ニューロゲン性正静性低血圧におけるノルエピネフリン前駆体療法
Horacio Kaufmann1, Daniela Saadia, Andrei Voustianiouk
1Mount Sinai School of Medicine, Box 1052, New York, NY 10029, USA. Horacio.Kaufmann@mssm.edu
Circulation
|July 30, 2003
まとめ
神経性正静性低血圧 (NOH) の患者は,L-threo-3,4-dihydroxyphenylserine (L-DOPS) 治療で改善された血圧と立った状態の耐性を経験しました. この合成アミノ酸はノレピネフリン (NE) に変換され,血圧を効果的に上昇させます.
科学分野:
- 神経科学は神経科学である.
- 薬理学 薬理学とは
- 心血管医学は,心臓血管医学である.
背景:
- ニューロゲン性正静性低血圧 (NOH) は,シナプス裂け目におけるノルアピネフリン (NE) の供給が不十分で,立ち上がった時の血圧調節が悪くなることが特徴です.
- この欠乏症は,患者の直立した姿勢で血圧を維持する能力に重大な影響を及ぼします.
研究 の 目的:
- L-threo-3,4-dihydroxyphenylserine (L-DOPS) が重度のNOHを患っている患者の血圧と正静性耐性を改善する効果を調査する.
- L-DOPSが圧縮効果を発揮するメカニズムを決定する.
主な方法:
- ドス・タイトレーション研究により,19人のNOH患者 (8人が純粋な自律性障害,11人が多系統性縮症) で最適なL-DOPS用量を特定しました.
- ダブルブラインド,プラセボ対照,クロスオーバー試験では,L-DOPSが血圧と静止性耐性に与える影響を評価した.
- 血のNE濃度と,L-DOPS応答に対するカルビドーパ (L-芳香性アミノ酸デカルボキシラーゼ阻害剤) の影響が評価されました.
主要な成果:
- 口服によるL-DOPS投与は,数時間の間,横になった状態と立った状態の両方で平均血圧を著しく増加させた.
- L-DOPS治療後に参加したすべての患者で,正静的耐性が改善されました.
- 血圧上昇は血のNE濃度の上昇と相関しており,カルビドーパ投与はNE増加とプレッサー応答の両方を鈍化させた.
結論:
- L-DOPSの急性投与は,NOH患者の血圧を効果的に上昇させ,正静性耐性を高めます.
- L-DOPSの治療効果は,中枢神経系の外でノレピネフリン (NE) に変換されることから起因する.
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