Responsiveness of internal thoracic arteries to nitroglycerin in patients with renal failure
Responsiveness of internal thoracic arteries to nitroglycerin in patients with renal failure
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DOI：
10.1007/s00380-017-1105-1
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发表时间：
2018-06-01
影响因子：
1.5
通讯作者：
Okamura，Tomio
中科院分区：
文献类型：
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作者：
Tawa，Masashi;Kinoshita，Takeshi;Okamura，Tomio
硝酸甘油通常用作解痉药，用于治疗冠状动脉搭桥术的痉挛。本研究调查了肾衰竭的存在是否影响接受冠状动脉搭桥手术的患者胸内动脉对硝酸甘油的反应性。根据估计的肾小球滤过率（eGFR，mL/min/1.73 m2）将患者分为三组：无肾衰竭（60 ≤ eGFR，n= 13）、中度肾衰竭（30 ≤ eGFR < 60，n= 10）和重度肾衰竭（eGFR < 30，n= 10）。器官室技术用于评估离体胸廓内动脉对血管扩张剂的浓度相关反应。硝酸甘油诱导浓度依赖性舒张，在重度但非中度肾衰竭患者中，这种舒张效果比没有肾衰竭的患者显着增强。此外，eGFR 与硝酸甘油的松弛功效呈负相关（P=0.016）。另一方面，三个级别的肾功能中，对 BAY 60-2770（与硝酸甘油一样增强 cGMP 生成）的松弛反应相似。也没有观察到 eGFR 与 BAY 60-2770 的松弛功效呈负相关（P= 0.314）。这些发现表明，严重的肾功能衰竭特别会增强硝酸甘油引起的胸内动脉移植物的松弛。
Nitroglycerin is commonly used as an antispasmodic for treating spasm of coronary artery bypass grafts. This study investigated whether the presence of renal failure affects reactivity to nitroglycerin in internal thoracic arteries obtained from patients undergoing coronary bypass surgery. The patients were divided into three groups according to estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): without renal failure (60 ≤ eGFR,n= 13), with moderate renal failure (30 ≤ eGFR < 60,n= 10), and with severe renal failure (eGFR < 30,n= 10). Organ chamber technique was used to evaluate concentration-related responses of isolated internal thoracic arteries to vasodilators. Nitroglycerin induced a concentration-dependent relaxation, which was significantly augmented in patients with severe but not moderate renal failure than in those without renal failure. In addition, there was a negative correlation between eGFR and the relaxant efficacy of nitroglycerin (P= 0.016). On the other hand, relaxant responses to BAY 60-2770 (which enhances cGMP generation as with nitroglycerin) were similar among three grades of renal function. An inverse relationship of eGFR to the relaxant efficacy of BAY 60-2770 was not observed, either (P= 0.314). These findings suggest that severe renal failure specifically potentiates nitroglycerin-induced relaxation in internal thoracic artery grafts.