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- 저자 : 권성운(Seong Woon Kwon) (검색결과 1 건)
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Angiotensin Converting Enzyme Inhibitor 가 Capsaicin 유발 기침반사에 미치는 영향
김동순(Dong Soon Kim),권성운(Seong Woon Kwon),김용복(Yong Bok Kim),임창영(Chang Young Lim),유원상(Won Sang Yoo),최석구(Suck Koo Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.5
N/A Background: Angiotensin converting enzyme(ACE) inhibitors are widely used for the treatment of hypertension and heart failure without serious side effects, but in some patients, they induce intractable cough. The mee-hanism of this cough is not known, but ACE and kininase II are the same enzyme, the derangement in the metabolism of kinines and Substance-P by ACE inhibitors has been proposed as one possibility. So we performed a placebo-controlled, double-blind, randomized crossover study, to find out whether the enalrpril can change the sensitivity to capsaicin which released Substance-P from the nerve ending and its relation to the development of cough after the enalarpril. Method: The subjects were 21 patients (9 men and 12 wemen) with mild to moderate hypertension. Eleven patients developed cough with the Enalarpril (cougher), and 10 pateints didn't have cough (non-cougher) and served as a control group. Baseline PFT, serum IgE level, and blood eosinophil count were done. The patients received either enalarpril 10 mg per day or placebo for one week, and after the washout period of at least one week, another drug(placebo if the patient had enalapril previously and vice versa) was given for a week. Blood pressure, pulmonary function test, and capsaicin challenge test were performed at the end of each period. Capsaicin challenge test was done by inhalation of different concentration of capsaicin via DeVil-bis 646 nebulizer with dosimeter (SCM Co., U.S.A.) and the lowest concentration which induced 2 or more coughs (Th-w) and 5 or more coughs (Th-5) were deter- mined. Result: The age of the two groups were similar (55.5 vs 52 years), but females were predominant in cougher (8 female and 4 male) compared to non-cougher (4 female and 6 male). There was no Significant difference in serum IgE level, eosinophil counts, and pulmonary function between two groups. Cough developed immediately after the inhalation of capsaicin, and the dose-response relationship was fonud between the number of coughs and the concentration of capsaicin. In all patients, Th-2 was 19.7±16.1uM and Th-5 was 78.8±48.6uM. But there was no significant difference in both Th-2 and Th-5 between coughers (21,3 uM and 72.2 uM) and non-coughers (18.0 uM and 81.6 uM). also, no significant change in Th-2 and Th-5 was found during the therapy of enarlapril compared to the placebo period in both groups. Among 11 coughers, 2 patients developed more coughs with capsaicin inhalation after the enarlapril compared to placebo period (responder), and in non-cougher, 3 among 10 patients were responders. Blood pressure was significantly decreased after the Enarlapril, but no significant change in pulmonary function was noted. Conclusion: Our data suggest that Enarlapril does not increase the sensitivity to capsaicin and the cough after the Enarlapril seems to have different mechanism.
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