQRUL.DZDVDNL.D]XKLNR1LVKLJDNL<XNLKLUR(VDND%XQML8QR6KLQ\D 0LQDWRJXFKL  ,QFUHDVHG SODVPD DGHQRVLQH FRQFHQWUDWLRQ LQ WKH VXEDFXWH SKDVH PD\ FRQWULEXWHWRDWWHQXDWLRQRIOHIWYHQWULFXODUGLODWLRQLQWKHFKURQLFSKDVHLQSDWLHQWV ZLWKDFXWHP\RFDUGLDOLQIDUFWLRQ

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