➉ෆ࿴⩏㸦ࡓࡅ࠺ࡕື≀⑓㝔㸪⚄ዉᕝ┴㛤ᴗ㸧 ≟࠾ࡼࡧ⊧ࡢ⢾ᒀ⑓ࡢ㐪࠸ࢆ⌮ゎࡍࡿy ≟ࡣ㞧㣗ື≀y ⊧ࡣ⫗㣗ື≀ ⢾ᒀ⑓ࡢ἞⒪⟶⌮ࡢ᪉ἲࢆ⌮ゎࡍࡿy ࢖ࣥࢫࣜࣥὀᑕࡀᇶᮏy 㣗஦⒪ἲࡶ἞⒪ࡢ୺ᙺ ⾑⢾್ࡢ࣮࣒࣍ࣔࢽࢱࣜࣥࢢἲ
y VTࡀ▱ࡗ࡚࠾ࡃ࡭ࡁせⅬ ᣢ⥆ⓗ࡞㧗⾑⢾࡜ᒀ⢾ࢆド᫂y デ᩿ࡣẚ㍑ⓗ⡆༢ ⊧ࡣⓑ⾰ࡀ኱᎘࠸㸟㸟y ṇᖖ࡛ࡶ300mg/dl㏆ࡃࡲ࡛ୖ᪼y ྠ᫬࡟ᒀ⢾ࢆ☜ㄆࡍࡿࡇ࡜

 デ᩿ࡀ㞴ࡋ࠸᫬ࡣ㸽y ᣢ⥆ⓗ࡞㧗⾑⢾ࡢド᫂ż ࣇࣝࢡࢺࢧ್࣑ࣥ㸦㐣ཤ⣙㸰㐌㛫㸧ż ⢾໬࣊ࣔࢢࣟࣅࣥ㸦㐣ཤ⣙㸰ࣨ᭶㛫㸧 ࢖ࣥࢫࣜࣥ౫Ꮡᛶ⢾ᒀ⑓

IDDMy ࢖ࣥࢫࣜࣥࡀᚲせ࡞⢾⑓ Ϩᆺ⢾ᒀ⑓y ࢖ࣥࢫࣜࣥศἪ⬟ࡀ࡯ࡰᾘኻ ࢖ࣥࢫࣜࣥ㠀౫Ꮡᛶ⢾ᒀ⑓ NIDDMy ࢖ࣥࢫࣜࣥ⒪ἲࡣᚲࡎࡋࡶᚲせ࡞࠸⢾ᒀ⑓y ⾑⢾㝆ୗ๣y 㣗஦⒪ἲy 㐠ື⒪ἲy ᑠඣ⢾ᒀ⑓y ච␿Ꮫⓗᶵᗎ࡛⮅ᓥȕ⣽⬊ࡀ◚ቯy 㑇ఏⓗᅉᏊ㸦㸽㸧 ϩᆺ⢾ᒀ⑓y ⫧‶y 㣗⏕άy 㑇ఏⓗᅉᏊ࣭య㉁Takeuchi Veterinary Hospital

2008 ⚟ᓥ ࡓࡅ࠺ࡕື≀⑓㝔⢾ᒀ⑓ࡢ࣓࢝ࢽࢬ࣒㘽✰㸻⣽⬊࡬ࡢ⢾ࡢධࡾཱྀz࢖ࣥࢫࣜࣥ⣽⬊ࡢ࢚ࢿࣝࢠ࣮※㸻⢾–⾑୰ࡢ⢾ࡀ⣽⬊ෆ࡟ධࡽ࡞࠸࡜฼⏝ࡉࢀ࡞࠸–⢾ࡀ⣽⬊ෆ࡟ධࡿ㘽㸻࢖ࣥࢫࣜࣥ–࢖ࣥࢫࣜࣥ࡟ࡼࡗ࡚ࡣࡌࡵ࡚⢾ࡀ฼⏝ࡉࢀࡿ ⊧ࡢ⢾ᒀ⑓ࡢཎᅉy ࠕ⫧‶ࠖࡀ୍␒ࡢཎᅉ ⊧ࡣࠕᮏᙜࡢ⫗㣗ື≀ࠖy 㧗ⅣỈ໬≀㣗ࡣ⫧‶•⢾ᒀ⑓ࡢᘬࡁ㔠 ⊧ࡢ⢾ᒀ⑓ࡣIIᆺ⢾ᒀ⑓ࡀ୺యy ࡯ࡰ࢖ࣥࢫࣜࣥ⒪ἲࡀᚲせ ⢾ᒀ⑓ࡢ⑕≧ࡣศ࠿ࡾ࡟ࡃ࠸ ⢾ᒀ⑓ᛶࢣࢺ࢔ࢩࢻ࣮ࢩࢫ

(DKA)y ⏕࿨ࡢ༴㝤ࢆక࠺y 㧗ᗘࡢ㞟୰἞⒪ࡀᚲせࣈࢻ࢘⢾0.5㹥/㹩㹥⾑⢾್ṇᖖIVᚋࡢ⾑⢾್࡜࢖ࣥࢫࣜࣥ⃰ᗘࡢẚ㍑⫧‶࢖ࣥࢫࣜࣥ⃰ᗘṇᖖ⫧‶࢖ࣥࢫࣜࣥ᢬ᢠᅉᏊ

࢖ࣥࢫࣜࣥศἪቑຍ
࢔࣑ࣜࣥศἪቑຍ
Ǻ⣽⬊ෆ࡟࢔࣑ࣜࣥỿ╔⮅ᓥ࢔࣑ࣟ࢖ࢻ⑕⮅ᓥᔂቯ
Takeuchi Veterinary Hospital ࢖ࣥࢫࣜࣥ⒪ἲࡀ୺యy 㠀ࢣࢺࣥᛶ⢾ᒀ⑓ż ༶ᗙ࡟࢖ࣥࢫࣜࣥ⒪ἲࢆ㛤ጞż デ᩿࡜ྠ᫬࡟ᐙ᪘࡟࢖ࣥࢫࣜࣥὀᑕࡢ᪉ἲࢆᣦᑟy ᪥ᮏ࡛฼⏝࡛ࡁࡿ࢖ࣥࢫࣜࣥ〇๣ࡣ㸽ż ࣛࣥࢱࢫy ⡿ᅜ࡛ࡣ⊧ᑓ⏝࢖ࣥࢫࣜࣥ(Pro Zinc)ࡀᕷ㈍y ⊧ࡣேࡢ࢖ࣥࢫࣜࣥ࡜┦ᛶࡀᝏ࠸ż స⏝ᣢ⥆᫬㛫ࡀ▷ࡍࡂ• 㸦ୖ㸧࣋ࢡࢺࣥࢹ࢟ࣥࢯࣥ♫〇 (100༢఩/0.3ml)࣮ࣟࢻ࣮ࢬ࢖ࣥࢫࣜࣥ⏝ὀᑕჾ• 㸦ୗ㸧୍⯡ⓗ㸦100༢఩/1ml㸧࢖ࣥࢫࣜࣥὀᑕჾ

Takeuchi Veterinary Hospital ⢾ᒀ⑓἞⒪࡛᭱ࡶ㔜せy ᭱㐺࡞࢖ࣥࢫࣜࣥ〇๣y పⅣỈ໬≀㸪㧗⺮ⓑ㣗㸪ప⬡⫫y 㧗⧄⥔㣗ࡣಶయᕪ㸽 ⊧ࡢ⢾ᒀ⑓ࡣ἞ࡿ஦ࡀ࠶ࡿ㸟㸟㸟ż 㐺ษ࡞㣗஦⒪ἲࡀ㘽ż 㣗஦⒪ἲࡢᣦᑟࡣVTࡢ㔜せ࡞௙஦ 㧗⥺⥔y ྾཰ࡢᖹᆒ໬ࠊ⾑⢾ኚືࢆ᭱ᑠ࡟ 㧗⺮ⓑࠊపⅣỈ໬≀y ⊧ࡢ࢖ࣥࢫࣜࣥศἪࡢࢺ࣮ࣜ࢞ż ࢔ࣝࢠࢽࣥ㸦࢔࣑ࣀ㓟㸧y 㧗ⅣỈ໬≀㣗ࡢ⊧ż ⢾ᒀ⑓ࢆⓎ⑓ࡋࡸࡍ࠸y ࣄࢺ㸦≟㸧ࡢࢺ࣮ࣜ࢞ż ࢢࣝࢥ࣮ࢫࣃ
࢘ࢳࢱ࢖ࣉస⏝ࡀᙅ࠸ࢢࣛࣝࢠࣥస⏝᫬㛫ࡀ㛗࠸

PZIࣞࣥࢸ

NPHస⏝ࡀᙉ࠸ࣞࢠ࣮ࣗࣛస⏝᫬㛫ࡀ▷࠸ࣛࣆࢵࢺ㸦࢔ࢫࣃ࣮ࢺ㸸ࣜࢫࣉࣟ㸧 1᪥2ᅇἲࡀࠊ⊧࡟᭱ࡶ㐺ࡍࡿ ึࡵ࡚⢾ᒀ⑓࡟࡞ࡗࡓ⊧ż ᪩ᮇ࡟ࢢࣝࢥ࣮ࢫ୰ẘࡀᨵၿż ࢖ࣥࢫࣜࣥ⒪ἲ࠿ࡽ㞳⬺ฟ᮶ࡿ⊧ࡢ⢾ᒀ⑓ࡣ἞⒵ࡍࡿ஦ࡀ࠶ࡿ≟ࡢ⢾ᒀ⑓ࡣ἞ࡽ࡞࠸⑕౛㻞䚷䝣䝹䜽䝖䝃䝭䞁䛾ኚື࢖ࣥࣥࢫࣜࣥࣥ⒪ἲ࠿ࡽ㞳⬺ࡋࡓ⊧㻡㻜㻜㻠㻣㻝㻠㻡㻜㻠㻜㻜㻠㻠㻟㻠㻜㻝㻟㻤㻣㻟㻡㻜㻠㻜㻤㻟㻡㻜㻟㻠㻤㻟㻢㻞➨㻝㻡㻜⑓᪥䜲䞁䝇䝸䞁䜾䝷䝹䜼䞁ᢞ୚୰Ṇ㻟㻜㻜㻞㻡㻜㻞㻣㻜㻞㻞㻥㻞㻜㻜㻝㻣㻣㻝㻡㻜㻝㻡㻤㻝㻡㻝㻝㻜㻜㻡㻜㻝㻡㻝㻢㻝㻣㻞㻜➨➨➨➨㻢⑓㻤⑓᪥᪥᪥㻝㻟㻢⑓㻜⑓㻡⑓᪥᪥᪥᪥➨㻥㻠➨㻞⑓㻣㻣➨㻝㻞㻢㻤➨➨㻢㻝➨㻢⑓㻡㻞➨㻝㻜㻟㻤➨➨㻞㻟➨⑓⑓᪥᪥᪥⑓⑓⑓᪥᪥᪥⑓⑓デ᪥᫬㻜ึ⾑ Ύ 䝣 䝹 䜽 䝖䝃 䝭䞁 ್㻠㻢㻤㻠㻢㻜 ࢖ࣥࢫࣜࣥ⒪ἲ㛤ጞ᫬
y 24-48᫬㛫ධ㝔ࡉࡏ࡚ࣔࢽࢱ࣮y ༶๣࡟࢖ࣥࢫࣜࣥ⒪ἲᣦᑟࡋ࡚⮬Ꮿ⒪ἲ㛤ጞ PZI㸦NPHࠊࢢࣛࣝࢠࣥ㸧y 1-3U/cat࡛ᮅ୍␒࡟ὀᑕ ⾑⢾᭤⥺㸸pre,㸦1hr㸧,3hr㸪6hr㸪9hry ⾑⢾್ࢆᑡࡋ࡛ࡶୗࡆ࡚࠸ࡿ࠿㸽y ୗࡆࡍࡂ࡚࠸࡞࠸࠿㸽y ⌮᝿ⓗ࡞⾑⢾್᭤⥺ࡀᚓࡽࢀ࡞ࡃ࡜ࡶࡼ࠸
y 1᪥┠࠶ࡿ࠸ࡣ2᪥┠ࡲ࡛☜ㄆࢆ⥆ࡅࡿy ຠᯝࡀ࠶ࡾ༴㝤ࡀ࡞ࡅࢀࡤy ᪩ࡵ࡟ᐙᗞ࡛ࡢὀᑕἲࢆᣦᑟࡋ࡚ᐙ࡟ᖐࡍ

≧ែࣇࣝࢡࢺࢧ್࣑ࣥ㻔䃛㼙㼛㼘㻛㼘㻕ᖹᆒ೺ᗣ⊧㻞㻞㻝㻙㻟㻠㻝

284୍㐣ᛶ㧗⾑⢾㻞㻜㻠㻙㻟㻜㻡

313⢾ᒀ⑓㻞㻞㻢㻙㻤㻟㻡487

ᴫࡋ࡚㸺450(ȝmol/l)ࢆⰋ࠸ࢥࣥࢺ࣮ࣟࣝ ࡇࡇ࠿ࡽࡢ⣙1㐌㛫y ື≀ࡢయࢆ࢖ࣥࢫࣜࣥ࡟័ࡽࡍż ࢢࣝࢥ࣮ࢫ୰ẘ⑕࠿ࡽࡢ㞳⬺y ௦ㅰ␗ᖖࢆᨵၿࡍࡿy 㣫࠸୺ࡀ័ࢀࡿż ὀᑕἲ࡜つ๎ṇࡋ࠸㣗஦⒪ἲ
ż ὀᑕ⒪ἲࡣᐙᗞ࡛⾜࠺ż ࡜ࡃ࡟ཝᐦ࡞⾑⢾್ࡢ ᐃࡣᚲせ࡞࠸⾑⢾್ࡀᖖ࡟100-300mg/dl㸦⊧㸧ࡢ⠊ᅖࢆ⥔ᣢ⮫ᗋୖ೺ᗣ࡛ࢫࢺࣞࢫࡀ↓࠸㣫࠸୺࠾ࡼࡧ⋇་ᖌࡀ἞⒪⤒㐣࡟‶㊊ ࡼ࠸ࢥࣥࢺ࣮ࣟࣝࡢᇶ‽yyyyyyάືᛶࡀ࠶ࡿ
ከ㣧ከᒀ࣭ከ㣗ࡀ࡞࠸ప⾑⢾⑕≧ࡀ࡞࠸
య㔜ࡀᏳᐃ
㌟య᳨ᰝᡤぢࡀṇᖖᮅࡢ✵⭡᫬⾑⢾್150-300mg/dl㸦ᒀ⢾㝜ᛶ㸧ࡣಙ㢗ᛶࡀ㧗࠸ ᝏ࠸ࢥࣥࢺ࣮ࣟࣝࢆ♧၀ࡍࡿᡤぢy Ⴔ╀㸭↓Ẽຊy ከ㣧ከᒀ㸭ከ㣗y ㌟య᳨ᰝ␗ᖖᡤぢż య㔜ῶᑡż ᮅࡢ✵⭡᫬⾑⢾್㧗್㸦ᒀ⢾㝧ᛶ㸧 ࡯࡜ࢇ࡝ࡀ㹇ᆺ⢾ᒀ⑓ ᚲࡎ࢖ࣥࢫࣜࣥ⒪ἲࡀᚲせ ୍⏕ᾭ㸪࢖ࣥࢫࣜࣥ⒪ἲࡀᚲせ ⮬ᕫච␿ᛶ⑌ᝈ㸽㸽 㑇ఏᛶy ࣑ࢽࢳࣗ࢔ࢩࣗࢼ࢘ࢨ࣮y ࢧ࢚ࣔࢻ 㹇ᆺ
 Ⓨ⑕ᖺ㱋㸸3-5ṓ


HLAᆺ㸸A28, A3㸪ዪ⏨ẚ㸻1.4:1

๪⭈୙඲(67%)ୖ⓶ᑠయᶵ⬟పୗ⑕㸦76%)⓶⭵⢓⭷࢝ࣥࢪࢲ⑕(73%)ᛶ⭢ᶵ⬟୙඲(45%)⮬ᕫච␿ᛶ⏥≧⭢⑌ᝈ(11%)࢖ࣥࢫࣜࣥ౫Ꮡᛶ⢾ᒀ⑓(24%)
y 㔜⑕➽↓ຊ⑕㸦ぢࡽࢀ࡞࠸㸧y ྾཰୙Ⰻ⑕ೃ⩌㸦㸰㸲㸣㸧yyyyyy㹇㹇ᆺ㸦ࢩ࣑ࣗࢵࢺ⑕ೃ⩌㸧 Ⓨ⑕ᖺ㱋㸸ᡂேᮇ㸦30ṓࣆ࣮
ࢡ㸧





HLAᆺ㸸B8,DW3,DR3,DR4㸪
ዪ⏨ẚ㸻1.8:1.0y ๪⭈୙඲(100%)y ⮬ᕫච␿ᛶ⏥≧⭢⑌ᝈ(69%)
y ࢖ࣥࢫࣜࣥ౫Ꮡᛶ⢾ᒀ⑓(52%)
y ᛶ⭢ᶵ⬟୙඲(4%)
y ୗᆶయᛶᒀᔂ⑕㸦⛥㸧y ୗᆶయᶵ⬟పୗ⑕㸦⛥㸧y 㔜⑕➽↓ຊ⑕㸦Ⓨ⑕⋡୙᫂㸧y ྾཰୙Ⰻ⑕ೃ⩌㸦ぢࡽࢀ࡞࠸㸧

Trence DL et al : Polyglandular autoimmune syndrome. American Journal of Medicine 77(1): 107-116, 1984
Lesin M : Polyglandular autoimmune syndromes. American Journal of Medical Sciences 290(2): 77-88, 1985 ᡂศᰯṇy 㧗⧄⥔㣗y ⅣỈ໬≀
y ⬡㉁
y ⺮ⓑ㉁

㸺45%
㸼30%
㸼30%

 ༢⢾㢮㸪஧⢾㢮ࢆྵࡲ࡞࠸ ⫧‶ࢆࢥࣥࢺ࣮ࣟࣝ 㣗஦ࡢ᫬㛫㸪㔞㸪࣮࢝ࣟࣜࢆ୍ᐃ࡟⨁ࢱ࢖ࣉ ≟ࡣࣄࢺࡢ࢖ࣥࢫࣜࣥࡀ㐺ࡋ࡚࠸ࡿ NPH➼୰᫬㛫స⏝ᆺ࢖ࣥࢫࣜࣥ ὀᑕࡣ㸯᪥㸰ᅇࡀᇶᮏ

 ⫧‶
 ⅖⑕

ĺ ཱྀ⭍⾨⏕ࡀ㔜せy ⮅⅖㸪ୗ㒊ᒀ㊰⑌ᝈy ṑ▼㸪ཱྀෆ⅖ ࢫࢺࣞࢫy ࢢࣝࢥࢥࣝࢳࢥ࢖ࢻy ࢔ࢻࣞࢼࣜࣥ㸪ࢢࣝ࢝ࢦࣥ ࡑࡢ௚ᵝࠎ࡞⅖⑕඲࡚ ప⾑⢾⑕ࡢᚋࡢ㧗⾑⢾ᣢ⥆ῶᑡy ࢝࢘ࣥࢱ࣮ࣞࢠࣗࣛ࡜࣮ࣜ࣍ࣝࣔࣥż ࢢࣝ࢝ࢦࣥ㸪࢔ࢻࣞࢼࣜࣥ㸪ࢢࣝࢥࢥࣝࢳࢥ࢖ࢻ ࢯࣔࢪ࣮ຠᯝࡢᣢ⥆ᮇ㛫y ᩘ᪥㛫ᣢ⥆y ண᝿ࡋ࡟ࡃ࠸y ࢖ࣥࢫࣜࣥࢆቑࡸࡍ࡜༴㝤 ⮬Ꮿ࡛⾑⢾್ࢆᐃ ⡆᫆⾑⢾ᐃ⿦⨨ ⮬Ꮿ࡛⾑⢾᭤⥺y ࢫࢺࣞࢫࡀᑡ࡞࠸y ṇ☜࡞⾑⢾್ࡀࢃ࠿ࡿ࣮࣒࣭࣍ࣔࢽࢱࣜࣥࢢ

Takeuchi Veterinary Hospital

2008 ⚟ᓥ ࡓࡅ࠺ࡕື≀⑓㝔Takeuchi Veterinary Hospital

2008 ⚟ᓥ ࡓࡅ࠺ࡕື≀⑓㝔