肝素配合適當運動能減緩川崎氏疾病患的心臟局部缺血

治療將能促進新血管萌生

  日本研究人員發現,結合肝素與適當運動將能有效的降低患有川崎式疾病孩童的心肌局部缺血。以五月二十九日在issue of Circulation: Journal of the American Heart Association所發表的實驗結果為基礎,他們假設這食物治療法能刺激缺血部位的心血管增生。研究創辦人Masaru Terai提到,這肝素-運動療程,相對外科手術與血管再生手術而言,是另種不具侵襲性的選擇治療。在某些情況下,這種食物治療方法將也可以作為心血管繞道手術的銜接中繼治療。

 
 

Heparin Plus Exercise Eases Cardiac Ischemia in Kawasaki Disease

Treatment May Sprout New Blood Vessels

By Tonja Wynn Hampton, MD
WebMD Medical News

Reviewed by Michael W. Smith, MD

May 29, 2001 -- Japanese researchers have found that combining heparin and exercise may be an effective way to decrease myocardial ischemia in children with Kawasaki disease. Based on study results published in the May 29 issue of Circulation: Journal of the American Heart Association, they propose that the regimen stimulates neovascularization in ischemic areas.

Study author Masaru Terai, MD, says the heparin-exercise regimen is a noninvasive alternative to surgery or revascularization. In certain situations, the regimen also may serve as a bridge therapy to bypass surgery.

"Most patients who have coronary artery occlusion can be treated with surgical bypass if the lesion is graftable," Terai tells WebMD. "In the case of distal coronary artery obstruction, physicians may try to treat with surgery, but in most cases, [patients] do not develop angina, so such patients may not receive any treatment. Yet, even in such cases, some patients demonstrate myocardial perfusion defect during exercise." Terai is with the department of pediatrics at Chiba (Japan) University School of Medicine.

In the study, 7 patients aged 6-19 with Kawasaki disease, a completely occluded coronary artery, and stress-induced myocardial ischemia in the collateral dependent areas received a 10-day, twice-a-day regimen of heparin followed by bicycle exercise. Heparin at 100 IU/kg (maximum, 5,000 IU) was given intravenously 10 minutes before each exercise session. Bicycle exercise continued for at least 10 minutes, as long as the patient did not develop ischemic changes, ventricular tachyarrhythmia, or hypotension.

Three patients with Kawasaki disease who had myocardial ischemia and did not receive the exercise-heparin regimen served as controls.

Dipyridamole-loading single photon emission computed tomography (SPECT) was used to evaluate changes in myocardial perfusion following treatment. Computerized quantitative coronary angiography was performed to assess changes in the diameter of the occluded artery and evaluate collateral circulation. The average time between baseline and follow-up angiography was 5 months.

On SPECT, Terai and colleagues found that the heparin-exercise treated patients experienced improved myocardial perfusion in the collateral dependent areas and a significant reduction in total defect scores in all patients after the completion of 20 sessions. In contrast, control patients experienced either no change or an increase in stress defect scores.

In the heparin-exercise treated patients, angiography revealed a dramatic increase in the diameter of the occluded artery. In two of the patients, there was also evidence of the development of new epicardial collateral vessels.

Although direct evidence of neovascularization could not be found in the study, Terai says the increased blood flow around the ischemic areas suggests that heparin may be creating new vessels.

But he tells WebMD that previous studies have shown neither heparin nor exercise alone was enough to improve blood flow, implying that the combination of heparin and exercise is necessary.

Kathryn Taubert, PhD, vice president of science and medicine at the American Heart Association, says the study is a hopeful sign for some kids with cardiac problems resulting from Kawasaki disease.

"Heparin is believed to help the growth of new blood vessels," Taubert says. "The new blood vessels sprout and provide an alternative channel for blood to flow around the clot. Hopefully, this would be an alternative to open heart surgery."

"It's a very positive finding," she tells WebMD. "It's the first study, and it included only seven patients, so we want to see if it holds true in a larger population."

With reporting by Mark Moran

© 2001 WebMD Corporation. All rights reserved.

    



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