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特集 肺高血圧症Cutting Edge Ⅳ．肺高血圧症治療：内科的治療と外科的治療，そして将来の治療
PDE5阻害薬とsGC刺激薬—特徴と使い分け，何を根拠に選択するのか？
著者： 渡邉裕司12
所属機関： 1浜松医科大学医学部 2国立国際医療研究センター
ページ範囲：P.411 - P.417
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・cGMPのレベルは，産生系である上流のNO-sGC活性と，分解系である下流のPDE5活性のバランスにより決定される．
・PDE5阻害薬はcGMPの分解を阻止してcGMPを蓄積し，sGC刺激薬はsGC活性を高めてcGMP産生を増加させ肺動脈血管拡張をもたらす．
・PDE5阻害薬によってcGMPの分解が阻止されたとしても，上流でNOが産生されなければ十分量のcGMPは蓄積しない．
・sGC刺激薬によりcGMP産生が亢進したとしても，強力なPDE5活性によって速やかにcGMPが分解されてしまえば十分なcGMP量は維持できない．
・PDE5阻害薬は肺血管選択性があること，sGC刺激薬は非選択的で全身血管に作用することを特長とする．
・cGMPのレベルは，産生系である上流のNO-sGC活性と，分解系である下流のPDE5活性のバランスにより決定される．
・PDE5阻害薬はcGMPの分解を阻止してcGMPを蓄積し，sGC刺激薬はsGC活性を高めてcGMP産生を増加させ肺動脈血管拡張をもたらす．
・PDE5阻害薬によってcGMPの分解が阻止されたとしても，上流でNOが産生されなければ十分量のcGMPは蓄積しない．
・sGC刺激薬によりcGMP産生が亢進したとしても，強力なPDE5活性によって速やかにcGMPが分解されてしまえば十分なcGMP量は維持できない．
・PDE5阻害薬は肺血管選択性があること，sGC刺激薬は非選択的で全身血管に作用することを特長とする．
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