理学療法ジャーナル40巻12号

2006年12月発行

特集 末梢循環障害と理学療法

閉塞性動脈硬化症の無侵襲検査法と運動療法効果

著者： 佐藤真治¹

所属機関： ¹埼玉医科大学リハビリテーション科

ページ範囲：P.993 - P.998

はじめに

　閉塞性動脈硬化症は，四肢の血管の動脈硬化により下肢に虚血症状を示す疾患で，心血管系疾患の合併が多いことが特徴である．その発症率は欧米を中心に増加の一途をたどっており，最近では無症候例を含めると55歳以上の19％に存在するとの報告もある^1）．

　閉塞性動脈硬化症の治療目標は大きく分けて2つである．1つは，患肢の虚血症状を改善し，間欠性跛行（歩くと下肢の各部位に痛みを生じ，休むと数分以内に消失する）と壊疽のリスクを軽減すること．もう1つは，全身に及ぶ動脈硬化症が原因となる心血管系疾患（虚血性心疾患，脳梗塞）の合併を予防することである．ここでは，主に前者に注目し，間欠性跛行の病態把握に有用な無侵襲検査法を紹介する．また，間欠性跛行に対する運動療法について，その効果のメカニズムと，われわれの成績の一部を解説する．

参考文献

1）Meijer WT, et al：Determination of peripheral arterial disease in the elderly：the Rotterdam study. Arch Intern Med 160：2934-2938, 2000

2）Baxter GM, Polak JF：Lower limb color flow imaging：a comparison with ankle brachial measurements and angiography. Clin Radiol 47：91-95, 1993

3）Khan NA, et al：Does the clinical examination predict lower extremity peripheral artery disease? JAMA 295：536-546, 2006

4）Ouriel K：Peripheral arterial disease. Lancet 358：1257-1264, 2001

5）重松　宏：下肢閉塞性動脈硬化症Q ＆ A，大塚製薬株式会社学術部，2001

6）Feringa HH, et al：The long-term prognostic value of the resting and postexercise ankle-brachial index. Arch Intern Med 166：529-535, 2006

7）Resnick HE, et al：Relationship of high and low ankle brachial index to all-case and cardiovascular disease mortality：the Strong Heart Study. Circulation 109：733-739, 2004

8）Murabito JM, et al：Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J 143：961-965, 2002

9）Hillestad LK：The peripheral blood flow in intermittent claudication. Ⅳ. The significance of the claudication distance. Acta Med Scand 173：467-478, 1963

10）Gardner AW, et al：Effects of handrail support on claudication and hemodynamic responses to single-stage and progressive treadmill protocols in peripheral vascular occlusive disease. Am J Cardiol 68：99-105, 1991

11）Gardner AW, et al：Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc 23：402-408, 1991

12）Gardner AW, Poehlman ET：Exercise rehabilitation program for the treatment of claudication pain. JAMA 274：975-980, 1995

13）Ernst E, Fialka V：A review of the clinical effectiveness of exercise therapy for intermittent claudication. Arch Intern Med 153：2357-2360, 1993

14）Gardner AW：Sex differences in claudication pain in subjects with peripheral arterial disease. Med Sci Sports Exerc 34：1695-1698, 2002

15）Mcdermott MM, et al：A pilot exercise intervention to improve lower extremity functioning in peripheral arterial disease unaccompanied by intermittent claudication. J Cardiopulm Rehabil 24：187-196, 2004

16）Mcdermott MM, et al：Leg symptoms in peripheral arterial disease. Associated clinical characteristics and functional impairment. JAMA 286：1599-1606, 2001

17）O'Hare AM, et al：High prevalence of peripheral arterial disease in persons with renal insufficiency：results from the National Hearth and Nutrition Examination Survey 1999-2000. Circulation 109：320-323, 2004

18）Stoyioglou A, Jaff MR：Medical treatment of peripheral arterial disease：a comprehensive review. J Vasc Interv Radiol 15：1197-1207, 2004

19）Regensteiner JG, et al：Chronic changes in skeletal muscle histology and function in peripheral artery disease. Circulation 87：413-421, 1993

20）Bauer TA, et al：Oxygen uptake kinetics during exercise are slowed in patients with peripheral artery disease. J Appl Physiol 87：809-816, 1999

21）Barker GA, et al：Walking performance, oxygen uptake kinetics and resting muscle pyruvate dehydrogenase complex activity in peripheral arterial disease. Clin Sci（Lond）106：241-249, 2004

22）松尾　汎：末梢動脈を診る．ハートビュー10：6-48，2003

23）Saltin B, et al：Exercise and circulation in health and disease, pp283-290, Human Kinetics, Illinoi, 2000

24）Hiatt WR, et al：Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 81：602-609, 1990

25）Niebauer J, et al：Attenuated progression of coronary artery disease after 6 years of multi-factorial risk intervention：Role of physical exercise. Circulation 96：2534-2541, 1997

26）Sato S, et al：Effects of physical activity on progression of carotid atherosclerotic lesions in patients with coronary heart disease. Circ J 70：s477, 2006

27）Brendle DC, et al：Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease. Am J Cardiol 87：324-329, 2001

28）Maejima Y, et al：Exercise after heparin administration-New therapeutic program for patients with non-option artheriosclerosis obliterans-. Circ J 69：1099-1104, 2005

29）Laufs U, et al：Physical training increase endothelial progenitor cells, inhibition of neointima formation, and enhances angiogenesis. Circulation 109：220-226, 2004

30）Adams V, et al：Increase of circulating endothelial progenitor cells in patients with coronary artery disease after exercise-induced ischemia. Arterioscler Thromb Vasc Biol 24：684-690, 2004

31）Brass EP, Hiatt WR：Acquired skeletal muscle metabolic myopathy in atherosclerotic peripheral arterial disease. Vasc Med 5：55-59, 2000

32）Weitz JI, et al：Diagnosis and treatment of chronic arterial insufficiency of the lower extremities：A critical review. Circulation 94：3026-3049, 1996

33）佐藤真治：閉塞性動脈硬化症（ASO）患者における間欠性跛行距離と運動終了直後の足関節・上腕血圧比（ABI）低下率の関係．第10回日本心臓リハビリテーション学会抄録，p67，2004