冠動脈造影に伴う心理的ストレスが血漿カテコラミン, 血小板機能に及ぼす影響

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Emotional stress is believed to be one of the risk factors of ischemic heart disease. However, the mechanism how emotional stress relates to the development of ischemic heart disease is not clear. Platelets and catecholamines are known to play an important role in the pathogenesis of atherosclerosis. On the other hand, patients undergoing cardiac catheterization usually feel much emotional stress such as anxiety and fear. In this study, we investigated the effects of emotional stress on cardiovascular hemodynamics, plasma catecholamines, and platelet function in patients with ischemic heart disease at cardiac catheterization. Blood samples were obtained from 20 patients with ischemic heart disease immediately before cardiac catheterization (stress period) without premedication. Control blood samples were obtained from these patients one week after cardiac catheterization (no stress period). At the same time, systolic and diastolic blood pressures, and heart rate were simultaneously monitored. The plasma levels of epinephrine, norepinephrine, β-thromboglobulin (βTG) and platelet factor 4 (PF 4) were determined. Whole blood platelet aggregation induced by ADP was also measured. The concentrations of epinephrine and norepinephrine were measured by HPLC-THI, and those of βTG and PF 4 were determined by radioimmunoassay. Whole blood platelet aggregation induced by 10μM ADP was determined by impedance method, Systolic and diastolic blood pressures in stress period (141.5±l8.4 mmHg, 79.3±11.5,respectively) (mean±tSD) were significantly elevated compared with those in no stress period (117.8±9.O, 70.8±8.9,respectively). Heart rate in stress period was also significantly higher than that of no stress period. Plasma levels of epinephrine and norepinephrine in stress period (0.098±0.051 ng/ml, 0.320±0.140 ng/ml, respectively) were significantly increased from those in no stress period (0.033±0.019. 0.251±0.101,respectively). The increasing rate (stress period/ no stress period) of epinephrine was 2.93,and that of norepinephrine 1.27. Plasma levels of βTG and PF 4 in stress period (71.4±18.9 ng/ml, 20.9±8.3 ng/ml, respectively) were significantly elevated compared with those in no stress period (36.6±6.4,11.5±5.7,respectively). Whole blood platelet aggregation in stress period was also elevated compared with that in no stress period. In this study, it was clarified that emotional stress caused in increase of plasma levels of catecholamines and the activation of platelet function, and suggested that these changes at least in part related to the development of ischemic heart disease.
日本心身医学会の論文
1993-08-01

冠動脈造影に伴う心理的ストレスが血漿カテコラミン, 血小板機能に及ぼす影響

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