| 特集名 | 透析患者の心臓―心臓病による死亡を減らすために | |
|---|---|---|
| 題名 | 長期透析患者の心臓病理学 | |
| 発刊年月 | 2010年 05月 | |
| 著者 | 河上 牧夫 | 聖隷佐倉市民病院病理科 |
| 著者 | 吉田 啓 | 東京慈恵会医科大学病院腎臓内科 |
| 著者 | 中山 昌明 | 東北大学大学院腎不全対策研究講座 |
| 著者 | 池上 雅博 | 東京慈恵会医科大学病院病理部 |
| 著者 | 川口 良人 | 東京慈恵会医科大学腎・高血圧内科客員教授／神奈川県立汐見台病院顧問 |
| 【 要旨 】 | 心臓は駆出エンジン部Aとその支援装置Bからなっている．腎糸球体での限外濾過の駆動力となる心臓は，腎血流廃絶によって量圧負荷はともにたかまる．それらの負荷は，透析による改善が期待されるが，心室のさらなる拡張性肥大をきたすのみならず，A領域には末期exponentialな心筋間質の脱水性びまん性collagenosis，B領域では弁膜，冠動脈の硬化のlinearな増強を有意にきたす．加えて石灰化は後者により強く発現し，ケースによっては心筋実質内の細動脈や硬化間質にも及ぶ．これら一連の変化群が透析の長期化に伴いlinearまたはexponentialに増強している事実は“uremic heart”の病変の増強的進展の延長上に“透析心”が位置し，その疾患概念の確立に有意に働く． | |
| Theme | Heart and it's Diseases in Dialysis Patients -- For their better longevity | |
|---|---|---|
| Title | Cardiac pathology of long-term dialysis | |
| Author | Makio Kawakami | Department of Pathology, Seirei Sakura Hospital |
| Author | Hiraku Yoshida | Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine |
| Author | Masaaki Nakayama | Research Division of Dialysis and Chronic Kidney Disease, Tohoku University Graduate School of Medicine |
| Author | Masahiro Ikegami | Department of Pathology, Clinical Service, The Jikei University School of Medicine |
| Author | Yoshindo Kawaguchi | Division of Nephrology and Hypertension, The Jikei University School of Medicine/Kanagawa Prefectual Shiomidai Hospital |
| [ Summary ] | The heart consists of two elements. The first element may be thought of as an "engine" (A), due to its function in providing circulatory motive power. The secondary cardiac functions may be considered to be "supportive" (B). Because of its roles in producing glomerular ultrafiltrates and controlling renal blood flow, the heart is burdened with the tasks of modulating both blood pressure and volume. It is hoped that therapeutic intervention with hemo or peritoneal dialysis may provide some relief for stress placed on the heart. However, that treatment modality may lead to increased ventricular dilatative hypertroghy. Diffuse collagenosis and cardiac degeneration may occur at exponentially, increasing rates in the later phases of circulatory failure (A). Valvular and coronary sclerosis may be potentiated in a linear fashion in the "supportive" functions of the heart (B). The observed results of changes in cardiac function, in relation to duration of dialysis therapy, have laid the foundation for implementation of the term "dialysed heart" as a refinement of the term "uremic heart". |
|