     ◊✲ຓᡂᴗ⦼ሗ࿌㞟㸦ᖹᡂ 㸧ᖺᗘᏛ⾡άືᨭ᥼
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බ┈㈈ᅋἲே ᚠ⎔ჾ⑓◊✲᣺⯆㈈ᅋ

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1

Ფ Ⴘ ഏ Ფ0Qᄂ   ᆮ   ᛢ   ᫆  ᄂ ᆮ ˊ ᘙ ᎍ᪫ǨǼȁȟȖ Ʒܼଈࣱ᭗ǳȬǹȆȭȸȫᘉၐƴӏǅƢஊဇࣱƷ౨᚛ƴ᧙Ƣǔᄂᆮ

ૻඬჇྸ‫܇‬ɶ࣎ᘉ‫ן‬ƴ᧙Ƣǔᡙួᛦ௹ඕ᣼ ᨺ࠯᭗ᘉ‫ן‬धᎍƴƓƚǔǢȳǸǪȆȳǷȳîӖܾ˳ਛ৴ᕤ ᲻᳌᲼ Ʒ‫ބ‬ᣠ੎ඟ‫ف‬ь˺ဇƳƨƼƴᘉሥϋႝೞᏡƴ᧙Ƣǔൔ᠋ȷ౨᚛ඕ᣼ ᨺ࠯

඙ၲ˯৴ࣱ᭗ᘉ‫ן‬ƴ‫ݣ‬ƢǔјௐႎƳᨀ‫ן‬ᕤƷ́ဇƴ᧙Ƣǔᄂᆮඕ᣼ ᨺ࠯

࣎ೞᏡᚐௌǽȕȈǦǧǢž*GCTV (WPEVKQP 8KGYſƷᚐௌችࡇƱƦƷᐮ࠿ႎஊဇࣱƷ౨᚛ங஄ գᅎ᭗ᘉ‫ן‬඙ၲƴƓƚǔȬǶȫǿǹƷஊјࣱƴ᧙Ƣǔᄂᆮ‫ ߢޥ‬፯ᨺဃ෇፼ॹ၏Ŵ᭗ᘉ‫ן‬඙ၲƴƓƚǔǪȫȡǵȫǿȳƷஊјࣱƴ᧙Ƣǔᄂᆮ௎ Ⴧɟᢹ

ॸࣱᏴᐥ၏धᎍưƷኄ‫ބ‬၏ሥྸƷܱ७ƱᕤཋၲඥƷஊဇࣱƴƭƍƯɶ஭ ૓‫܇‬ࣱ࣯஖ᏯЈᘉǁƷᨀ‫ן‬ၲඥƴ᧙Ƣǔᄂᆮ‫ޛ‬ɥ  ‫ܨ‬





ࣱ࣯࣎ሂయ‫ص‬ƴƓƚǔࣱ࣯஖᭗ᘉኄƱॸࣱᏴᐥ၏Ʒᨈϋʖ᧸ӏƼᧈ஖ʖࢸƴӏǅƢࢨ᪪ƴ᧙Ƣǔᄂᆮ᣼ӝ ୙‫پ‬





࣎৐ኬѣƱ࣎Ҿࣱ‫ص‬ఀၐƴ‫ݣ‬Ƣǔᕤཋȷ᩼ᕤཋၲඥƷѼਙႎ඙ၲ৆ဦƷ౨᚛ᒬ᣼ ᄂԍឪᇌ᝟ᒵ଺࣎ਊ‫٭‬ѣᚐௌƴǑǔᐯࢷᅕኺೞᏡƱϛѣᏦ၌धƷႻ᧙ᚐௌྚ᢯ᙵൟ‫܇‬ɧૢᏦ၌धưƷǫȆȸȆȫ඙ၲƓǑƼȇȐǤǹ඙ၲƷஊဇࣱƱӳ́ၐƴ᧙Ƣǔᄂᆮ᣼ဋ  ߁



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2

࢚ࢮࢳ࣑ࣈࡢᐙ᪘ᛶ㧗ࢥࣞࢫࢸ࣮ࣟࣝ⾑⑕࡟ཬࡰࡍ᭷⏝ᛶࡢ᳨ウ࡟㛵ࡍࡿ◊✲ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭㒊㛗 ᪁Ἴ ┿⌮ᏊϨ㸬⥴ ゝ

㸦F,07㸧
ࠊᚰ⾑⟶⑌ᝈࡢᏑᅾ࡜ࡢ㛵㐃ࢆᶓ᩿◊✲᳨࡛ᐙ᪘ᛶ㧗ࢥࣞࢫࢸ࣮ࣟࣝ⾑⑕ )+ ࣊ࢸࣟ᥋ྜయࡣࠊ

ウࡋࡓࠋⴭ᫂࡞㧗 /'/& ⾑⑕ࠊᗂᑡᮇࡼࡾࡢ⓶⭵࠾ࡼࡧ⭝㯤Ⰽ⭘ࠊⱝᖺᛶື⬦◳໬⑕࡟ࡼࡿෙື⬦⑌ᝈࡀ≉ᚩⓗϩ㸬ᑐ㇟࣭᪉ἲ

࡛࠶ࡿࠋࢥࣞࢫࢸ࣮ࣟࣝྜᡂ㜼ᐖ⸆࡛࠶ࡿࢫࢱࢳࣥ

ᑐ㇟ᝈ⪅ࢆ୰ᚰ࡜ࡋࡓ /'/& పୗ⒪ἲࡀ㑅ᢥࡉࢀࡿࡀࠊ
/'/&ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮௦ㅰෆ⛉࡟ᐃᮇⓗ࡟㏻㝔⟶⌮┠ᶆ್࡛࠶ࡿ PJG/ ᮍ‶࡬ࡢ฿㐩⋡ࡣ౫↛ࡋ࡚࠸ࡿ )+ ࣊ࢸࣟ᥋ྜయᝈ⪅  ౛ࠋᝈ⪅⫼ᬒࡣࠊ࡜ࡋ࡚పࡃࠊࡲࡓᚰ⾑⟶࢖࣋ࣥࢺࡢᢚไࡶ༑ศ࡜ࡣ⾲  ࡟♧ࡍࠋᖹᆒᖺ㱋ࡣ  ṓ࡛࠶ࡾࠊ⏨ᛶࡀ  ྡ࠸࠼࡞࠸ࠋ)+ ࡟࠾࠸࡚ࡶ /'/& ್పୗ⒪ἲᚋࡢṧᏑ㸦㸣㸧
ྵࡲࢀ࡚࠸ࡓࠋ
ᚰ⾑⟶⑌ᝈࡣ  ྡ㸦㸣㸧

ࣜࢫࢡࢆ⟶⌮ࡍࡿᚲせࡀ࠶ࡿࠋ

ࡀ᭷ࡋ࡚࠸ࡓࠋࡍ࡭࡚ࡢᝈ⪅ࡣࢫࢱࢳࣥࢆෆ᭹ࡋ࡚

୍⯡ⓗ࡟ၿ⋢ࢥࣞࢫࢸ࣮ࣟࣝ࡜ࡋ࡚▱ࡽࢀ࡚࠸ࡿ

࠾ࡾࠊ
 ྡ
㸦㸣㸧
ࡢᝈ⪅ࡀ࢚ࢮࢳ࣑ࣈࢆࠊ
 ྡ
㸦㸣㸧

+'/& ್ࡢపୗࡣ )+ ࡟࠾ࡅࡿ/'/& పୗ⒪ἲࡢṧᏑࡀࣉࣟࣈࢥ࣮ࣝࢆࠊ ྡ㸦㸣㸧ࡀࢥࣞࢫࢳ࣑ࢻࢆ

ࣜࢫࢡࡢೃ⿵࡜ࡋ࡚ᣲࡆࡽࢀࡿࠋᩘࠎࡢ␿Ꮫ◊✲ࡸෆ᭹ࡋ࡚࠸ࡓࠋࢽࢥࢳࣥ㓟〇๣࡜࢚࢖ࢥࢧ࣌ࣥࢱ࢚

ほᐹ◊✲࡟࠾࠸࡚ +'/& ್ࡢపୗࡣᚰ⾑⟶⑌ᝈࡢⓎࣥ㓟ࡣྛ  ྡ㸦㸣㸧ࠊࣇ࢕ࣈ࣮ࣛࢺࡣ  ྡࡀෆ᭹ࡋ

⑕࡜㛵㐃ࡀ࠶ࡿࡇ࡜ࡀ♧ࡉࢀ࡚ࡁࡓࠋ+'/ ࡢᢠື⬦࡚࠸ࡓࠋ࡞࠾ᮏ◊✲ࡢࣉࣟࢺࢥࣝࡣᅜ❧ᚠ⎔ჾ⑓◊◳໬స⏝ࡢ࠺ࡕ᭱ࡶ㔜せ࡞ࡶࡢࡣ᢯ᾘ࡟㐣๫࡟⵳✚✲ࢭࣥࢱ࣮ࡢ೔⌮ጤဨ఍࡟࡚ᢎㄆࡉࢀ࡚࠸ࡿ 1Rࡋࡓࢥࣞࢫࢸ࣮ࣟࣝࢆᘬࡁᢤࡁࠊ⫹Ồ㓟࡟ኚ᥮ྍ⬟0 ࠋ࡞⫢⮚࡬㐠ᦙࡋࠊ౽୰࡬᤼ἥࡍࡿࠕࢥࣞࢫࢸ࣮ࣟࣝ

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㏫㌿㏦స⏝࡛ࠖ࠶ࡿࠋࡋ࠿ࡋࠊࢥࣞࢫࢸ࢚ࣜࣝࢫࢸ

⮫ᗋ᳨ᰝࢹ࣮ࢱ

ࣝ㌿㏦⺮ⓑ㜼ᐖ⸆ࢆࡣࡌࡵ࡜ࡍࡿ +'/& ቑຍ἞⒪ࡢ✵⭡᫬᥇⾑ࢆᐇ᪋ࡋࠊ⬡㉁➼ࢆ ᐃࡋࡓࠋ࢔࢟ࣞࢫ

ᚰ⾑⟶⑌ᝈ࢖࣋ࣥࢺᢚไຠᯝࡣ᫂ࡽ࠿࡛࡞ࡃࠊ
+'/&⭝ཌ࡟ࡘ࠸࡚ࡣ ; ⥺㌾⥺᧜ᙳࢆᐇ᪋ࡋᚑ᮶ἲ࡟ࡼࡾ

್㸦+'/ ࡢ㔞㸧࡛ࡣ࡞ࡃࠊ+'/ ࡢᶵ⬟㸦+'/ ࡢ㉁㸧ࡀィ ࡋࡓࠋ㢁ື⬦ෆ⭷୰⭷」ྜయཌ㸦F,07㸧ࡣࠊ௮ࡼࡾ㔜せ࡛࠶ࡿ࡜࠸࠺⪃࠼᪉ࡀᗈࡲࡗ࡚ࡁ࡚࠸ࡿࠋ

⮩఩࡟࡚⥲㢕ື⬦ෆ࡟࠾ࡅࡿ᭱኱ ,07 ࢆ⏬㠃୰ᚰ࡟᭱㏆࡛ࡣෙື⬦⑌ᝈࡢ⑕౛ᑐ↷◊✲࠾ࡼࡧࢥ࣮࣍ࢺ

ᥥฟࡋࠊࡑࡢ୧ഃ FP ࡈ࡜࡟ィ  Ⅼࢆィ ࡋࠊ Ⅼ◊✲࡟࠾࠸࡚ࠊᝈ⪅ +'/ ࡢ࣐ࢡࣟࣇ࢓࣮ࢪ࠿ࡽࡢࢥ

ࡢᖹᆒ್ࢆồࡵᖹᆒ ,07 ࢆ⟬ฟࡋࡓࠋ

ࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡀࠊ+'/& ್ࡼࡾࡶᙉ࠸㈇ࡢ༴㝤ᅉᏊ࡛࠶ࡿࡇ࡜ࡀሗ࿌ࡉࢀࡓࠋ

ᚰ⾑⟶⑌ᝈࡢᐃ⩏)+ ᝈ⪅ࡢ+'/ ࡟ࡼࡿࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣ㸯㸧ᚰ㟁ᅗኚ໬ࡶࡋࡃࡣ⾑Ύ㓝⣲್ࡢኚ໬ࢆక࠺ᚰ

೺ᖖே࡟ẚ㍑ࡋ࡚పୗࡋ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸

➽᱾ሰࠊ㸰㸧⹫⾑ᛶ⬻༞୰ࠊ㸱㸧⮫ᗋⓗ࡟デ᩿ࡉࢀࡿࡀࠊ)+ ᝈ⪅࡟࠾࠸࡚ +'/ ࡟ࡼࡿࢥࣞࢫࢸ࣮ࣟࣝᘬ

ࡓ⊃ᚰ⑕ࠊ㸲㸧ෙື⬦ࣂ࢖ࣃࢫᡭ⾡ࡶࡋࡃࡣ⤒⓶ⓗࡁᢤࡁ⬟ࡀື⬦◳໬ࡢⓎ⑕㐍ᒎࡸᚰ⾑⟶࢖࣋ࣥࢺ࡜

ෙື⬦ᙧᡂ⾡ࡢ᪋⾜Ṕࠊ㸳㸧ෙື⬦㐀ᙳ࡛ 㸣௨ୖ㛵㐃ࡀ࠶ࡿ࠿࡟ࡘ࠸࡚ࡣ᫂ࡽ࠿࡛࡞࠸ࠋᡃࠎࡣࠊ)+ࡢ⊃✽⑓ኚࢆ᭷ࡍࡿࡶࡢࠊࡢ࠸ࡎࢀ࠿࡟ヱᙜࡍࡿሙ࣊ࢸࣟ᥋ྜయᝈ⪅ࢆᑐ㇟࡟ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ

ྜ࡟ᚰ⾑⟶⑌ᝈ࠶ࡾ࡜ᐃ⩏ࡋࡓࠋ⬟࡜࢔࢟ࣞࢫ⭝⫧ཌࠊ㢁ື⬦ෆ⭷୰⭷」ྜయཌ

1ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢ ᐃ࣐࢘ࢫ⏤᮶࣐ࢡࣟࣇ࢓࣮ࢪᵝ⣽⬊࡛࠶ࡿ - ⣽⬊࡟ȣ&LPOࡢ>+@ࢥࣞࢫࢸ࣮ࣟࣝࢆ᫬㛫స⏝ࡉࡏࣛ࣋ࣝࡋࠊࡑࡢᚋ࣏࢚ࣜࢳࣞࣥࢢࣜࢥ࣮ࣝ
ࢆ⏝࠸࡚࢔࣏࣏ࣜ⺮ⓑ % ࢆ㝖ཤࡋࡓᝈ⪅⾑Ύࢆ㸣ࡢ⃰ᗘ࡛  ᫬㛫స⏝ࡉࡏࡓࠋ⣽⬊ෆࡢ>+@ࢥࣞࢫࢸ࣮ࣟࣝࡣ⬡㉁ᢳฟᚋ࡟ᾮయࢩࣥࢳ࣮ࣞࢩࣙࣥ

࢝࢘ࣥࢱ࣮ࢆ⏝࠸࡚࢝࢘ࣥࢺࡋࠊྠࡌࡃ࢝࢘ࣥࢺࡋ
ࡓᇵᆅ୰ࡢ>+@ࢆ㝖ࡋ࡚⟬ฟࡋࡓࠋࡍ࡞ࢃࡕࠊ

ᘬࡁᢤࡁ⬟㸦㸣㸧㸻[ ᇵᆅ୰>+@㸦ᇵᆅ୰>+@⣽⬊ෆ>+@㸧ࠋ ࡲࡓᶆ‽໬ࡢࡓࡵ࡟೺ᖖே  ྡ࠿ࡽ᥇ྲྀ࣭ಖᏑࡋ
ࡓࣉ࣮ࣝ⾑Ύࢆẖᅇᐇ㦂࡟౑⏝ࡋࠊᝈ⪅ᘬࡁᢤࡁ⬟ࣉ࣮ࣝ⾑Ύᘬࡁᢤࡁ⬟ࡢ್ࢆ⤖ᯝ࡜ࡋ࡚᥇⏝ࡋࡓࠋᅗ㸯㸬+'/& ್࡜ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜ࡢ㛵㐃⾲㸯㸬ᝈ⪅⫼ᬒ 㸦1 㸧ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜࢔࢟ࣞࢫ⭝ཌ࡜ࡢ㛵㐃 ༢┦㛵࡟࠾࠸࡚ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣ࢔࢟ࣞࢫ⭝ཌ࡜㈇ࡢ㛵㐃ࢆ♧ࡋࡓ㸦5 ࠊ3㸧ࠋᖺ㱋࡜ᛶูࢆㄪᩚࡋࡓ⥺ᙧᅇᖐศᯒࠊ࠾ࡼ
ࡧᖺ㱋࡜ᛶู࡟ຍ࠼࡚ෙື⬦༴㝤ᅉᏊ࡜ࡋ࡚ႚ↮Ṕࡢ᭷↓ࠊ㧗⾑ᅽࡢ᭷↓ࠊ⢾ᒀ⑓ࡢ᭷↓ࠊ⫧‶ࡢ᭷↓ࠊ/'/& ್ࢆ⊂❧ኚᩘ࡜ࡋ࡚ຍ࠼ㄪᩚࡋࡓ⥺ᙧᅇᖐศᯒ࡟࠾࠸࡚ࡶࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡣ࢔
࢟ࣞࢫ⭝ཌ࡜㛵㐃ࡀ࠶ࡗࡓ㸦⾲㸰㸧ࠋࡋ࠿ࡋࠊ+'/&್ࢆ⊂❧ኚᩘ࡜ࡋ࡚ࡉࡽ࡟ຍ࠼ࡓゎᯒ࡟࠾࠸࡚ࡣࡇ
ࡢ㛵㐃ࡣᙅࡲࡾࠊ⤫ィᏛⓗ᭷ពᕪࡣᾘኻࡋࡓ㸦⾲ 㸧
ࠋ
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ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜㢁ື⬦ ,07 ࡜ࡢ
㛵㐃




Ϫ㸬⤖ ᯝ)+ ᝈ⪅࡟࠾ࡅࡿࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟㢁ື⬦ ,07 ࡜㈇ࡢ㛵㐃ࢆ♧ࡋࡓ㸦5 ࠊ3 )+ ᝈ⪅࡟࠾ࡅࡿࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢᶆ㸧ࠋྠᵝ࡟ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣᖹᆒ㢁‽໬ᚋࡢᖹᆒ್ࡣ s ࡛࠶ࡗࡓࠋࢥࣞࢫࢸ

ື⬦ ,07 ࡜ࡶ㈇ࡢ㛵㐃ࢆ♧ࡋࡓ㸦5 ࠊ3࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣᅗ㸯ࡢࡼ࠺࡟ +'/& ್࡜ࡣṇࡢ㸧ࠋᖺ㱋࡜ᛶูࢆㄪᩚࡋࡓ⥺ᙧᅇᖐศᯒࠊ࠾ࡼ

㛵㐃ࢆ♧ࡋࡓ㸦5 ࠊ3㸧ࠋࡧᖺ㱋࡜ᛶู࡟ຍ࠼࡚ෙື⬦༴㝤ᅉᏊ࡜ࡋ࡚ႚ↮Ṕ༢┦㛵࡟࠾࠸࡚ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣ᭱኱ࡢ᭷↓ࠊ㧗⾑ᅽࡢ᭷↓ࠊ⢾ᒀ⑓ࡢ᭷↓ࠊ⫧‶ࡢ᭷↓ࠊ/'/& ್ࢆ⊂❧ኚᩘ࡜ࡋ࡚ຍ࠼ㄪᩚࡋࡓ⥺ᙧᅇᖐศᯒ࡟࠾࠸࡚ࡶࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡣᖹ

ᆒ㢁ື⬦ ,07㸦⾲㸱㸧࡜㛵㐃ࡀ࠶ࡗࡓࠋࡋ࠿ࡋࠊ+'/&2್ࢆ⊂❧ኚᩘ࡜ࡋ࡚ࡉࡽ࡟ຍ࠼ࡓゎᯒ࡟࠾࠸࡚ࡣࠊ

㧗⾑ᅽ⑕ࡀᚰ⾑⟶⑌ᝈࡢᏑᅾ࡜㛵㐃ࡀ࠶ࡗࡓࠋ

୧᪉࡜ࡶ࢔࢟ࣞࢫ⭝ཌ࡜ྠᵝ࡟ࡇࡢ㛵㐃ࡣᙅࡲࡾࠊ

⤫ィᏛⓗ᭷ពᕪࡣᾘኻࡋࡓ㸦⾲㸱㸧⾲㸲㸬ᚰ⾑⟶⑌ᝈࡢ᭷↓࡜⮫ᗋࣃ࣓࣮ࣛࢱ

⾲㸰㸬ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜࢔࢟ࣞࢫ⭝ཌ࡜ࡢ㛵㐃⾲㸱㸬ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜ᖹᆒ㢁ື⬦,07 ࡜ࡢ㛵㐃⾲㸳㸬ᚰ⾑⟶⑌ᝈࡢ᭷↓࡟㛵ࡍࡿࣟࢪࢫࢸ࢕ࢵࢡゎ
ᯒ






 ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜ᚰ⾑⟶⑌ᝈࡢᏑᅾ࡜



ࡢ㛵㐃

ϫ ⪃ ᐹ⾲㸲࡟♧ࡍ࡜࠾ࡾࠊᚰ⾑⟶⑌ᝈࡢ᪤ ࡀ࠶ࡿᝈ⪅ࡣ  ᮏ◊✲࡛ࡣࢫࢱࢳࣥ➼ࡢ /'/& పୗ⒪ἲࢆࡍ࡛᪤ ࡀ࡞࠸ᝈ⪅࡟ẚ㍑ࡋ࡚ᖹᆒᖺ㱋࠾ࡼࡧᖹᆒయ᱁

࡟᪋⾜ࡉࢀ࡚࠸ࡿ )+ ࣊ࢸࣟ᥋ྜయᝈ⪅࡟࠾࠸࡚ࡶࠊ

ᣦᩘ㸦ERG\PDVVLQGH[㸧ࡀ㧗ࡃࠊႚ↮Ṕࡢ࠶ࡿ⪅ࠊࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡣ +'/& ್࡜⊂❧㧗⾑ᅽ⑕࠾ࡼࡧ⢾ᒀ⑓ࡢྜే⋡ࡀ㧗࠿ࡗࡓࠋ⾑Ύࡋ࡚ᚰ⾑⟶⑌ᝈࡢᏑᅾ࡜㛵㐃ࡀ࠶ࡿࡇ࡜ࢆึࡵ࡚᫂

/'/& ್ࡣ୧⩌࡛ᕪࡣ࡞࠿ࡗࡓࡀࠊ
+'/& ್ࡣᚰ⾑⟶ࡽ࠿࡟ࡋࡓࠋṧᏑࣜࢫࢡࡢほⅬ࠿ࡽࠊ+'/ ᶵ⬟࡜ࡋ⑌ᝈࢆ᭷ࡍࡿ⪅࡛᭷ព࡟పࡃࠊ
⾑Ύ 7* ್ࡣ㧗࠿ࡗࡓࠋ࡚ࡢࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣ )+ ࣊ࢸࣟ᥋ྜయ

ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣᚰ⑌ᝈࢆ᭷ࡍࡿ⪅࡛᭷ᝈ⪅࡟࠾࠸࡚ࣜࢫࢡ࣐࣮࣮࢝ࡶࡋࡃࡣ἞⒪ࢱ࣮ࢤࢵព࡟ప࠿ࡗࡓ㸦 sYVs3ࢺ࡜࡞ࡾ࠺ࡿ࠿ࡶࡋࢀ࡞࠸ࠋ

 ࠋࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡣ࢔࢟ࣞࢫ⭝ཌࡢ ḟ࡟ᚰ⾑⟶⑌ᝈࡢ᭷↓࡟㛵ࡍࡿࣟࢪࢫࢸ࢕ࢵࢡᅇ

኱ࡁࡉ࡜ࡶ㛵㐃ࡍࡿࡇ࡜ࢆึࡵ࡚᫂ࡽ࠿࡟ࡋࡓࠋࡇ

ᖐศᯒࢆᐇ᪋ࡋࡓ࡜ࡇࢁࠊᖺ㱋ࠊᛶูࠊෙື⬦༴㝤ࡢ㛵ಀࡣᖺ㱋ࡸᛶูࠊෙ༴㝤ᅉᏊ㸦ႚ↮࣭㧗⾑ᅽ࣭ᅉᏊ࡜ࡋ࡚ႚ↮Ṕࡢ᭷↓ࠊ㧗⾑ᅽࡢ᭷↓ࠊ⢾ᒀ⑓ࡢ⢾ᒀ⑓࣭⫧‶࣭/'/& ್㸧ࢆ⊂❧ኚᩘ࡜ࡋ࡚ㄪᩚࡋ

᭷↓ࠊ⫧‶ࡢ᭷↓ࠊ/'/& ್࠾ࡼࡧ +'/& ್ࢆ⊂❧࡚ࡶಖᣢࡉࢀ࡚࠸ࡓࠋࡇࡢࡇ࡜ࡣ࢔࢟ࣞࢫ⭝ࢆࡣࡌኚᩘ࡜ࡋ࡚ຍ࠼ㄪᩚࡋࡓ⥺ᙧᅇᖐศᯒ࡟࠾࠸࡚ࡶࢥ

ࡵ࡜ࡍࡿ㯤Ⰽ⭘ᙧᡂ࡟࣐ࢡࣟࣇ࢓࣮ࢪࡢἻἓ໬࠾ࡼ

ࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡣᚰ⾑⟶⑌ᝈࡢᏑᅾ

ࡧ⬺Ἳἓ໬ࡀ㛵୚ࡋ࡚࠸ࡿ࡜࠸࠺㐣ཤࡢሗ࿌ࢆᨭᣢ

࡜㛵㐃ࡀ࠶ࡾࠊࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡣ +'/&ࡍࡿࡶࡢ࡛࠶ࡿࠋࡲࡓ↓⑕ೃᛶື⬦◳໬⑕ࡢᣦᶆ࡛

್ࡼࡾࡶᙉ࠸㈇ࡢࣜࢫࢡᅉᏊ࡛࠶ࡗࡓ㸦⾲㸳㸧ࠋྛෙ࠶ࡿ㢁ື⬦ ,07 ࡢቑ኱࡜ࡶࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ

༴㝤ᅉᏊࡢ࠺ࡕࠊࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟௨እ࡟⬟ࡣ㛵㐃ࡋ࡚࠸ࡓࠋࡇࡢ㛵ಀࡣ࢔࢟ࣞࢫ⭝ཌ࡜ࡢ㛵3㐃࡜ྠᵝ࡟ࠊᖺ㱋ࡸᛶูࠊෙ༴㝤ᅉᏊ㸦ႚ↮࣭㧗⾑௦ㅰෆ⛉་㛗ᅽ࣭⢾ᒀ⑓࣭⫧‶࣭/'/& ್㸧ࢆ⊂❧ኚᩘ࡜ࡋ࡚ㄪᓊᮏ ୍㑻࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭ᩚࡋ࡚ࡶಖᣢࡉࢀ࡚࠸ࡓࠋ
ࡇࡢࡇ࡜ࡣ )+ ࣊ࢸࣟ᥋ྜ

௦ㅰෆ⛉་㛗యᝈ⪅࡟࠾ࡅࡿື⬦◳໬ᙧᡂ࣭㐍ᒎࡢᢚไ࡟ࡣ +'/⋢㑣ぞẸᏊ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭ࡢᶵ⬟ࡀ㔜せ࡛࠶ࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿࠋࡋ࠿ࡋࠊ

௦ㅰෆ⛉་ᖌ

ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡜࢔࢟ࣞࢫ⭝ཌ࠾ࡼࡧ㢁኱⏿ ὒᏊ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭ື⬦ ,07 ࡜ࡢ㛵㐃ࡣ⾑Ύ +'/& ್ࢆㄪᩚᅉᏊ࡜ࡋ࡚

௦ㅰෆ⛉་ᖌ

ຍ࠼ࡿ࡜ᙅࡲࡗࡓࡇ࡜࠿ࡽࠊ+'/ ᶵ⬟࡜ࡋ࡚ࢥࣞࢫᶶ㇂ ┿⏤࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭ࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟࡟ຍ࠼࡚ᢠ⅖⑕స⏝ࡸᢠ㓟໬స௦ㅰෆ⛉་ᖌ

⏝ࡶᐤ୚ࡋ࡚࠸ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋᐇ㝿ࠊ⫧ሯ ㄹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭௦

2RVWHUYHHU ࡽࡣ )+ ᝈ⪅࡟࠾ࡅࡿ⭝㯤Ⰽ⭘ᙧᡂࡢ⛬ㅰෆ⛉ࣞࢪࢹࣥࢺ

ᗘࡣࢥࣞࢫࢸ࣮ࣟࣝ㏫㌿㏦⣔ࡸ /'/ ࡢ㓟໬࡟㛵ࡍࡿ⳻⏣ ⸛࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭௦㑇ఏᏊከᵝᛶ࡜㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࢆሗ࿌ࡋ࡚࠸ࡿࠋ

ㅰෆ⛉ࣞࢪࢹࣥࢺ

ࡲࡓ$UWLHGDࡽࡣ)+ᝈ⪅࡟࠾ࡅࡿ㯤Ⰽ⭘ᙧᡂࡣ㓟໬ᐑᮏ ᜨᏹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㞟ᅋ᳨デ/'/ ࡟ᛂ⟅ࡍࡿ⅖⑕ᛶ཯ᛂࡀ㛵୚ࡋ࡚࠸ࡿࡇ࡜ࢆሗ

㒊㛗࿌ࡋ࡚࠸ࡿࠋᇼ  ⨾㤶࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ ࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡀ⾑Ύ +'/& ್ែ௦ㅰ㒊࣭◊✲ဨ ࡢపୗ࡜ࡣ⊂❧ࡋ࡚ &9' ࡢᏑᅾ࡜㛵㐃ࡋ࡚࠸ࡓࡇ࡜

࿴⏣ಇ㍜࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែࡣព⩏῝࠸࡜⪃࠼ࡿࠋ)+ ࣊ࢸࣟ᥋ྜయᝈ⪅࡟࠾࠸࡚௦ㅰ㒊࣭ὶື◊✲ဨ࢔࢟ࣞࢫ⭝ཌࡸ㢁ື⬦ ,07 ࡣᚰ⾑⟶⑌ᝈࡢࣜࢫࢡ࣐

ᰘ⏣ᫎᏊ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែ࣮࣮࢝࡜ࡋ࡚㐣ཤ࡟ሗ࿌ࡉࢀ࡚ࡁࡓࡀࠊࡍ࡭࡚ࢆண

௦ㅰ㒊࣭≉௵◊✲ဨࡍࡿࡇ࡜ࡣ࡛ࡁ࡚࠸࡞࠸ࠋࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤᒣᮏ ๛ྐ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ࡁ⬟࡟ࡼࡾᚰ⾑⟶⑌ᝈࡢᏑᅾࢆண ࡛ࡁࡿࡢ࡛࠶ࢀ

ែ௦ㅰ㒊࣭ᐈဨ◊✲ဨࡤࣜࢫࢡ࣐࣮࣮࢝࡜ࡋ࡚᭷ព⩏࡛࠶ࢁ࠺ࠋ

᳃ᮏࡵࡄࡴ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ ௒ᚋࡣࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡀࣜࢫࢡ࣐࣮࢝

ែ௦ㅰ㒊࣭◊✲⿵ຓဨ࣮࡛࠶ࡿ࠿ࢆࡉࡽ࡟᫂ࡽ࠿࡟ࡍࡿࡓࡵ࡟๓ྥࡁほᐹ㥖஭ ோ⨾࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓◊✲࡟ࡼࡿ᳨ウࡀᮃࡲࢀࡿࠋࡲࡓ +'/ ᶵ⬟ࢆᨵၿࡍែ௦ㅰ㒊࣭◊✲⿵ຓဨࡿ࣓࢝ࢽࢬ࣒ࡢゎ᫂ࡸ⸆≀➼ࡢ௓ධຠᯝࢆ᫂ࡽ࠿࡟

࿴⏣㑳ே࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែࡍࡿࡇ࡜࡛ࠊ)+ ࣊ࢸࣟ᥋ྜయᝈ⪅ࡢṧᏑࣜࢫࢡࢆࡼ

௦ㅰ㒊࣭◊ಟ⏕ࡾపୗࡉࡏࡿࡇ࡜ࡀྍ⬟࡟࡞ࡿ࡜⪃࠼ࡿࠋ⃝ᮧඖẼ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែ௦ㅰ㒊࣭◊ಟ⏕Ϭ㸬⤖ ㄽ

ྜྷ⏣ᬗᏊ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែ 㧗 /'/& ⾑⑕࡟ࡼࡾᚰ⾑⟶⑌ᝈⓎ⑕ࣜࢫࢡࢆ᭷ࡍ

௦ㅰ㒊࣭஦ົ⿵ຓဨ

ࡿ )+ ࣊ࢸࣟ᥋ྜయᝈ⪅࡟࠾࠸࡚ࠊ+'/ ᶵ⬟࡜ࡋ࡚ࡢࢥࣞࢫࢸ࣮ࣟࣝᘬࡁᢤࡁ⬟ࡢపୗࡀࡼࡾࣜࢫࢡࢆୖ

ࡆࡿᅉᏊ࡜࡞ࡗ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡜࡞ࡗࡓࠋ







ϭ㸬◊✲༠ຊ⪅㐨಴ 㞞ோ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ⑓ែ௦ㅰ㒊࣭◊ಟ⏕෠ᐙ ༓㭯࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ⑓ែ௦ㅰ㒊࣭◊ಟ⏕ᑠ಴ ṇᜏ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮◊✲ᡤ࣭⑓ែ௦ㅰ㒊࣭◊✲ဨᵐ㔝 ஂኈ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⢾ᒀ⑓࣭4୰ᚰ⾑ᅽ࡟㛵ࡍࡿ㏣㊧◊✲ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮㧗⾑ᅽ࣭⭈⮚⛉㒊㛗   Ἑ 㔝 㞝 ᖹ Ϩ㸬⥴ ゝ࠙ᑐ㇟ࠚ 㧗⾑ᅽࡣᚰ⾑⟶⑌ᝈࡢ୺せ࡞༴㝤ᅉᏊ࡛࠶ࡿࡀࠊ ⥅⥆⑕౛㸸እ᮶㏻㝔୰ࡢ㧗⾑ᅽᝈ⪅࡛ࠊᖹᡂ ⾑ᅽ࡜ᚰ⾑⟶⑌ᝈ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࡣࠊ㏻ᖖ ᐃࡉᖺࡢ୰ᚰ⾑ᅽࢫࢱࢹ࢕ཧຍ⪅ࢀࡿୖ⭎ື⬦ࡢ⾑ᅽࡼࡾࠊᚰ⮚࡟㏆࠸኱ື⬦࡞࡝ࡢ ᪂つ⑕౛㸸እ᮶㏻㝔୰ࡢ㧗⾑ᅽᝈ⪅࡛ࠊ௨ୗࡢ᮲

୰ᚰື⬦ࡢ⾑ᅽ㸦୰ᚰ⾑ᅽ㸧ࡀࡼࡾ㔜せ࡜⪃࠼ࡽࢀ௳ࢆ‶ࡓࡍࡶࡢ㸸ձ㝆ᅽ⸆᭹⏝୰ࡶࡋࡃࡣ᪂ࡓ࡟㝆ࡿࠋ୰ᚰ⾑ᅽࡣࠊ㠀౵くⓗ࡟ィ ࡉࢀࡓ㳐㦵ື⬦ࡢᅽ⸆ࢆ᭹⏝㛤ጞࠊղᖺ㱋 35 ṓ௨ୖࠊᛶูࡣၥࢃ࡞࠸ࠊ

⬦Ἴゎᯒ࡟ࡼࡾ᥎ィ࡛ࡁࡿࡇ࡜ࡀ♧ࡉࢀ࡚࠸ࡿࠋࡲ

ճ⬦Ἴ⾑ᅽィ㸦HEM-9000AI㸧࡟ࡼࡾ㳐㦵ື⬦⬦Ἴゎࡓࠊࡑࡢ㛵㐃ᣦᶆ࡛࠶ࡿ Augmentation Index㸦AI㸸኱ᯒࢆ  ᅇ௨ୖ᪋⾜῭ࡳື⬦཯ᑕἼࡢᣦᶆ㸧ࡶࠊື⬦◳໬ࡸᚰ⾑⟶⑌ᝈ࡜ࡢ ┠ᶆ⑕౛ᩘ㸸200 ౛ ඹྠ◊✲඲య࡛ 2500 ౛ 㛵㐃ࡀὀ┠ࡉࢀ࡚࠸ࡿࠋ

ᮏ◊✲࡬ࡢ༠ຊࡢྠពࡣࠊᑐ㇟⪅࡟ㄝ᫂ᩥ᭩ࢆ⏝ 㧗⾑ᅽࡢ἞⒪࡟࠾࠸࡚ࡣ㝆ᅽࡢ⛬ᗘࡸ┠ᶆ⾑ᅽ್ࠊ࠸࡚ㄝ᫂ࡋࠊᮏேࡢ⨫ྡ࡟ࡼࡾྠពࢆᚓࡿࠋ㝆 ᅽ ⸆ ࡀ 㔜 せ ࡜ ⪃ ࠼ ࡽ ࢀ ࡿ ࡀ ࠊ ASCOT-CAFÉ࠙᪉ἲࠚ(Anglo-Scandinavian Cardiac Outcome Trial - Conduit ⬦Ἴ᳨ᰝ

Artery Function Evaluation) ◊✲࡛ࡣᚰ⾑⟶ணᚋ࡟୰ ⬦Ἴ⾑ᅽィ㸦HEM-9000AIࠊ࣒࢜ࣟࣥ࣊ࣝࢫࢣ࢔㸧ᚰ⾑ᅽࡢᕪࡀ㛵୚ࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋࡲࡓࠊᮏ

ࢆ౑⏝ࡋ࡚ࠊ⾑ᅽ࠾ࡼࡧ⬦Ἴࣃ࣓࣮ࣛࢱ (AI, SBP2)◊ ✲ ࡢ ඛ ⾜ ◊ ✲ ࡛ ࠶ ࡿ ୰ ᚰ ⾑ ᅽ ◊ ✲ 㸦 ABC-J:ࡢ ᐃࢆ⾜࠺ࠋᮏ᳨ᰝࡣ㠀౵くⓗ࡛ࠊ᪥ᮏ㧗⾑ᅽᏛ

Antihypertensives and Blood pressure of Central artery఍ࡢ㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ࡟࠾࠸࡚ࠊ⾑⟶㞀ᐖホ

study in Japan㸧࡛ࡣࠊከ᪋タඹྠࡢᶓ᩿ⓗ᳨ウ࡟࠾࠸౯ࡢ᳨ᰝ࡜ࡋ࡚᥎ዡࡉࢀ࡚࠸ࡿࠋྠᶵჾࡣ⸆஦ἲㄆ

࡚ࠊྛ✀ࡢ㝆ᅽ⸆ࡀ୰ᚰ⾑ᅽࡸ AI ࡟␗࡞ࡿຠᯝࢆཬ

ྍရ࡛࠶ࡾࠊᏳ඲ᛶࡀ☜ㄆࡉࢀ࡚࠸ࡿࠋ

ࡰࡋࠊ⾑⟶ᣑᙇᛶࡢ㝆ᅽ⸆ࡀࡇࢀࡽࢆࡼࡾపୗࡉࡏ ㄪᰝ᪉ἲ

ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡋ࠿ࡋࠊ㝆ᅽ⸆ࡢ୰ᚰ⾑ձ12 ࠿᭶ࡈ࡜ࡢᐃᮇⓗㄪᰝ࡟ࡼࡾ௨ୗࡢ᝟ሗࢆ཰㞟ᅽࡸ AI ࡬ࡢຠᯝࡸࠊ
ࡑࢀࡽ࡜ᚰ⾑⟶⑌ᝈ࡜ࡢ㛵㐃ࢆࡍࡿࠋ༏ྡ໬ࡉࢀࡓࢹ࣮ࢱࢆ୰ኸ஦ົᒁ࡟ᒆࡅࡿࠋ

ࡼࡾ᫂ࡽ࠿࡟ࡍࡿ࡟ࡣࠊከᩘࡢ㧗⾑ᅽᝈ⪅࡟ࡘ࠸࡚ղ⬦Ἴ⾑ᅽィࡢࣇࣛࢵࢩ࣓ࣗࣔࣜ࡟グ㘓ࡉࢀ࡚࠸ࡿ

ࡢ⦪᩿ⓗ◊✲࡟ࡼࡿ᳨ウࡀᚲせ࡛࠶ࡿࠋ

᳨ᰝᒚṔࡢࢹࢪࢱࣝࢹ࣮ࢱ࠿ࡽࠊ⾑ᅽ࠾ࡼࡧᧉ㦵ື ᮏ◊✲㸦ABC-J㏣㊧◊✲㸧ࡣࠊ㏻ᖖデ⒪ࡢ⠊ᅖෆ࡛⬦⬦Ἴࣃ࣓࣮ࣛࢱࢆ཰㞟ࡍࡿࠋ㝆ᅽ⸆ෆ᭹୰࠶ࡿ࠸ࡣ㝆ᅽ἞⒪ࢆ㛤ጞࡋࡓ㧗⾑ᅽᝈ デ⒪㘓࠿ࡽࡢ㌿グ㸸⪅ࢆᑐ㇟࡜ࡋ࡚ࠊ  ୰ᚰ⾑ᅽ࡜ணᚋࡢ㛵ಀࢆ᳨ウձ᭹⏝୰ࡢ㝆ᅽ⸆ࡢ⸆๣ྡࢆྵࡴ἞⒪ෆᐜࡍࡿࠊ  㝆ᅽ⸆἞⒪ࡢ⥅⥆࡟ࡼࡿ୰ᚰ⾑ᅽࡢኚ໬ղ⾑ᾮ᳨ᰝ㸦⾑⢾ࠊ⬡㉁ࠊ⭈ᶵ⬟ࠊ㟁ゎ㉁㸧ࢆୖ⭎⾑ᅽ࡜ẚ㍑ࡍࡿࠊ  㝆ᅽ἞⒪㛤ጞ๓ᚋࡢ୰

ճᒀ᳨ᰝ㸦ᒀࢱࣥࣃࢡࠊᚤ㔞࢔ࣝࣈ࣑ࣥ㸧ᚰ⾑ᅽࡢኚ໬ࢆୖ⭎⾑ᅽ࡜ẚ㍑ࡋྛ㝆ᅽ⸆ࡢ≉ᚩࢆմᚰ⾑⟶ᶵ⬟᳨ᰝ㸦ᚰ࢚ࢥ࣮㸸࢜ࣉࢩࣙࣥ㸧୰ᚰ⾑ᅽ࡬ࡢຠᯝ࡜ࡋ࡚ホ౯ࡍࡿࡇ࡜ࠊࢆ┠ⓗ࡜ࡍյᝈ⪅ᒓᛶ㸦ᖺ㱋ࠊᛶูࠊ㌟㛗ࠊయ㔜ࠊ᪤ Ṕࠊᐙࡿከ᪋タඹྠ◊✲࡛ࠊ2009ᖺ࡟㛤ጞࡉࢀࡓࠋᮏᖺᗘ

᪘Ṕࠊ⏕ά⩦័㸧

ࡣⓏ㘓⑕౛ࡢ㏣㊧ㄪᰝࢆ⾜ࡗࡓࠋնᚰ⾑⟶࢖࣋ࣥࢺࡢ᭷↓ࠊ⏕Ꮡ㸭Ṛஸࡢ☜ㄆ ࢚ࣥࢺ࣮ࣜ࠿ࡽࡢಶࠎࡢ⑕౛ࡢ㏣㊧ᮇ㛫ࡣ 2 ᖺ௨ϩ㸬ᑐ㇟࣭᪉ἲ

ୖࢆ┠ᶆ࡜ࡍࡿࠋ

5ෆ᭹୰࠶ࡿ࠸ࡣ㝆ᅽ἞⒪ࢆ㛤ጞࡋࡓ㧗⾑ᅽᝈ⪅ࢆᑐ࠙◊✲඲య⤌⧊ࠚ୰ኸ஦ົᒁ㸸㇟࡜ࡋ࡚ࠊከ᪋タඹྠ࡛ࠊ୰ᚰ⾑ᅽ࡜ணᚋࡢ㛵ಀࢆ⮬἞་⛉኱Ꮫ

⮬἞་⛉኱Ꮫ㸦௦⾲㸧  ᩍᤵ   ᓥ⏣࿴ᖾ᳨ウࡋࠊ㝆ᅽ⸆἞⒪ࡢ⥅⥆࡟ࡼࡿ୰ᚰ⾑ᅽࡢኚ໬ࢆ

㸦୰ኸ஦ົᒁ㸧   ㅮᖌ   ᐑୗ ὒୖ⭎⾑ᅽ࡜ẚ㍑ࡋࠊྛ㝆ᅽ⸆ࡢ≉ᚩࢆ୰ᚰ⾑ᅽ࡬ࡢᮾ໭኱Ꮫ        ᩍᤵ   ௒஭ ₶  ຠᯝ࡜ࡋ࡚ホ౯ࡍࡿࡇ࡜ࠊࢆ┠ⓗ࡜ࡍࡿࡶࡢ࡛࠶ࡿࠋ            ෸ᩍᤵ  ᶫᮏ₶୍㑻ᮏ◊✲ࡢ᭱⤊⤖ᯝࡣࡲࡔㄽᩥ໬ࡉࢀ࡚࠸࡞࠸ࡀࠊඹ

஑ᕞ኱Ꮫ        ᩍᤵ   ◁ᕝ㈼஧  ྠ◊✲඲య࡛ࡣ4000౛௨ୖࡀⓏ㘓ࡉࢀࠊከᩘࡢᚰ⾑            ෸ᩍᤵ  ᘅᒸⰋ㝯 ⟶࢖࣋ࣥࢺࡀሗ࿌ࡉࢀ࡚࠾ࡾࠊ㡰ㄪ࡟㐍ᤖࡋࡓ࡜⪃ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㒊㛗  Ἑ㔝㞝ᖹ  ࠼ࡽࢀࡿࠋᮏ◊✲࡟ࡼࡾࠊ୰ᚰ⾑ᅽ࡜⮚ჾ㞀ᐖࡸᚰ             ་㛗  ᒾᔱ⩏㞝⾑⟶ணᚋ࡜ࡢ㛵㐃ࡸࠊࡑࢀ࡟ཬࡰࡍྛ✀㝆ᅽ⸆ࡢຠឡ፾኱Ꮫ        ෸ᩍᤵ  ᑠཎඞᙪ  ᯝ࡟ࡘ࠸࡚ࠊከࡃࡢ᪂▱ぢࡀᚓࡽࢀࡿࡇ࡜ࡀᮇᚅࡉ            ㅮᖌ   ⏣ཎᗣ⋞ࢀࡿࠋᇸ⋢་⛉኱Ꮫ      ᩍᤵ   㕥ᮌὒ㏻                       ➉୰ᜏኵϬ㸬⤖ ㄽ

ᮾி་⛉኱Ꮫඵ⋤Ꮚ་⒪ࢭࣥࢱ࣮ ୰ᚰ⾑ᅽࡣୖ⭎⾑ᅽࡼࡾ⮚ჾ㞀ᐖࡸᚰ⾑⟶⑌ᝈ࡟            ᩍᤵ   㧗ἑㅬ஧    ࡼࡾᐦ᥋࡟㛵㐃ࡋࠊ⮫ᗋୖ᭷⏝࡞ᣦᶆ࡜⪃࠼ࡽࢀࡿࠋ                  ᭯⃝ ᙲ

ABC-J㏣㊧◊✲ࡣࠊ㝆ᅽ⸆἞⒪୰࠶ࡿ࠸ࡣ἞⒪ࢆ㛤ጞࡋࡓ㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡜ࡋ࡚ࠊ୰ᚰ⾑ᅽ࡜ᚰ⾑⟶ணϪ㸬⤖ ᯝᚋࢆ᳨ウࡍࡿከ᪋タඹྠࡢ⦪᩿ⓗ◊✲࡛࠶ࡿࠋᮏᖺ

 ABC-J ㏣㊧◊✲࡟ࡣࠊᙜ᪋タ࠿ࡽࡣ 57 ౛ࡀⓏ㘓ࡉᗘࡣࠊⓏ㘓⑕౛࡟ࡘ࠸࡚㏣㊧ㄪᰝࢆ⾜ࡗࡓࠋᮏ◊✲ࢀࡓࠋᮏᖺᗘࡣⓏ㘓ࡉࢀࡓ⑕౛ࡢ㏣㊧ㄪᰝࢆ⾜࠸ࠊ࡟ࡼࡾࠊ୰ᚰ⾑ᅽ࡜⮚ჾ㞀ᐖࡸᚰ⾑⟶ணᚋ࡜ࡢ㛵㐃㝆ᅽ⸆ࢆྵࡴ἞⒪ෆᐜࠊ⾑ᾮ࣭ᒀ᳨ᰝࠊᚰ⾑⟶ᶵ⬟ࡸࠊࡑࢀ࡟ཬࡰࡍྛ✀㝆ᅽ⸆ࡢຠᯝ࡟ࡘ࠸࡚ࠊከࡃ

᳨ᰝࠊᝈ⪅ᒓᛶࠊᚰ⾑⟶࢖࣋ࣥࢺࡢ᭷↓ࠊ⏕Ꮡ㸭Ṛࡢ᪂▱ぢࡀᮇᚅࡉࢀࡿࠋ

ஸࡢ☜ㄆࢆデ⒪㘓࡟ᇶ࡙࠸࡚ㄪ࡭ࠊᚓࡽࢀࡓࢹ࣮ࢱ

ࢆ୰ኸ஦ົᒁ࡟㏦௜ࡋࡓࠋᚓࡽࢀࡓࢹ࣮ࢱࡣ௚᪋タϭ㸬◊✲༠ຊ⪅

࠿ࡽࡢ㈨ᩱ࡜ྜࢃࡏ࡚ࠊ୰ኸ஦ົᒁ࡟࠾࠸࡚ゎᯒࡉ ᒾᔱ⩏㞝 ᅜ❧ᚠ⎔ჾ⑓ࢭࣥࢱ࣮

ࢀࡓࠋࡇࢀࡲ࡛඲య࡛ࡣࠊ⬻࣭ᚰ࣭⭈ࡢ࢖࣋ࣥࢺࡸ      㧗⾑ᅽ࣭⭈⮚⛉་㛗Ṛஸ࡞࡝ࠊ ࢆ㉸࠼ࡿ࢖࣋ࣥࢺࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋϮ㸬ཧ⪃ᩥ⊩ϫ㸬⪃ ᐹ

1) Williams B, Lacy PS, Thom SM, Cruickshank K, ୰ᚰ⾑ᅽ࡜ᚰ⾑⟶⑌ᝈ࡜ࡢ㛵㐃ࡀὀ┠ࡉࢀ࡚࠾ࡾࠊ

Stanton A, Collier A, et al: Differential impact of bloodࡲࡓ㝆ᅽ⸆࡟ࡼࡾ୰ᚰ⾑ᅽ࡜ୖ⭎⾑ᅽ࡬ࡢຠᯝࡀ␗

pressure-lowering drugs on central aortic pressure and࡞ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗ࡚ࡁࡓࠋᮏ◊✲ࡢඛ⾜◊✲clinical outcomes: principal results of the Conduit࡛࠶ࡿ୰ᚰ⾑ᅽࢫࢱࢹ࢕㸦ABC-J㸧࡛ࡣࠊከᩘ౛ࡢ

Artery Function Evaluation (CAFÉ) study. Circulation

἞⒪୰ࡢ㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡜ࡋࡓከ᪋タඹྠࡢᶓ᩿

2006; 113: 1213-1225.
2) Ἑ㔝㞝ᖹ㸸ྛ✀㝆ᅽ⸆ࡢ୰ᚰື⬦ᅽࡢపୗຠᯝ.

ⓗ᳨ウ࡟࠾࠸࡚ࠊྛ✀ࡢ㝆ᅽ⸆ࡀ୰ᚰ⾑ᅽࡸ AI ࡟␗⾑ᅽ 2009; 16: 777-781.

࡞ࡿຠᯝࢆཬࡰࡋࠊ⾑⟶ᣑᙇᛶࡢ㝆ᅽ⸆㸦࢔ࣥࢪ࢜ࢸࣥࢩࣥཷᐜయᣕᢠ⸆ࠊ࢔ࣥࢪ࢜ࢸࣥࢩࣥኚ᥮㓝⣲3) Ᏻ⏣ஂ௦㸪Ἑ㔝㞝ᖹ㸸㧗⾑ᅽ⑓ែ࡟࠾ࡅࡿ୰ᚰື

㜼ᐖ⸆ࠊ࢝ࣝࢩ࣒࢘ᣕᢠ⸆ࠊȘ㐽᩿⸆㸧ࡀࠊ⾑⟶ࢆ⬦⾑ᅽࡢព⩏. 㧗⾑ᅽ㸦ୖ㸧➨ 4 ∧ᇶ♏⦅㸪᪥ᮏ࠶ࡲࡾᣑᙇࡋ࡞࠸㝆ᅽ⸆㸦ș㐽᩿⸆ࠊ฼ᒀ⸆㸧࡟ẚ⮫ᗋ 2009; 67 ᕳ ቑหྕ 6: 108-112.

࡭࡚ࠊࡇࢀࡽࢆࡼࡾపୗࡉࡏࡿࡇ࡜ࡀㄆࡵࡽࢀࡓࠋ

4) Miyashita H, Aizawa A, Hashimoto J, Hirooka Y, Imai ࡋ࠿ࡋࠊྛ✀ࡢ㝆ᅽ⸆ࡢ୰ᚰ⾑ᅽࡸAI࡬ࡢຠᯝࡸࠊ

Y, Kawano Y, et al: Cross-sectional characterization ofࡑࢀࡽࡢᚰ⾑⟶⑌ᝈ࡜ࡢ㛵㐃ࢆࡼࡾ᫂ࡽ࠿࡟ࡍࡿ࡟

all classes of antihypertensives in terms of central bloodࡣࠊከᩘࡢ㧗⾑ᅽᝈ⪅࡟ࡘ࠸࡚ࡢ⦪᩿ⓗ◊✲࡟ࡼࡿpressure in Japanese hypertensive patients. Am J

᳨ウࡀᚲせ࡜⪃࠼ࡽࢀࡿࠋABC-J㏣㊧◊✲ࡣ㸪㝆ᅽ⸆Hypertens 2010; 23: 260-268.

65) Townsend RR, Roman MJ, Najjar SS, Cockcroft JR,
Feig PU, Stockbridge NL: Central blood pressure
measurements – an opportunity for efficacy and safety
in drug development? J Am Soc Hypertens 2010; 4:
211-214.
 Ἑ㔝㞝ᖹ㸪㧗⏣ⱥ᫂㸸⾑ᅽ ᐃ㸸デᐹᐊ⾑ᅽ㸪ᐙᗞ⾑ᅽ㸪᫬㛫⾑ᅽ㸪AI୰ᚰ⾑ᅽDiabetes
Frontier 2012; 23: 467-472.
7) Ohta Y, Kawano Y, Iwashima Y, Hayashi S, Yoshihara F,
Matayoshi T, Takiuchi S, Kamide K, Nakamura S,
Horio T: Control of home blood pressure with an
amlodipine- or losartan-based regimen and progressionof carotid artery intima-media thickness in hypertensive
patients: the HOSP substudy. Clin Exp Hypertens 35:
279-284, 2013.
8) Roman MJ, Devereaux RD: Associations of central andperipheral

blood

cardiovascularpressures

phenotypes.

withintermediate

Hypertension

63:

1148-1153, 2014.

7㧗⾑ᅽᝈ⪅࡟࠾ࡅࡿ࢔ࣥࢪ࢜ࢸࣥࢩࣥϩཷᐜయᣕᢠ⸆㸦$5%㸧ࡢᒀ㓟᤼ἥቑຍస⏝࣭࡞ࡽࡧ࡟
⾑⟶ෆ⓶ᶵ⬟࡟㛵ࡍࡿẚ㍑᳨࣭ウ̿(IIHFWRIDQJLRWHQVLQUHFHSWRUEORFNHURQXULFDFLGH[FUHWLRQRUYDVFXODUHQGRWKHOLDOIXQFWLRQ̿ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈⮚⛉㒊㛗Ἑ 㔝 㞝 ᖹϨ㸬⥴ ゝࡎ㸪ヨ㦂ᮇ㛫୰ࡣ㝆ᅽ⸆ࡢ⏝㔞ࡣኚ᭦ࡋ࡞࠿ࡗࡓ㸬㝆ᅽ⒪ἲ࡟࠾࠸࡚ࡣ㸪⾑ᅽ್ࡔࡅ࡛࡞ࡃ㸪ᚰ⾑⟶ᑐ㇟⪅ࡢ᭹⏝㝆ᅽ⸆ࡣ ARB 100㸣㸪
Ca ᣕᢠ⸆ 82㸣㸪⑌ᝈࡢࣜࢫࢡ࡛࠶ࡿ⬡㉁␗ᖖ⑕ࡸ⢾ᒀ⑓㸪㧗ᒀ㓟⾑

฼ᒀ⸆ 47㸣㸪D㐽᩿⸆ 6㸣㸪E㐽᩿⸆ 12㸣࡛࠶ࡗࡓ㸬⑕࡞࡝ࡢ⏕ά⩦័⑓ࡢࢺ࣮ࢱࣝ࡞἞⒪ࢆࡵࡊࡋ㸪ືᒀ㓟㝆ୗ⸆᭹⏝⪅ࡣ 5 ྡ㸦ᒀ㓟⏕ᡂᢚไ⸆ 3 ྡ㸪⬦◳໬ࡢ㐍ᒎࢆ㜵ࡄࡇ࡜ࡀ㔜せ࡛࠶ࡿ㸬㧗ᒀ㓟⾑⑕ᒀ㓟᤼ἥಁ㐍⸆ 2 ྡ㸧࡛࠶ࡗࡓ㸬ヨ㦂ᮇ㛫୰ࡣ௚ࡢࡣ⊂❧ࡋࡓᚰ⾑⟶⑓ࡢ༴㝤ᅉᏊ࡛࠶ࡿࡔࡅ࡛࡞ࡃ

㝆ᅽ⸆ࡸࡑࡢ௚ࡢ⸆๣ࡣኚ᭦ࡋ࡞࠿ࡗࡓ㸬1)2)㸪៏ᛶ⭈⮚⑓㸦CKD㸧ࡢⓎ⑕࣭㐍ᒎ࡜㛵ಀࡍࡿࡇእ᮶⾑ᅽࡣ㸪5 ศ㛫Ᏻ㟼ᚋ㸪ᗙ఩࡛ࡢ 2 ᅇࡢ⾑ᅽ࡜ 3)ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡇ࡜࠿ࡽ㸪ࡑࡢ⟶⌮ࡀぢ┤ࡉᖹᆒ್ࢆ⏝࠸ࡓ㸬ᐙᗞ⾑ᅽࡣ㸪ཷデ๓ 3 ᪥㛫ࡢᮅࡢࢀ࡚࠸ࡿ㸬⾑ᅽ್ࡢᖹᆒ್ࢆ⏝࠸ࡓ㸬⸆๣ኚ᭦๓࡟✵⭡᫬᥇⾑࢔ࣥࢪ࢜ࢸࣥࢩࣥII ཷᐜయᣕᢠ⸆(ARB)ࡢࣟࢧࣝ

ࢆ࠾ࡇ࡞࠸㸪㝶᫬ᒀ୰ᒀ㓟㸭ࢡࣞ࢔ࢳࢽࣥẚ㸦UUAࢱࣥࡣ㸪⭈ᒀ⣽⟶ࡢᒀ㓟ࢺࣛࣥࢫ࣏࣮ࢱ࣮࡛࠶ࡿ㸭UCr㸧
㸪24 ᫬㛫⵳ᒀ࡟࠾࠸࡚ᒀ㓟᤼ἥ㔞㸦EUA㸧

urate transporter 1㸦URAT1㸧ࡢ㜼ᐖ࡟ࡼࡾ⾑Ύᒀ࡜ᒀ㓟ࢡࣜ࢔ࣛࣥࢫ㸦CUA㸧ࢆホ౯ࡋ㸪࢖ࣝ࣋ࢧࣝ

㓟್ࢆపୗࡉࡏࡿࡀ 4)㸪࢖ࣝ࣋ࢧࣝࢱࣥࡶࣟࢧࣝࢱ

ࢱࣥ࡬ࡢኚ᭦ 3 ࣧ᭶ᚋ࡟෌ホ౯ࡋࡓ㸬ࡲࡓ㸪⮚ჾಖࣥ࡜ྠᵝ࡟ URAT1 㜼ᐖຠᯝࢆ᭷ࡍࡿࡇ࡜ࡀሗ࿌

ㆤస⏝ࡢホ౯࡜ࡋ࡚㸪ᒀ୰࢔ࣝࣈ࣑ࣥ㔞㸪㢕ື⬦ෆࡉࢀ࡚࠸ࡿ 5)㸬⭷୰⭷ཌ㸪⬦Ἴఏ᧛㏿ᗘ㸦baPWV㸧㸪⾑ὶ౫Ꮡᛶ⾑௒ᅇ㸪ࣟࢧࣝࢱࣥ௨እࡢ ARB ෆ᭹ୗࡢ㧗ᒀ㓟⾑⟶ᣑᙇ཯ᛂ㸦FMD㸧ࢆ㸪⅖⑕࣐࣮࣮࢝ࡢ monocyte⑕ྜే㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡟㸪⑓ᆺศ㢮ࢆホ౯ࡋ㸪࢖chemoattractant protein-1㸦MCP-1㸧
㸪㓟໬ࢫࢺࣞ

ࣝ࣋ࢧࣝࢱࣥ࡬ኚ᭦ᚋࡢᒀ㓟ືែ࡟ࡘ࠸᳨࡚ウࡋࡓ㸬ࢫ ࣐ ࣮ ࢝ ࣮ ࡢ ᒀ ୰ 8-Hydroxydeoxyguanosine
㸦8OHdG㸧ࢆ ᐃࡋࡓ㸬᥎⟬⣒⌫యℐ㐣㸦e GFR㸧ࡣ⏨ᛶ㸸194⾑Ύࢡࣞ࢔ࢳࢽࣥѸ1.094ᖺ㱋Ѹ0.287㸪

ϩ㸬ᑐ㇟࣭᪉ἲ
ᑐ㇟ࡣ㸪⾑Ύᒀ㓟್㸦UA 㸼7 mg㸭dl ࡶࡋࡃࡣዪᛶ㸸194⾑Ύࢡࣞ࢔ࢳࢽࣥѸ1.094ᖺ㱋Ѹ0.287

ᒀ㓟㝆ୗ⸆᭹⏝࡟ࡶ࠿࠿ࢃࡽࡎ UA㸼6 mg㸭dl ࡛㸪

0.739 ࡢᘧࢆ⏝࠸࡚⟬ฟࡋࡓ 6)㸬

ࣟࢧࣝࢱࣥ௨እࡢ ARB ෆ᭹ୗࡢ㧗ᒀ㓟⾑⑕ྜే㧗⤖ᯝࡣᖹᆒsᶆ‽೫ᕪ࡛♧ࡋ㸪⤫ィ࡟ࡣᑐᛂࡢ࠶

⾑ᅽእ᮶ᝈ⪅ 17 ྡ㸦ᖹᆒᖺ㱋 68s13 ṓ㸪⏨ᛶ 11

ࡿ t ᳨ᐃ࡜F2 ᳨ᐃࢆ⏝࠸㸪p㸺0.05 ࢆ᭷ពᕪ࠶ࡾ࡜

ྡ㸪ዪᛶ 6 ྡ㸧࡛࠶ࡿ㸬ᢞ୚ࡉࢀ࡚࠸ࡓ ARB ࡣ㸪ࡋࡓ㸬࣓࢜ࣝࢧࣝࢱࣥ㸦5 ྡ㸧㸪࢝ࣥࢹࢧࣝࢱࣥ㸦3 ྡ㸧㸪Ϫ㸬⤖ ᯝ

ࣂࣝࢧࣝࢱࣥ㸦2 ྡ㸧㸪ࢸ࣑ࣝࢧࣝࢱࣥ㸦7 ྡ㸧࡛࠶ࡗࡓ㸬඲ဨ࡟ᒀ㓟⟶⌮ࡀ୙༑ศ࡛࠶ࡿࡇ࡜ࢆㄝ᫂ࡋ㸪⾲ 1 ࡟࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢኚ᭦๓ᚋࡢྛࣃ࣓ࣛ

࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼ࡢྠពࢆᚓࡓ㸬౑⏝ࡉ࣮ࢱ࣮ࢆ♧ࡍ㸬ࣟࢧࣝࢱࣥ௨እࡢ ARB ᭹⏝᫬ࡢ඲ࢀ࡚࠸ࡓ ARB ࢆᖖ⏝㔞᥮⟬࡛ᑐᛂࡍࡿ࢖ࣝ࣋ࢧࣝ

ᑐ㇟⪅ࡢ eGFR ࡣ 55s19 ml㸭ศ㸭1.73 m2 ࡛㸪ࢱࣥ㸦50ࠥ200 mg㸭᪥㸧࡬ኚ᭦ࡋ㸪3 ࣧ᭶㛫ᢞ୚ࡋ

CKD ࢫࢸ࣮ࢪ 2 ࡀ 8 ྡ㸪ࢫࢸ࣮ࢪ 3 ࡀ 6 ྡ㸪ࢫࡓ㸬㝆ᅽ⸆ࡢษࡾ᭰࠼᫬࡟ࡣ wash-out ᮇ㛫ࡣタࡅ

ࢸ࣮ࢪ 4 ࡀ 3 ྡྵࡲࢀ࡚࠸ࡓ㸬UA ࡣ 7.6s0.7 mg

8㸭dl㸪UUA㸭UCr ࡣ 0.43s0.21㸪24 ᫬㛫⵳ᒀ࡟࠾ࢆㄆࡵࡓ㸦3.57s1.63 vs. 4.44s2.68㸪p㸺0.05㸪ᅗᅗࡅࡿ EUA ࡣ 0.25s0.10 mg㸭kg㸭᫬㸪
CUA ࡣ 3.57

1㸧
㸬CUA ࡢኚ໬ࡣ㸪UA ࡢኚ໬࡜᭷ព࡞㈇┦㛵ࢆs1.63 ml㸭ศ࡛㸪㝶᫬ᒀ࡛ࡣ඲ᑐ㇟⪅ 17 ྡ୰ 16ᅗ 2㸧㸬ᒀ㓟᤼ἥಁ㐍♧ࡋࡓ㸦r㸻Ѹ0.43㸪p㸺0.05㸪ᅗྡ㸦94.1㸣㸧ࡀᒀ㓟᤼ἥపୗᆺ࡟ศ㢮ࡉࢀ㸪24 ᫬㛫㻝㻜㻜⵳ᒀ࡛ࡣ඲౛ࡀᒀ㓟᤼ἥపୗᆺ࡛࠶ࡗࡓ㸬㻤㻜⾲㸯 ௚ࡢ ARB ࠿ࡽ࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢኚ᭦๓ᚋࡢᣦᶆ

㻢㻜

ᮾி㻌

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኱㜰㻌

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㻝㻌᭶㻌

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 ᅗ 2  ARB ኚ᭦ᚋࡢ CUA ࡜ UA ࡢኚ໬ࡢ㛵ಀ⸆᭹⏝⪅㸪ᒀ㓟⏕ᡂᢚไ⸆᭹⏝⪅㸪ᒀ㓟㝆ୗ⸆㠀᭹⏝⪅࡟࠾࠸࡚㸪CUA ቑຍస⏝ࡸᒀ㓟㝆ୗస⏝࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸬ᒀ୰࢔ࣝࣈ࣑ࣥ㔞㸪MCP-1㸪
ᒀ୰ 8OHdG㸪baPWV ࡣపୗഴྥࢆ㸪FMD ࡣቑຍഴྥࢆ♧ࡋࡓࡀ㸪࠸ࡎࢀࡶ᭷ព࡛ࡣ࡞࠿ࡗࡓ㸬ARB
ูࡢ UA ࡢኚ໬࡟㛵ࡋ࡚ࡣ㸪࣓࢜ࣝࢧࣝࢱࣥ⩌࡜ࢸ࣑ࣝࢧࣝࢱࣥ⩌࡛ UA ࡢ᭷ព࡞పୗࡀࡳࡽࢀ㸪ࣂࣝ㸦ᖹᆒsᶆ‽೫ᕪ㸧㸪ࢧࣝࢱࣥ⩌࡜࢝ࣥࢹࢧࣝࢱࣥ⩌࡟࠾࠸࡚ࡣపୗഴྥ

㸨p㸺0.05㸪㸨㸨p㸺0.01 vs. ௚ࡢ ARBࢆ♧ࡋࡓࡀ㸪᭷ព࡞ኚ໬࡛ࡣ࡞࠿ࡗࡓ㸬ࡲࡓ㸪࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢኚ᭦ᚋࡢᒀ㓟ືែࡢᨵၿࡣ࠸ࡎࢀࡢ

࢖ࣝ࣋ࢧࣝࢱࣥࡢᢞ୚㔞ࡣᖹᆒ 106 mg㸦50 mg 2

CKD ࢫࢸ࣮ࢪ࡛ࡶࡳࡽࢀ㸪ࢫࢸ࣮ࢪู࡟࠾ࡅࡿᒀ⾲ 2㸧㸬㓟ືែࡢኚ໬࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸦⾲ྡ㸪100 mg 13 ྡ㸪200 mg 2 ྡ㸧࡛࠶ࡗࡓ㸬࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢኚ᭦ 3 ࣧ᭶ᚋ㸪デᐹᐊ⾑ᅽ㸪ᐙᗞ⾑ᅽࡣపୗഴྥࢆ♧ࡋࡓࡀ㸪᭷ព࡛ࡣ࡞࠿ࡗࡓ㸦⾲
⾲ 1㸧㸬

⾲ 2 CKD ࢫࢸ࣮ࢪูᒀ㓟ືែࡢኚ໬

UA ࡜⾑⢾ࡣ᭷ព࡞పୗࢆㄆࡵ㹙UA㸸7.6s0.7 vs.
7.0s0.8 mg㸭dl㸪p㸺0.01㸪㸦ᅗᅗ 1㸧㸪⾑⢾㸸106s
16 vs. 101s13 mg㸭dl㸪p㸺0.05㹛
㸪e GFR ࡣ᭷ព࡞ቑຍࢆ♧ࡋࡓ㸦55s19 vs. 58s20ml㸭ศ㸭
1.73m2㸪p㸺0.05㸧
㸬UUA㸭UCr ࡣୖ᪼ഴྥࢆ㸦0.43
s0.21 vs. 0.46s0.26㸪n. s.㸧
㸪CUA ࡣ᭷ព࡞ୖ᪼

㸦ᖹᆒsᶆ‽೫ᕪ㸧
㸪CKD㸸៏ᛶ⭈⮚⑓ϫ㸬⪃ ᐹ

㻝㻜㻜㧗ᒀ㓟⾑⑕ࡣ⫧‶㸪㧗⾑ᅽ㸪⬡㉁␗ᖖ⑕㸪⪏⢾⬟

㻤㻜
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␗ᖖ࡞࡝ࡢ⏕ά⩦័⑓ࢆྜేࡍࡿࡇ࡜ࡀከࡃ㸪࣓ࢱ

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࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࢆక࠺㧗⾑ᅽᝈ⪅࡛ࡣ㧗㢖ᗘ኱㜰㻌࡟㧗ᒀ㓟⾑⑕ࢆྜేࡍࡿ. 㝆ᅽ⸆ࡢ࡞࠿࡛ Ca ᣕᢠ㻞㻜⸆㸪ARB㸪ACE 㜼ᐖ⸆㸪D㐽᩿⸆㸪࣒࢝ࣜ࢘ಖᣢᛶ

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฼ᒀ⸆ࡣᒀ㓟௦ㅰ࡟ᝏᙳ㡪ࢆཬࡰࡉ࡞࠸࡜⪃࠼ࡽࢀ㻠㻌᭶㻌࡚࠸ࡿࡀ㸪ARB ࡢࣟࢧࣝࢱࣥࡣ࣋ࣥࢬࣈ࣐ࣟࣟࣥ
 ᅗ 1  ࢖ࣝ࣋ࢧࣝࢱࣥኚ᭦๓ᚋࡢᒀ㓟ືែࡢኚ໬

࡜ྠᵝ࡟⭈ᒀ⣽⟶࡟Ꮡᅾࡍࡿ URAT1 ࢆ㜼ᐖࡋ࡚㸨p㸺0.05㸪㸨㸨p㸺0.01 vs. ௚ࡢ ARBᒀ㓟᤼ἥࢆቑຍࡉࡏ㸪UA ࢆᖹᆒ 0.7 mg㸭dl పୗ9ࡉࡏࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ 7)㸬ᮏ◊✲࡛ࡣ㸪࢖ࣝᯘ┿୍㑻࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㧗⾑ᅽ࣭⭈࣋ࢧࣝࢱࣥ࡬ࡢኚ᭦ᚋ㸪UA ࡣ⣙ 0.6 mg㸭dl పୗ⮚⛉࣭་ဨࡋ㸪࡜ࡃ࡟࣓࢜ࣝࢧࣝࢱࣥ㸪ࢸ࣑ࣝࢧࣝࢱࣥ࠿ࡽࡢ

ᴋ༤࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㧗⾑ᅽ࣭⭈⮚⛉࣭ኚ᭦࡛ᒀ㓟ືែࡀ᭷ព࡟ᨵၿࡋࡓ㸬࣓࢜ࣝࢧࣝࢱࣥ

་ဨ

࡛ࡣ URAT1㸪voltage-driven urate transporter 1
㸦URATv1㸧㜼ᐖస⏝ࡀㄆࡵࡽࢀ࡚࠾ࡽࡎ㸪ࡲࡓࢸϮ㸬ཧ⪃ᩥ⊩࣑ࣝࢧࣝࢱࣥࡣ URAT1㸪URATv1 㜼ᐖస⏝ࡀㄆࡵ1)Fang J, Alderman M. Serum uric acid andࡽࢀ࡚࠸ࡿࡀ 5)㸪ᒀ୰࡟᤼ἥࡉࢀ࡞࠸ࡓࡵ⮫ᗋⓗ࡟

cardiovascular mortalityThe NHANES I

ᒀ㓟᤼ἥಁ㐍స⏝ࡣ࡯࡜ࢇ࡝ㄆࡵࡽࢀ࡞࠸㸬୍᪉࡛㸪Epidemiologic Follow-up Study, 1971-1992.

࢖ࣝ࣋ࢧࣝࢱࣥࡣ URAT1 ࠾ࡼࡧ URATv1 ࡟ࡼࡿ

JAMA 2000; 283: 2404-2410.

ᒀ㓟ྲྀࡾ㎸ࡳ㜼ᐖస⏝ࡀ࠶ࡾ 5)㸪
࡜ࡃ࡟ UA ࡀ 7 mg

2)

Bos M, Koudstaal P, Albert H, et al. Uric acid㸭dl ௨ୖࡢ⑕౛࡟࠾࠸࡚ࡑࡢຠᯝࡀ᫂ࡽ࠿࡛࠶ࡿ㸬is a risk factor for myocardial infarction andࡲࡓ㸪࢖ࣝ࣋ࢧࣝࢱࣥ࡟ࡣᒀ㓟పୗస⏝ࡔࡅ࡛࡞ࡃ㸪

stroke: The Rotterdam study. Stroke 2006;ᒀ୰࢔ࣝࣈ࣑ࣥᢚไస⏝࡞࡝ࡢ⭈࡟ᑐࡍࡿ⮚ჾಖㆤ

37: 1503-1507.

స⏝㸪FMD ᨵၿస⏝㸪⅖⑕࡟㛵ࡍࡿ MCP-1㸭

3)

Iseki K, Ikemiya Y, Inoue T, et al.

CDR2 ⣔ࡢᢚไస⏝㸪
PPAR-g άᛶ໬స⏝࡞࡝ࡀሗ

Significance of hyperuricemia as a risk factor࿌ࡉࢀ࡚࠸ࡿ 8)㸬ᮏ◊✲࡟࠾࠸࡚ࡣ㸪࢖ࣝ࣋ࢧࣝࢱ

for developing ESRD in a screened cohort.

ࣥ࡬ࡢኚ᭦ᚋ࡟ᒀ࢔ࣝࣈ࣑ࣥ᤼ἥ㔞㸪baPWV㸪Am J Kidney Dis 2004; 44: 642-650.

MCP-1㸪ᒀ୰ 8OHdG ࡣῶᑡഴྥࢆ㸪FMD ࡣቑຍ

4)Fauvel P, Velon S, Berra N, et al. Effects ofഴྥࢆ♧ࡋࡓࡶࡢࡢ㸪᭷ព࡛ࡣ࡞ࡃ㸪௚ࡢ ARB ࡟

losartan on renal function in patients withࡃࡽ࡭࡚᫂ࡽ࠿࡞ᢠ⅖⑕స⏝ࡸᢠ㓟໬స⏝ࢆㄆࡵ࡞

essential࠿ࡗࡓ㸬ࡋ࠿ࡋ࡞ࡀࡽ㸪࢖ࣝ࣋ࢧࣝࢱࣥ࡬ࡢษࡾ᭰

Pharmacol 1996; 28: 259-263.
5)࠼࡟ࡼࡾ⾑⢾್ࡢ᭷ព࡞పୗࡀㄆࡵࡽࢀࡓࡇ࡜࠿ࡽ㸪
PPAR-g άᛶ໬స⏝ࡢ㛵୚ࡀ♧၀ࡉࢀࡿ㸬

hypertension.

J

Cardiovasc

Nakamura M, Anzai N, Jutabha P, et al.
Concenttration-dependent inhibitory effects

ᮏ᳨ウ࡛ࡣ㸪඲౛ࡀ௚ࡢ ARB ࠿ࡽ࢖ࣝ࣋ࢧࣝࢱ

of irbesartan on renal uric acid transporters.
J Pharmacol Sci 2010; 114: 115-118.

ࣥ࡬ࡢษࡾ᭰࠼ࢆ࠾ࡇ࡞ࡗࡓᑐ↷ࡢ࡞࠸◊✲࡛㸪⑕౛ᩘࡶᑡ࡞ࡃ㸪࢖ࣝ࣋ࢧࣝࢱࣥࡢᢞ୚ᮇ㛫ࡣ 3 ࣧ᭶

6)Matuo S, Imai E, Yasuda Y, et al. Revised࡛࠶ࡗࡓ㸬࢖ࣝ࣋ࢧࣝࢱࣥࡢ⮚ჾಖㆤ࡞࡝ࡢຠᯝࢆ

equations for estimated GFR from serumࡼࡾ᫂ࡽ࠿࡟ࡍࡿ࡟ࡣ㸪ከᩘ౛࡟ࡘ࠸࡚ࡢ↓సⅭヨcreatinine in Japan. Am J Kidney Dis 2009;㦂࡟ࡼࡿ㛗ᮇⓗ࡞᳨ウࡀᚲせ࡛࠶ࡿ㸬

53: 982-992.
7)Ϭ㸬⤖ ㄽ
㧗ᒀ㓟⾑⑕ᝈ⪅ࡣ㸪௚ࡢ⏕ά⩦័⑓ࢆྜేࡋ࡚࠸

Iwanaga T, Sato M, Maeda T, et al.
Concentration-dependentmode

interaction

IIofangiotensinofreceptorࡿ౛ࡀከࡃ㸪ࡲࡓ㧗⾑ᅽᝈ⪅࡛ࡣࡑࡢ࡯࡜ࢇ࡝ࡀᒀ

blockers with uric acid transporter. J㓟᤼ἥపୗᆺ࡛࠶ࡾ㸪ᒀ㓟పୗస⏝ࢆ௓ࡋࡓ CKD

Pharmacol Exp Ther 2007; 320: 211-217.
8)ࡸᚰ⾑⟶⑓ࡢⓎ⑕࠾ࡼࡧ㐍ᒎࢆண㜵ࡍࡿࡓࡵ࡟ࡶᒀ

Proudfoot J, Croft K, Puddey I, et al.

㓟್࡟㓄៖ࡋࡓ㝆ᅽ἞⒪ࡀᮃࡲࡋ࠸㸬࢖ࣝ࣋ࢧࣝࢱ

Angiotensin II type 1 receptor antagonistsࣥࡣᒀ㓟ືែࢆᨵၿࡍࡿࡇ࡜࠿ࡽ㧗ᒀ㓟⾑⑕ྜే㧗

inhibits basal as well as low-density⾑ᅽ࡟᭷⏝࡜ᛮࢃࢀࡿ.

lipoprotein

andfactor-stimulated

platelet^activating
human

monocyteϭ㸬◊✲༠ຊ⪅

chemoattractant protein-1. J Pharmacol Expᒾᔱ⩏㞝࣭Ặྡ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㧗⾑

Ther 2003; 305: 846-853.

ᅽ࣭⭈⮚⛉࣭་㛗኱⏣⿱Ꮚ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㧗⾑ᅽ࣭⭈⮚⛉࣭་ဨ/㛛ྖ᤿῭఍⑓㝔 ෆ⛉࣭㒊㛗10἞⒪᢬ᢠᛶ㧗⾑ᅽ࡟ᑐࡍࡿຠᯝⓗ࡞㝆ᅽ⸆ࡢే⏝࡟㛵ࡍࡿ◊✲(IHHFWLYHFRPELQDWLRQWKHUDS\IRUWKHUDS\UHVLVWDQWK\SHUWHQVLRQᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈⮚⛉㒊㛗Ἑ 㔝 㞝 ᖹϨ㸬⥴ ゝࡢእ᮶ཷデ๓  㐌㛫ࡢᖹᆒ್ࢆ᥇⏝ࡋࡓࠋᚰ⾑⟶⑌ᝈⓎ⑕ண㜵ࡢࡓࡵ࡟ࡣཝ᱁࡞㝆ᅽࡀࡲࡓࠊࣟࢧࣝࢱࣥ+&7= ࡬ࡢษࡾ᭰࠼๓ᚋ࡛㔜せ࡛࠶ࡾ㸪ཝ᱁࡞㝆ᅽ┠ᶆࢆ㐩ᡂࡍࡿࡓࡵ࡟

⾑ᾮ᳨ᰝࢆᐇ᪋ࡋࠊ⢾࣭⬡㉁ࣃ࣓࣮ࣛࢱ࣮ࠊ⭈ࡣ㝆ᅽ⸆ࡢే⏝⒪ἲࡀࡋࡤࡋࡤᚲせ࡜࡞ࡿࠋ㝆ᶵ⬟ࠊᒀ㓟ࠊ&཯ᛂᛶ⺮ⓑ㸦&53㸧ࢆ ᐃࡋࡓࠋᅽ⸆ࡢే⏝࡜ࡋ࡚࢔ࣥࢪ࢜ࢸࣥࢩࣥϩཷᐜయᣕ࢖ࣥࢫࣜࣥ᢬ᢠᛶࡢᣦᶆ࡛࠶ࡿ +20$5 ࡣ✵⭡ᢠ⸆㸦ARB㸧࡜฼ᒀ⸆ࡢే⏝ࡣ㸪ࢃࡀᅜࡢࠕ㧗᫬⾑⢾㸦PJGO㸧✵⭡᫬࢖ࣥࢫࣜࣥ㸦ȣ8PO㸧⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ 2014㸦JSH2014㸧
ࠖ1㸧࡛ ࡛ồࡵࡓࠋ᥎ᐃ⣒⌫యℐ㐣⋡ࡣ᪥ᮏ⭈⮚Ꮫࡶ᥎ዡࡉࢀ࡚࠸ࡿ㸬
ARB ࡜฼ᒀ⸆ࡢ⤌ࡳྜࢃࡏ఍ࡢ &.' デ⒪࢞࢖ࢻࣛ࢖ࣥ  ࡟ᚑ࠸ࠊᨵゞ 0'5'ࡣ,㣗ሷឤཷᛶࡢ㠃࠿ࡽ┦஌ⓗ࡞㝆ᅽຠᯝࡀᚓ

⡆᫆ᘧࡼࡾồࡵࡓࠋࡉࡽ࡟㝶᫬ᒀ࡟࡚ᒀ୰࢔ࣝ

ࡽࢀࡿࡇ࡜,฼ᒀ⸆ᢞ୚࡟ࡼࡿ࢖ࣥࢫࣜࣥឤཷ

ࣈ࣑ࣥࢆ ᐃࡋࠊ
ࡑࡢ᤼ἥ⋡ࢆᒀ୰࢔ࣝࣈ࣑ࣥ

ᛶࡢపୗ㸦⪏⢾⬟ࡢ␗ᖖ㸧ࡸప࣒࢝ࣜ࢘㸦K㸧

ࢡࣞ࢔ࢳࢽࣥẚ㸦PJJ&U㸧࡛⾲ࡋࡓࠋ⾑⑕ࢆ ARB ࡀ┦ẅࡍࡿࡇ࡜㸪ࡉࡽ࡟ࣟࢧࣝࢱ

⤫ィゎᯒࡣ 6WDW9LHZ㸦9HUVLRQ㸧ࢆ⏝࠸࡛ࣥࡣࡑࡢ≉␗ⓗ࡞ᒀ㓟᤼ἥಁ㐍స⏝ࡀ฼ᒀ⸆࡚⾜ࢃࢀࠊ್㸦㐃⥆ኚᩘ㸧ࡣᖹᆒsᶆ‽೫ᕪ࡛࡟ࡼࡿ⾑୰ᒀ㓟್ୖ᪼ࡶᢚ࠼ࡿࡇ࡜࡞࡝฼Ⅼࡀ⾲ࡉࢀࡓࠋษࡾ᭰࠼๓ᚋ࡛ࡢ⾑ᅽࠊᚰᢿᩘ࡞ࡽ

኱ࡁ࠸ࠋࡧ࡟⮫ᗋ᳨ᰝࣃ࣓࣮ࣛࢱ࣮ࡢྛኚ໬ࡢ᭷ពᕪࡣ

ᮏ◊✲࡛ࡣ㸪㝆ᅽ୙༑ศ౛࡟࠾ࡅࡿ✀ࠎࡢ㝆

SDLUHGW᳨ᐃࢆ⏝࠸࡚ホ౯ࡋࡓࠋణࡋࠊ&53ࠊ

ᅽ⸆࠿ࡽࣟࢧࣝࢱࣥ㸭ࣄࢻࣟࢡࣟࣟࢳ࢔ࢪࢻ

ᒀ୰࢔ࣝࣈ࣑ࣥ࡟ࡘ࠸࡚ࡣ㠀ᑐ⛠ศᕸࡢࡓࡵࠊ

㸦HCTZ㸧㓄ྜ๣࡬ࡢษࡾ᭰࠼࡟ࡼࡿ㝆ᅽຠᯝ㸪ࣀࣥࣃ࣓ࣛࢺࣜࢵࢡࢸࢫࢺ㸦:LOFR[RQVLJQHG

⮫ᗋ᳨ᰝࣃ࣓࣮ࣛࢱࡢኚ໬࡜㝆ᅽຠᯝ࡟ᐤ୚ࡍ

UDQNWHVW㸧ࢆ⏝࠸࡚᭷ពᕪ᳨ᐃࢆ⾜ࡗࡓࠋྛゎࡿᅉᏊ࡟ࡘ࠸᳨࡚ウࡋࠊࡑࡢ἞⒪ຠᯝࢆண ࡍ

ᯒ࡜ࡶ3್ᮍ‶ࢆ⤫ィᏛⓗ᭷ព࡜ุᐃࡋࡓࠋ

ࡿࡓࡵࡢᅉᏊ࡟ࡘ࠸᳨࡚ウࡋ࡚࠸ࡿࠋ

Ϫ㸬⤖ ᯝ
ϩ㸬ᑐ㇟࣭᪉ἲ

ᮏ◊✲ᑐ㇟⪅  ౛ࡢᝈ⪅⫼ᬒࢆ⾲⾲  ࡟♧ࡍ㸬ᑐ㇟ࡣࠊ㸯✀㢮௨ୖࡢ㝆ᅽ⸆᭹⏝࡟࡚ᖹᆒᖺ㱋ࡣ s ṓ⏨ᛶ  ౛ࠊዪᛶ  ౛࡛ࠊ



-6+ ࡟♧ࡍ㝆ᅽ┠ᶆ࡟㐩ࡋ࡞࠸ᮏែᛶ㧗ᖹᆒࡢ ERG\PDVVLQGH[㸦%0,㸧ࡣ  NJ㸭P⾑ᅽᝈ⪅  ౛࡛ࠊࣟࢧࣝࢱࣥ PJ+&7=PJ࡛࠶ࡗࡓ㸬ษࡾ᭰࠼๓ࡢ᭹⏝㝆ᅽ⸆ࡣ $5% ౛ࠊ㓄ྜ๣㸦 㘄᪥ࠊᮅ  ᅇᢞ୚㸧࡬ࡢษࡾ᭰࠼㸦୍࢔ࣥࢪ࢜ࢸࣥࢩࣥኚ᥮㓝⣲ $&( 㜼ᐖ⸆  ౛ࠊ฼

㒊ࡣ㏣ຍᢞ୚㸧๓࡜ษࡾ᭰࠼⣙  ࣨ᭶ᚋ࡛እ᮶ᒀ⸆  ౛ࠊ࢝ࣝࢩ࣒࢘ &D ᣕᢠ⸆  ౛ࠊș 㐽⾑ᅽ࣭ᚰᢿᩘࠊᐙᗞ⾑ᅽࢆࡑࢀࡒࢀẚ㍑ࡋࡓࠋ᩿⸆  ౛ࠊȘ 㐽᩿⸆  ౛࡛࠶ࡗࡓࠋࡇࡢ࡞࠿࡛

እ᮶⾑ᅽ࣭ᚰᢿᩘࡣ  ศ௨ୖࡢᏳ㟼ᚋᗙ఩࡛ࣟࢧࣝࢱࣥ㸭+&7= ࡬ษࡾ᭰࠼ࡽࢀࡓࡶ࡜ࡢ㝆ᐃࡋࠊษࡾ᭰࠼๓ᚋ࡛ࡢࡑࢀࡒࢀ  ཷデࡢᖹᆒ

ᅽ⸆ࡣ $5% ౛ࠊ$&( 㜼ᐖ⸆  ౛ࠊ$5%㸩฼ᒀ⸆ ࢆእ᮶⾑ᅽ್࣭ᚰᢿᩘ࡜ࡋࡓࠋᐙᗞ⾑ᅽࡣ᪩ᮅ౛ࠊ฼ᒀ⸆  ౛ࠊ&D ᣕᢠ⸆  ౛ࠊș 㐽᩿⸆ 㸦㉳ᗋᚋ㸯᫬㛫௨ෆࠊᮅ㣗๓㸧࠾ࡼࡧࡲࡓࡣᑵ

౛࡛ࠊṧࡾ  ౛ࡣษࡾ᭰࠼࡞ࡋࡢ㏣ຍᢞ୚࡛࠶

ᐷ๓࡟ẖ᪥ ᐃࡋ࡚࠸ࡿࡑࢀࡒࢀ  ౛ࠊ ౛ࡗࡓࠋษࡾ᭰࠼௨እࡢ⸆๣ࡣヨ㦂ᮇ㛫୰ᢞ୚㔞ࠊࡢࡳࢆゎᯒࡢᑐ㇟࡜ࡋࠊษࡾ᭰࠼๓ᚋࡑࢀࡒࢀ

ᢞ୚᪉ἲ࡜ࡶኚ࠼ࡎ࡟⥅⥆ࡋࡓࠋ11ࣟࢧࣝࢱࣥ㸭+&7= ࡬ࡢษࡾ᭰࠼࡟ࡼࡾࠊእ᮶

㝆ᅽຠᯝ࡟㛵㐃ࡍࡿ⫼ᬒᅉᏊࢆ᳨ウࡍࡿࡓࡵࠊ

཰⦰ᮇ⾑ᅽࡣ㸬s㸬PP+J࠿ࡽ㸬s㸬እ᮶཰⦰ᮇ⾑ᅽࡢ㝆ୗᗘ࡜ษࡾ᭰࠼๓ࡢ⮫ᗋ᳨PP+J ࡬ࠊእ᮶ᣑᙇᮇ⾑ᅽࡣ 㸬s㸬PP+Jᰝࣃ࣓࣮ࣛࢱ࡜ࡢ┦㛵ࢆ᳨ウࡋࡓ࡜ࡇࢁࠊ⾑₢࠿ࡽ 㸬s㸬PP+J ࡬࡜ࡑࢀࡒࢀ᭷ព࡟పୗ

ࣞࢽࣥάᛶ࡜⾑ᅽኚ໬ᗘࡢ࠶࠸ࡔ࡟᭷ព࡞┦㛵ࡋࡓ ࡜ࡶ࡟ S ࠋእ᮶ᚰᢿᩘࡣษࡾ᭰࠼๓

㛵ಀࢆㄆࡵ㸦U㸻㸬ࠊS 㸬㸧ࠊษࡾ᭰࠼㸬s㸬ESPࠊษࡾ᭰࠼ᚋ 㸬s㸬ESP๓ࡢࣞࢽࣥάᛶࡀప್࡛࠶ࡿ࡯࡝㝆ᅽᗘࡣ኱࡛

࡜ኚ໬ࡣ࡞࠿ࡗࡓ㸦S㸻㸬㸧
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 ౛࡟ࡘ࠸࡚ࠊ᥎ᐃ㣗ሷᦤྲྀ㔞࡜㝆ᅽᗘࡢ㛵ಀ$&( 㜼ᐖ⸆ ౛ࢆ᳨ウࡋࡓ࡜ࡇࢁࠊ඲య࡛ࡣ᥎ᐃ㣗ሷᦤྲྀ㔞࡜

$5%฼ᒀ⸆ ౛㝆ᅽᗘ࡟᭷ព࡞㛵ಀࡣࡳࡽࢀ࡞࠿ࡗࡓࡶࡢࡢࠊ

฼ᒀ⸆  ౛ษࡾ᭰࠼๓࡟฼ᒀ⸆ࡀᢞ୚ࡉࢀ࡚࠸ࡓ  ౛ࢆ㝖&D ᣕᢠ⸆ ౛࠸ࡓ  ౛࡛ࡣࠊ᥎ᐃ㣗ሷᦤྲྀ㔞࡜⾑ᅽኚ໬ᗘࡢș 㐽᩿⸆ ౛࠶࠸ࡔ࡟᭷ព࡞┦㛵㛵ಀࢆㄆࡵ㸦U㸻㸬ࠊS࡞ࡋ㸦㏣ຍࡢࡳ㸧  ౛㸻ࠋ㸧ࠊษࡾ᭰࠼๓ࡢ᥎ᐃ㣗ሷᦤྲྀ㔞ࡀከ࠸

$5%



࡯࡝㝆ᅽຠᯝࡀ኱ࡁ࠿ࡗࡓ㸦ᅗᅗ 㸧ࠋᐙᗞ⾑ᅽࡣࠊ᪩ᮅ࠾ࡼࡧᑵᐷ๓࡜ࡶ࡟ࠊ཰⦰ᮇ࣭

ᣑᙇᮇ⾑ᅽ࡜ࡶ᭷ព࡞పୗࢆ♧ࡋࡓ㸦᪩ᮅ㸸཰⦰ᮇ⾑ᅽ 㸬s㸬Ѝ㸬s㸬PP+Jࠊ㻝㻜㻜ᣑᙇᮇ⾑ᅽ 㸬s㸬Ѝ㸬s㸬PP+Jࠊ㻤㻜ᑵᐷ๓཰⦰ᮇ⾑ᅽ 㸬s㸬Ѝ㸬s㸬

㻢㻜

ᮾி㻌

PP+Jࠊᣑᙇᮇ⾑ᅽ 㸬s㸬Ѝ㸬s㸬

㻠㻜

ྡྂᒇ㻌

PP+Jࠊ࠸ࡎࢀࡶ S㸧
ࠋ

㻞㻜

኱㜰㻌

ษࡾ᭰࠼๓ᚋ࡛ࡢ⮫ᗋ᳨ᰝࢹ࣮ࢱࡢኚ໬࡛ࡣࠊ

㻜⢾࣭⬡㉁ࡢྛࣃ࣓࣮ࣛࢱ࡟ኚ໬ࡣࡳࡽࢀࡎࠊ

㻝㻌᭶㻌

㻞㻌᭶㻌

㻟㻌᭶㻌

㻠㻌᭶㻌

+20$5 ࡶ᭷ព࡞ኚ໬ࡣ࡞࠿ࡗࡓࠋ⭈ᶵ⬟࡛ࡣࠊᒀ⣲❅⣲ࠊࢡࣞ࢔ࢳࢽࣥࡣ㍍ᗘ࡞ቑຍࢆࡳࡓࡀࠊ

 ᅗ 2  ษࡾ᭰࠼๓࡟฼ᒀ⸆ࡀᢞ୚ࡉࢀ࡚࠸࡞࠸⑕౛࡛ࡢ

H*)5 ࡟᭷ព࡞పୗࡣ࡞࠿ࡗࡓ㸬⾑Ύ .ࠊᒀ㓟್ࣟࢧࣝࢱࣥ㸭HCTZ 㓄ྜ๣࡬ࡢษࡾ᭰࠼࡟ࡼࡿእ᮶཰⦰ᮇ

࡟ࡶኚ໬ࡣࡳࡽࢀ࡞࠿ࡗࡓࠋ&53 ࠾ࡼࡧᒀ୰࢔

⾑ᅽ㝆ୗᗘ࡜᥎ᐃ㣗ሷᦤྲྀ㔞㸦ษࡾ᭰࠼๓㸧ࡢ㛵ಀࣝࣈ࣑ࣥࡣษࡾ᭰࠼࡟ࡼࡾ᭷ព࡟ῶᑡࡋࡓࠋ
%13ϫ㸬⪃ ᐹ

ࡣపୗഴྥࢆ♧ࡋࡓࡀࠊ᭷ព࡛ࡣ࡞࠿ࡗࡓ㸬⾑ᮏ◊✲ࡢ┠ⓗࡣࠊࣟࢧࣝࢱࣥ㸭+&7= ࡬ࡢษࡾ₢ࣞࢽࣥάᛶࡣ᭷ព࡟ቑຍࡋࡓࠋ

᭰࠼࡟ࡼࡿ㝆ᅽࡢቑᙉࡀ࡝ࡢࡼ࠺࡞⫼ᬒᅉᏊ࡜ࡘࡂ࡟ࣟࢧࣝࢱࣥ㸭+&7= ࡬ࡢษࡾ᭰࠼࡟ࡼࡿ

12

1 ∧, ᮾி: ᮾி་Ꮫ♫; 2012. P. 1-145.

㛵㐃ࡍࡿ࠿ࠊࡍ࡞ࢃࡕ㝆ᅽຠᯝࢆண▱ࡍࡿᅉᏊ3)

ࢆぢฟࡍࡇ࡜࡛࠶ࡿࠋษࡾ᭰࠼࡟ࡼࡿእ᮶཰⦰

Alderman M, Madhavan S, Cohen H, etᮇ⾑ᅽࡢపୗᗘ࡜ษࡾ᭰࠼๓ࡢ⮫ᗋ᳨ᰝࣃ࣓ࣛ

al. Low urinary sodium is associated࣮ࢱ࡜ࡢ┦㛵ࢆㄪ࡭ࡓ࡜ࡇࢁࠊ⾑₢ࣞࢽࣥάᛶ

with࡜⾑ᅽኚ໬ᗘࡢ࠶࠸ࡔ࡟᭷ព࡞┦㛵㛵ಀࡀࡳࡽ

infarction among treated hypertensiveࢀࠊษࡾ᭰࠼๓ࡢࣞࢽࣥάᛶࡀ࿧್࡛࠶ࡿ࡯࡝

men. Hypertension 1995; 25: 1144-1152.

㝆ᅽᗘࡣ኱ࡁ࠿ࡗࡓࠋࡲࡓࠊ฼ᒀ⸆ࡀ஦๓࡟ᢞ
୚ࡉࢀ࡚࠸࡞࠿ࡗࡓ౛ࡔࡅ࡛ࡳࡿ࡜ࠊ᥎ᐃ㣗ሷᦤྲྀ㔞࡜⾑ᅽኚ໬ᗘࡢ࠶࠸ࡔ࡟ࡶ᭷ព࡞┦㛵㛵ಀࢆㄆࡵࠊษࡾ᭰࠼๓ࡢ᥎ᐃ㣗ሷᦤྲྀ㔞ࡀከ࠸࡯࡝㝆ᅽᗘࡀ኱ࡁ࠿ࡗࡓࠋᮏ◊✲ᑐ㇟౛ࡢ⣙༙
ᩘ࡟ 5$ ⣔㜼ᐖ⸆ࡀࡶ࡜ࡶ࡜ධࡗ࡚࠸ࡓࡇ࡜ࠊ
౛୰  ౛࡛ࡣ฼ᒀ⸆ࡀ᪂ࡓ࡟㏣ຍࡉࢀࡓᙧ࡜
࡞ࡿࡇ࡜ࡼࡾࠊᮏ◊✲࡛ࡢ㝆ᅽቑᙉస⏝ࡣ +&7=
ࡢ㏣ຍຠᯝࡀ࠾ࡶ࡟ฟࡓࡶࡢ࡜⪃࠼ࡽࢀࡿࠋ⾑₢ࣞࢽࣥάᛶࡢప್ࡣ㣗ሷᦤྲྀࡢ㐣๫ࡸ㣗ሷឤཷᛶࡢ≉㐍࡜㛵㐃ࡍࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡀ
㸧ࠊࡇࢀࡽࡣ฼ᒀ⸆ࡢຠࡁࡸࡍ࠸⑓ែ࡛࠶ࡾࠊ

ᮏ◊✲ࡢ⤖ᯝࡣࡑࢀࢆᐇ㝿࡟ド᫂ࡋࡓࡶࡢ࡜࠸
࠼ࡿࠋࡍ࡞ࢃࡕࠊ࡜ࡃ࡟ 5$ ⣔㜼ᐖ⸆࠿ࡽ $5%㸭฼ᒀ⸆ྜ๣࡬ࡢษࡾ᭰࠼ࢆ⪃࠼ࡿ࡜ࡁࠊ⾑₢ࣞࢽࣥάᛶࡢపୗࡣ㝆ᅽࡢቑᙉࡀᮇᚅࡉࢀࡿ୍ࡘ
ࡢ┠Ᏻ࡜࡞ࢁ࠺ࠋ

Ϭ㸬⤖ ㄽ
㝆ᅽ୙༑ศ࡞㧗⾑ᅽᝈ⪅࡟ᑐࡋ࡚✀ࠎࡢ㝆ᅽ⸆࠿ࡽࣟࢧࣝࢱࣥ㸭+&7= 㓄ྜ๣࡬ࡢษࡾ᭰࠼
ࡣࠊእ᮶࠾ࡼࡧᐙᗞ⾑ᅽࢆ᭷ព࡟ᨵၿࡋࠊ࡜ࡃ
࡟⾑₢ࣞࢽࣥప್࡞ࡽࡧ࡟㣗ሷᦤྲྀ㔞ࡢከ࠸౛࡛ࡼࡾ᭷ຠ࡛࠶ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ
⾑₢ࣞࢽࣥάᛶࡢ ᐃࡣࠊ$5%㸭฼ᒀ⸆ྜ๣࡬
ࡢษࡾ᭰࠼ࡢ᭷ຠᛶࢆண ࡍࡿ┠Ᏻ࡜ࡋ࡚᭷⏝࡜⪃࠼ࡽࢀࡿࠋ
ϭ㸬◊✲༠ຊ⪅ᇼᑿṊྐ࣭ᕝᓮ་⛉኱Ꮫᕝᓮ⑓㝔࣭ᩍᤵᒾᔱ⩏㞝࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ 㧗⾑ᅽ࣭⭈⮚⛉࣭་㛗Ϯ㸬ཧ⪃ᩥ⊩1)᪥ᮏ㧗⾑ᅽᏛ఍㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ
సᡂጤဨ఍. 㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ
2014. ➨ 1 ∧. ᮾி: ࣛ࢖ࣇࢧ࢖࢚ࣥࢫฟ
∧; 2014. P. 1-234.

2)᪥ᮏ⭈⮚Ꮫ఍. CKD デ⒪࢞࢖ࢻ 2012. ➨13greaterriskofmyocardialᚰᶵ⬟ゎᯒࢯࣇࢺ࢙࢘࢔ࠕ+HDUW)XQFWLRQ9LHZࠖࡢゎᯒ⢭ᗘ࡜ࡑࡢ⮫ᗋⓗ᭷⏝ᛶࡢ᳨ウᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᨺᑕ⥺㒊 ་㛗 ᮌ ᭮ ၨ ♸Ϩ㸬⥴ ゝࡓࠋ㸦ྛ⩌ 10 ྡ⛬ᗘ㸧ᚰ㟁ᅗྠᮇᚰ➽⾑ὶ SPECT ࡟࠾࠸࡚ࡣ༢࡞ࡿ⾑ṇᖖ⩌㸸ᚰᶵ⬟ィ ࡸࢫࢡ࣮ࣜࢽࣥࢢࢆ┠ⓗ࡟i.

ὶホ౯࡟ࡼࡿ⤌⧊㞀ᐖศᕸࡢデ᩿࣭ホ౯ࡢࡳ࡞ࡽࡎࠊ

ྠ᳨ᰝࡀ᪋⾜ࡉࢀࡓᝈ⪅ࡢ୰࡛ࠊᚰ⑌ᝈࡢ᪤ 

௒ࡸᚰᶵ⬟ゎᯒࡣᚲ㡲࡛࠶ࡿࠋゎᯒࢯࣇࢺ࢙࢘࢔ࡢ

ࡀ࡞ࡃࠊ᳨ᰝ⤖ᯝ࠿ࡽࡣṇᖖᚰ➽⾑ὶཬࡧṇᖖ㐍Ṍ࡟క࠸ࠊ༢࡞ࡿᕥᐊᐜ✚ࡸቨ㐠ືࡢࡳ࡞ࡽࡎࠊ

ᚰᶵ⬟࡜デ᩿ࡉࢀࡓ 7 ౛ࠋ

᭱㏆࡛ࡣᕥᐊ཰⦰༠ㄪ୙඲(LV dyssynchrony: LVD)

⫧኱ᆺᚰ➽⑕㸦Hypertrophic cardiomyopathy: HCM㸧ii.

ࡶホ౯࡛ࡁࡿࡼ࠺࡟࡞ࡾࠊᚰ⮚෌ྠᮇ⒪ἲ㸦CRT㸧⩌㸸QGS ࡞࡝ᚑ᮶ࡢゎᯒࢯࣇࢺ࢙࢘࢔࡛ࡣࠊᒁ

ࡢ㐺ᛂỴᐃࡸ἞⒪ຠᯝண ࡟᭷⏝࡛࠶ࡿࡇ࡜ࡶሗ࿌

ᡤⓗ࡞ᚰ➽⫧኱⑕౛࡛ᚰ➽ᢳฟ࢚࣮ࣛࡀ⏕ࡌࠊ

1-3ࡉࢀ࡚࠸ࡿ ࠋࡇࡢࡼ࠺࡟ၟᴗ࣮࣋ࢫࡢᚰᶵ⬟ゎᯒᚰᶵ⬟ࡢィ ⢭ᗘࡀపୗࡍࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࢯࣇࢺ࡟࠾࠸࡚ࡣ࡯ࡰẖᖺ᪂ࡓ࡞ᶵ⬟ࡀ㏣ຍࡉࢀࠊࡿ㸦ᩥ⊩㸧ࠋࡑࡇ࡛ࠊᮏ᳨ウ࡛ࡣྛ✀᳨ᰝ࡟࡚ィ ⢭ᗘࡶྥୖࡋ࡚࠸ࡿ࡟ࡶ࠿࠿ࢃࡽࡎࠊࡑࡢࣂ࣮

HCM ࡜デ᩿ࡉࢀࡓᝈ⪅࡛ࠊᚋ㏙ࡢ QGS ࡟ࡼࡿࢪࣙࣥ࢔ࢵࣉ࡟ࡣከ㢠ࡢࢥࢫࢺࡀ࠿࠿ࡿࡓࡵࠊከࡃᶵ⬟ホ౯࡟࠾࠸࡚ᕥᐊ㥑ฟ⋡ࡀ 50㸣௨ୖ࡜ṇᖖࡢ᪋タ࡛ࡣྂࡃ࡚ᶵ⬟ࡢไ㝈ࡉࢀࡓࢯࣇࢺࡢ౑⏝ࢆ཰⦰⬟ࢆ᭷ࡋࠊᚰ➽⾑ὶ࡛ࡶ᫂ࡽ࠿࡞␗ᖖࡢㄆ

⥅⥆ࡏࡊࡿࢆᚓ࡞࠸⌧≧ࡀ࠶ࡿࠋࡋ࠿ࡋ᫖ᖺࠊ᪥ᮏ

ࡵࡽࢀ࡞࠸⑕౛㸸10 ౛ࢆ HCM ⩌࡜ࡋ᳨࡚ウᑐ࣓ࢪࣇ࢕ࢪࢵࢡࢫ♫ࡀ㛤Ⓨࡋࡓᚰᶵ⬟ゎᯒࢯࣇࢺ㇟࡜ࡍࡿࠋ

ࠕHeart Function View㸦HFV㸧ࠖࡣ⊂⮬ࡢᚰ➽ᢳฟ࢔ᚰ⮚෌ྠᮇ⒪ἲ㸦CRT㸧⩌㸦㔜⑕៏ᛶᚰ୙඲౛㸧㸸

iii.

ࣝࢦࣜࢬࢆ⏝࠸୍࡚㏻ࡾࡢᚰᶵ⬟ゎᯒࡀྍ⬟࡛࠶ࡾࠊ

HFV ࡢ఩┦ゎᯒἲࡢィ ⢭ᗘࢆ᳨ウࡍࡿࡓࡵ࡟

ࡉࡽ࡟≉➹ࡍ࡭ࡁⅬࡣࠕ↓ൾ౪୚࡛ࠖ࠶ࡿࡇ࡜ࡼࡾ

CRT ࡀ᪋⾜ࡉࢀࡓᝈ⪅ࡢෆࠊCRT ๓ཬࡧᚋ 6 ࣨ⌧ᅾὀ┠ࡉࢀ࡚࠸ࡿࢯࣇࢺࡢ୍ࡘ࡛࠶ࡿࠋ୰࡛ࡶ

᭶࡟ᚰ㟁ᅗྠᮇᚰ➽⾑ὶ SPECT ࡀ᪋⾜ࡉࢀࡓ⑕

LVD ࢆゎᯒ࡛ࡁࡿ఩┦ゎᯒᶵ⬟ࡣᕷ㈍ࡢゎᯒࢯࣇ

౛ 8 ౛ࢆ᳨ウᑐ㇟࡜ࡍࡿࠋࡲࡓࠊCRT ᚋ࡟ᚰᶵࢺ࢙࢘࢔ࡣ㠀ᖖ࡟㧗㢠࡛࠶ࡿࡇ࡜࠿ࡽᮏࢯࣇࢺ࡬ࡢ

⬟ᨵၿ㸦QGS ࡟ࡼࡾᚰᶵ⬟ゎᯒ࡟࠾࠸࡚

ྛ་⒪ᶵ㛵࠿ࡽࡢᮇᚅࡣ㠀ᖖ࡟኱ࡁ࠸ࠋࡋ࠿ࡋࠊࣜ

LVEF>10%ቑຍࡶࡋࡃࡣ LVESV ⦰ᑠ>10㸣㸧ࡢ࣮ࣜࢫࡉࢀ࡚㛫ࡶ࡞࠸ࡇ࡜࠿ࡽࠊᶵ⬟ゎᯒࡢ⢭ᗘࡸᚓࡽࢀࡓ⑕౛㸦Responder ⩌㸸4 ౛㸧࡜ᚓࡽࢀ࡞

௚ࡢၟ⏝ᚰᶵ⬟ゎᯒࢯࣇࢺ࡜ࡢ┦㐪Ⅼ࡞࡝ࡣࡲࡔ᫂

࠿ࡗࡓ⑕౛㸦Non-Responder ⩌㸸4 ౛㸧ࡢ 2 ⩌࡟ࡽ࠿࡟ࡉࢀ࡚࠸࡞࠸ࠋࡑࡇ࡛ࠊ௒ᅇࡢ◊✲࡛ࡣᮏࢯศ㢮ࡋࠊ఩┦ゎᯒᣦᶆࢆゎᯒࡍࡿࠋࣇࢺࡢゎᯒ⢭ᗘࢆᅜ㝿ⓗ࡟᭱ࡶ኱ࡁ࡞ࢩ࢙࢔ࢆ㄂ࡿ
ၟ⏝ᚰᶵ⬟ゎᯒࢯࣇࢺ㸸Quantitative Gated SPECT2.

㸦QGS㸧࡟ࡼࡿゎᯒ࡜ẚ㍑᳨ウࢆ⾜࠸ࠊᮏࢯࣇࢺࡢձ ᚰ㟁ᅗྠᮇᏳ㟼᫬ᚰ➽⾑ὶ SPECT㸸99mTc ᶆ㆑᭷⏝࡞ⅬࡸᨵၿࢆせࡍࡿⅬ࡞࡝ࢆ᫂ࡽ࠿࡟ࡋ࡚࠸ࡃࠋᚰ➽⾑ὶホ౯〇๣㸦sestamibi:350-600MBq ࡶࡋ᪉ἲ㸸ࡃࡣ tetrofosmine:592-740MBq㸧ࢆ౑⏝ࡋࠊᚰ㟁ϩ㸬ᑐ㇟࣭᪉ἲ
1.

ᅗྠᮇࡣ㸯ᚰᢿ࠶ࡓࡾ 16 ศ๭࡛཰㞟ࠋղ ཰㞟⿦⨨㸸ADAC ♫〇 Vertex ࡶࡋࡃࡣ Phillipsᑐ㇟♫〇 BrightView ࢆ౑⏝ࠋ㐣ཤ࡟Ᏻ㟼᫬ᚰ㟁ᅗྠᮇᚰ➽⾑ὶ SPECT ࡀ᪋⾜ճ ゎᯒ㡯┠㸸ᚰ㟁ᅗྠᮇᚰ➽⾑ὶ SPECT ࡢࢹ࣮ࡉࢀࡓᝈ⪅ࡢ୰࡛௨ୗࡢᝈ⪅⩌ࢆᑐ㇟࡜ࡋ࡚ᢳฟࡋ

14ࢱࢆ࣐࣓࢞ࣥ࢝ࣛ㝃ᒓࡢᚰᶵ⬟ゎᯒࢯࣇࢺ࢙࢘

ṇᖖ⩌࡟࠾࠸࡚ࡣࠊᕥᐊᐜ✚࡟ࡘ࠸࡚ࡣᅗ 1 ࡟♧࢔ࠕQGS (quantitative gated SPECT)ࢯࣇࢺ࢙࢘࢔ࠖ

ࡍࡼ࠺࡟ HFV ཬࡧ QGS ࡟࡚Ⰻዲ࡞┦㛵ࡀᚓࡽࢀཬࡧ᪥ᮏ࣓ࢪࣇ࢕ࢪࢵࢡࢫ♫〇ࠕHeart Functionࡓ 㸦 LVEDV: r=0.98, P=0.0002, ESV: r=0.96,

View㸦HFV㸧ࠖࢆ⏝࠸࡚௨ୗࡢ㡯┠ࢆホ౯ࡍࡿࠋP=0.0006 㸧ࠋࡋ࠿ࡋࠊLVEF ࡟࠾࠸࡚ࡣ୧ࢯࣇࢺ࢘

i. ᕥᐊᚰᶵ⬟㸸࢙࢔㛫࡟᭷ព࡞┦㛵㛵ಀࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ

1.

ᕥᐊᣑᙇᮎᮇᐜ✚㸦LVEDV㸧

2.

ᕥᐊ཰⦰ᮎᮇᐜ✚㸦LVESV㸧

3.

ᕥᐊ㥑ฟ⋡㸦LVEF㸧

㸦r=0.36, N.S.㸧
ࠋᅗ 1㸸ṇᖖ⩌࡟࠾ࡅࡿᕥᐊᶵ⬟(LVEDV/LVESV/LVEF)ࡢẚ㍑

௨ୖࡢィ ࢆṇᖖ⩌㺃HCM ⩌㺃CRT ⩌࡛ィ
3.

ࡍࡿࠋ

HCM ⩌㸸
HCM ⩌࡟࠾ࡅࡿᕥᐊᶵ⬟ࡢゎᯒ್࡟ࡘ࠸࡚

ii. ఩┦ゎᯒᣦᶆ㸸ࡢ୧ࢯࣇࢺ࢙࢘࢔㛫࡛ࡢẚ㍑ࢆᅗ 2 ࡟♧ࡍࠋᅗ

CRT ⩌࡟࠾࠸࡚ࡣ LVD ホ౯㡯┠࡜ࡋ࡚ HFV
ཬࡧ QGS ඹ࡟௜ᒓࡍࡿ఩┦ゎᯒἲ࡟ࡼࡾ⟬ฟࡉࢀࡓ Phase SD (PSD)ࠊBand ᖜ㸦BW㸧ࢆィ ࡍࡿࠋ
3. ⤫ィゎᯒ㸸ୖグゎᯒ㡯┠࡟ࡘ࠸࡚ṇᖖ⩌ࠊHCM⩌ཬࡧ CRT ᪋⾜⩌࡛ࡑࢀࡒࢀồࡵࠊ୧ࢯࣇࢺ࢙࢘
࢔࡟ࡼࡿィ್࡟ࡘ࠸࡚ྛᣦᶆࢆẚ㍑ࡍࡿࠋ

LVEDC/LVESV/LVEFࠊཬࡧ LVD ᣦᶆ㸦PSD/BW㸧ࡢᚰᶵ⬟ࡢẚ㍑࡟࠾࠸࡚ࡣ୧ࢯࣇࢺ࢙࢘࢔㛫࡛ࡢ┦㛵㛵ಀࡢ᳨ᐃࢆࣆ࢔ࢯࣥࡢ┦㛵ಀᩘࡢ᳨ᐃࢆ⏝
࠸ࠊCRT ⩌࡟࠾ࡅࡿྛ✀ LVD ᣦᶆ࡟࠾࠸࡚ R ⩌࡜ NR ⩌࡜ࡢẚ㍑࡟࠾࠸࡚ࡣ unpaired T ᳨ᐃࢆ᪋⾜ࡋࡓࠋϪ㸬⤖ ᯝ
1.

࡛♧ࡉࢀࡿ࡜࠾ࡾࠊᕥᐊᐜ✚ཬࡧ㥑ฟ⋡ඹ࡟Ⰻᝈ⪅⫼ᬒ㸸ዲ ࡞ ┦ 㛵 ࡀ ᚓ ࡽ ࢀ ࡓ 㸦 LVEDV: r=0.97,ṇᖖ⩌࣭HCM ⩌࣭CRT ⩌ࡑࢀࡒࢀࡢᖺ㱋࣭

P<0.0001, LVESV: r=0.96, P<0.0001, LVEF:

ᛶู࣭ᚰᶵ⬟࡟ࡘ࠸࡚⾲ 1 ࡟♧ࡍࠋᖺ㱋࣭ᛶู

r=0.83, P=0.0027㸧ࠋ࡛ࡣ୧⩌㛫࡟ᕪࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࡀࠊ
ᚰᶵ⬟ࠊ≉࡟ EF ࡟㛵ࡋ࡚ࡣ 3 ⩌㛫࡛᭷ព࡞ᕪ
ࢆㄆࡵࡓࠋ≉࡟ࠊᝈ⪅⫼ᬒṇᖖ⩌㻌㻔㼚㻩㻣㻕㻴㻯㻹⩌㻌㻔㼚㼚 㻩㻝㻜㻕

㻯㻾㼀⩌㻌㻔㼚㻩㻤㻕ᖺ㱋㻢㻤㻚㻥㼼㻤㻚㻤

㻢㻞㻚㻠㼼㻝㻝 㻞㻚㻣㻡㻥㻚㻢㼼㻝㻡㻚㻜ᛶู㻌㻔⏨㻛ዪ䠅

㻡㻛㻞

㻣㻛㻡
㻡

㻣㻛㻝

㻸㼂㻱㻰㼂㻌㻔㼙㼘㻕㻢㻢㻚㻜㼼㻟㻢㻚㻤㻝㻜㻝㻚㻠㼼㻞㻞 㻥㻚㻢㻞㻥㻜㻚㻝㼼㻝㻟㻟㻚㻥 㻖 㻐㻸㼂㻱㻿㼂㻌㻔㼙㼘㻕㻝㻣㻚㻟㼼㻝㻝㻚㻝㻠㻡㻚㻡㼼㻞㻞 㻠㻚㻞㻞㻝㻣㻚㻥㼼㻝㻟㻞㻚㻡 㻖 㼲㻸㼂㻱㻲㻌㻔㻑㻕

㻣㻣㻚㻠㼼㻣㻚㻥

㻡㻢㻚㻣㼼㻝㻞㻞 㻚㻤㻏㻟㻜㻚㻜㼼㻝㻞㻚㻥㻖㻐

⾲ 1  ᝈ⪅⫼ᬒ*: P<0.0001 ᑐṇᖖ⩌ࠊ$: P=0.0002 ᑐ HCM ⩌,㼲: P=0.0003 ᑐ HCMࠊ #: P<0.05 ᑐṇᖖ⩌2.

ṇᖖ౛㸦small heart㸧⩌㸸ᅗ2 : HCM⩌࡟࠾ࡅࡿᕥᐊᶵ⬟(LVEDV /LVESV/LVEF)ࡢẚ㍑

15

4.

CRT ⩌㸸ձ ᕥᐊᶵ⬟㸸ᚰᶵ⬟࡟ࡘ࠸࡚ࡣᕥᐊᐜ✚࡟ࡘ࠸࡚ࡣ㠀ᖖ࡟Ⰻዲ࡞┦㛵ࡀㄆࡵࡽࢀ㸦EDV㸸r=0.98,
P<0.0001ࠊESV: r=0.98, P<0.0001㸧
ࠊ㥑ฟ⋡࡟࠾࠸࡚ࡶⰋዲ࡞┦㛵(r=0.91, P=0.0019)ࡀㄆ
ࡵࡽࢀ(ᅗ 3)ࠊ៏ᛶᚰ୙඲⑕౛࡟࠾࠸࡚ࡣᕥᐊ
ᶵ⬟ゎᯒ࡟࠾ࡅࡿጇᙜᛶࡀ♧၀ࡉࢀࡓࠋ

ᅗ 4: R ⩌࡜ NR ⩌࡛ࡢ LVD ᣦᶆẚ㍑

ϫ㸬⪃ ᐹ
௒ᅇࠊᡃࠎࡣᚰ㟁ᅗྠᮇᚰ➽⾑ὶ SPECT ࡟ࡼࡿᕥᐊᶵ⬟ホ౯࡟࠾࠸࡚ࠊ᪂ࡓ࡟㛤Ⓨࡉࢀࡓᚰᶵ⬟ゎᯒࢯࣇࢺ࢙࢘࢔ࠕHeart Function View:HFVࠖ࡜௦⾲ⓗࢯࣇࢺ࢙࢘࢔ QGS ࡜ࢆṇᖖ⩌࣭HCM ⩌࣭CRT
ᅗ 3 : CRT ⩌࡟࠾ࡅࡿᕥᐊᶵ⬟(LVEDV /LVESV/LVEF)ࡢẚ㍑⩌࡟࠾࠸࡚ẚ㍑᳨ウࡋࡓࠋղ ఩┦ゎᯒ࡟ࡼࡿ LV Dys ゎᯒ㸸࡛᭷ព࡞ᕪࡀㄆࡵࡽࢀࡓⅬ࡟ࡘ࠸࡚ࡣࠊṇᖖ⩌࡛ࡣᝈ⪅⫼ᬒࡢᚰᶵ⬟࡟ࡘ࠸࡚ࠊ≉࡟ LVEF ࡛ 3 ⩌㛫
LVESV<20ml ࡢ small heart ࡢ⑕౛ࡀ 4 ౛࡜㐣༙

PSD ཬࡧ BW ඹ࡟ HFV ࡜ QGS ࡢ㛫࡟ࡣ┦㛵ಀᩘࡣపࡃࠊ᭷ព࡞┦㛵ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ

ᩘࢆ༨ࡵࡓࡇ࡜࡟ࡼࡾࠊࡑࡢ⤖ᯝṇᖖ⩌ࡢ EF ࡀ㐣㸦PSD㸸r=0.30, N.S. BW: r=0.31, N.S.㸧
ࠋR ⩌኱ホ౯ࡉࢀ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࡇ࡜࡜ࠊHCM ⩌࡟࡜ NR ⩌ࡢẚ㍑࡟࠾࠸࡚ HFV ࡟ࡼࡿ PSD ཬ࠾࠸࡚ࡣ⫧኱㒊఩ࢆṇ☜࡟ᚰ➽ᢳฟ࡛ࡁ࡞࠿ࡗࡓ⤖ࡧ BW ࡣඹ࡟୧⩌㛫࡛᭷ព࡞ᕪࢆㄆࡵࠊR ⩌ᯝࠊᕥᐊᐜ✚ࡢ㐣኱ホ౯࣭㥑ฟ⋡ࡢ㐣ᑠホ౯ࢆ᮶ࡋ࡛ LVD ࡀ㧗ᗘ࡛࠶ࡿࡇ࡜ࡀ♧ࡉࢀࡓ㸦PSD:R࡚࠸ࡿྍ⬟ᛶ࡞࡝ࡀ⪃࠼ࡽࢀࡓࠋ

⩌ vs NR ⩌ =136.8±25.9 vs 79.0±23.3,

ṇᖖ⩌࡟࠾ࡅࡿ᳨ウ࡛ࡣࠊᕥᐊᐜ✚࡟㛵ࡋ࡚ࡣ୧

P=0.016, BW: R ⩌ vs NR ⩌=42.1±8.6 vsࢯࣇࢺ࢙࢘࢔㛫࡟Ⰻዲ࡞┦㛵ࢆㄆࡵࡓࡀࠊLVEF ࡟

22.3±3.7, P=0.0092㸧
ࠋ୍᪉ࠊQGS ࡛ࡶ HFV㛵ࡋ࡚ࡣ᭷ព࡞┦㛵ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋࡑࡢ⌮⏤ྠᵝ࡟R⩌࡛PSD ཬࡧBW ඹ࡟㧗್ࢆ♧ࡋࡓ࡜ࡋ࡚ࡣࠊLVESV<20ml ࡢ small heart㸸4 ౛࡟࠾ࡀࠊ୧⩌㛫࡛᭷ពᕪࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ(ᅗ 4)ࠋ

࠸࡚ࡣ QGS ࡢ LVEF ್ࡀ࠸ࡎࢀࡶ HFV ࡢࡑࢀࡽࡼࡾ 10㸣௨ୖ኱ࡁࡃィ ࡉࢀ࡚࠾ࡾࠊࡇࢀࡀ⤖ᯝ࡟ᙳ㡪ࡋ࡚࠸ࡿ࡜᥎ᐃࡉࢀࡓࠋ୍᪉ࠊLVESV>20ml
ࡢ⑕౛ 3 ౛࡟࠾࠸࡚ࡣ࡯ࡰྠ➼ࡢィ ⤖ᯝࡀᚓࡽࢀࡓࠋQGS ࡛ࡣ LVESV<20ml ࡢ small heart ⑕౛࡛
LVEF ࡀ㐣኱࡟ホ౯ࡉࢀࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠾ࡾࠊᮏ
⤖ᯝ࠿ࡽࡣ small heart ⑕౛࡟࠾࠸࡚ࡣ HFV ࡢ᪉ࡀ┿ࡢ LVEF ࡟㏆࠸ィ ್ࡀᚓࡽࢀࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ
HCM ⩌ཬࡧ CRT ⩌࡟࠾࠸࡚ࡣᕥᐊᐜ✚୪ࡧ࡟
LVEF ࡢྛ✀ᚰᶵ⬟ࡣ୧ࢯࣇࢺ࢙࢘࢔㛫࡛Ⰻዲ࡞┦16㛵ࡀㄆࡵࡽࢀࡓࡇ࡜࠿ࡽࠊsmall heart ࡛࡞࠸⑕౛㸹Ϯ㸬ཧ⪃ᩥ⊩

ᚰ⫧኱⑕౛ࡸ៏ᛶᚰ୙඲⑕౛㸦཰⦰⬟పୗཬࡧᕥᐊ

1) Boogers MM, Van Kriekinge SD, Hennemanᣑ኱㸧࡛ࡣᚑ᮶ࡢ௦⾲ⓗࢯࣇࢺ࢙࢘࢔࡜ྠ➼ࡢᚰᶵMM, et al. Quantitative gated SPECT-derived⬟ゎᯒࡀྍ⬟࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ

phase analysis on gated myocardial perfusion

ࡉࡽ࡟ CRT ⩌࡟࠾ࡅࡿ఩┦ゎᯒ࡛ࡣࠊHFV ࡟ࡼ

SPECT detects left ventricular dyssynchronyࡿ LVD ࡢホ౯ࡀྍ⬟࡛࠶ࡗࡓࡀࠊ௦⾲ⓗࢯࣇࢺ࢘and࢙࢔ QGS ࡟ࡼࡿィ ⤖ᯝ࡜ࡣ᭷ព࡞┦㛵ࡣㄆࡵࡽresynchronization therapy. J Nucl Med.

ࢀ࡞࠿ࡗࡓࠋࡇࡢ㐪࠸ࡣᚰ➽ᢳฟ࢔ࣝࢦࣜࢬ࣒ࡀ␗

2009;50:718-725.

predicts

responsetocardiac࡞ࡿࡇ࡜࡟㉳ᅉࡍࡿ࡜᥎ᐃࡉࢀࡿ 1ࠋࡲࡓࠊCRT ࡢ2) Henneman MM, Chen J, Ypenburg C, et al.

἞⒪ຠᯝண ࡟࠾࠸࡚ࡣ HFV ࡢ᪉ࡀ QGS ࡼࡾࡶ

Phase analysis of gated myocardial perfusionඃࢀ࡚࠸ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࠊHFV ࡢ᪉ࡀ៏ᛶᚰ

single-photon emission computed tomography୙඲ᝈ⪅࡟࠾࠸࡚ࡣᚰ➽ᢳฟ࢔ࣝࢦࣜࢬ࣒ࡀ㐺ࡋ࡚

compared with tissue Doppler imaging for the࠸ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ

assessment of left ventricular dyssynchrony. J
Am Coll Cardiol. 2007;49:1708-1714.

௨ୖࠊ2 ✀㢮ࡢࢯࣇࢺ࢙࢘࢔ࡢẚ㍑᳨ウࢆ⾜࠸ࠊ
HFV ࡀᚑ᮶ࡢᚰᶵ⬟ゎᯒࢯࣇࢺ࢙࢘࢔࡜㐯Ⰽ࡞ࡃ3) Henneman MM, Chen J, Dibbets-Schneider P,⮫ᗋୖ฼⏝࡛ࡁࡿࡇ࡜ࡀุ᫂ࡋࡓࡀࠊ௒ᅇࡢᑐ㇟⑕

et al. Can LV dyssynchrony as assessed with౛ࡣ࠸ࡎࢀࡶᑡᩘ࡛࠶ࡿࡇ࡜ࡼࡾࠊ௒ᚋࡼࡾከࡃࡢ

phase analysis on gated myocardial perfusion⑕౛᳨࡛ドࡍࡿᚲせࡀ࠶ࡿ࡜ᛮࢃࢀࡿࠋ

SPECT predict response to CRT? J Nucl Med.
2007;48:1104-1111.

Ϭ㸬⤖ ㄽ
᪂ࡓ࡟㛤Ⓨࡉࢀࡓ HFV ࡣᚑ᮶ࡢᚰᶵ⬟ゎᯒࢯࣇࢺ࢙࢘࢔࡜ྠ➼ࡢᚰᶵ⬟ゎᯒ⢭ᗘࢆ᭷ࡍࡿ࡜ุ᩿ࡉ
ࢀࡓࠋࡉࡽ࡟ࠊsmall heart ⑕౛ࡸ CRT ࡢ἞⒪ຠᯝண ࡟࠾࠸࡚ࡣ QGS ࡼࡾࡶඃࢀࡓゎᯒ⢭ᗘࢆᣢࡘྍ⬟ᛶࡶ♧၀ࡉࢀࡓࠋ

ϭ㸬◊✲༠ຊ⪅ᮾ ᑗᾈ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭་㛗୕⏣⚈ᐶ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᚰ⮚ෆ⛉࣭་ᖌすᮧᆂᘯ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺ
ᑕ⥺ᢏᖌ୺௵⸨ᓮ ᏹ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺ
ᑕ⥺ᢏᖌ୺௵
ᑎᕝ⿱௓㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺ
ᑕ⥺ᢏᖌ୺௵
ΎỈᙲⱥ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺᑕ⥺ᢏᖌ୰⯋ᖾྖ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺᑕ⥺ᢏᖌᐑࣀᑿ஭⚽ே㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺᑕ⥺ᢏᖌ
⃰㔝⚈ྐ㸸ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ ᨺᑕ⥺㒊࣭デ⒪ᨺ
ᑕ⥺ᢏᖌ

17

㧗⾑ᅽ἞⒪࡟࠾ࡅࡿࣞࢨࣝࢱࢫࡢ᭷ຠᛶ࡟㛵ࡍࡿ◊✲
̿$5% 㛫ࡢẚ㍑࡟㛵ࡍࡿ᳨ウ̿ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈⮚⛉་㛗 ᒾ ᔱ ⩏ 㞝 


2) ᪉ἲ

Ϩ㸬⥴ ゝ㧗⾑ᅽ࡟ࡼࡿᚰ⾑⟶⑌ᝈ(CVD)ண㜵࡟ࡣ✚ᴟⓗ࡞

ᅗ 1 ࡟♧ࡍࠋᮏヨ㦂ࡢほᐹ᳨࣭ᰝࢫࢣࢪ࣮ࣗࣝࢆᅗ

㝆ᅽࡀ᭷ຠ࡛࠶ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡾࠊ
ࠕ㧗⾑ᅽデ⒪ヨ㦂ࡣྛ 3 ࣨ᭶ࡢࢡࣟࢫ࣮࢜ࣂ࣮ἲ࡜ࡋࠊRA ⣔㜼࢞࢖ࢻࣛ࢖ࣥ 2014ࠖ(JSH2014) 1 ࡛ࡣࠊデᐹᐊ⾑ᅽᐖ⸆ࢆ࣓࢜ࣝࢧࣝࢱࣥ(OLM) 20 mg ࡶࡋࡃࡣ࢝ࣥ

࡟ຍ࠼࡚ᐙᗞ⾑ᅽ࠶ࡿ࠸ࡣ 24 ᫬㛫⾑ᅽࢆホ౯ࡋࠊࢹࢧࣝࢱࣥ(CAN) 8mg ࡟ኚ᭦ࡶࡋࡃࡣᢞ୚ࡋࡓࠋ324 ᫬㛫࡟ࢃࡓࡿཝ᱁࡞㝆ᅽ἞⒪ࢆ┠ᣦࡍࡇ࡜ࡢ㔜࢝᭶ᚋ࡟ࠊྛ⩌ࢆ OLM 20mg ࠿ࡽ CAN 8mg ࡟ࠊ

せᛶࡀ㏙࡭ࡽࢀ࡚࠸ࡿࠋ᪥ᖖデ⒪࡟࠾࠸࡚ࠊ㝆ᅽ⸆࠶ࡿ࠸ࡣ CAN 8mg ࠿ࡽ OLM 20mg ࡟ษࡾ᭰࠼࡚

ࡢ༢๣⒪ἲࡢࡳ࡛㝆ᅽ┠ᶆࢆ㐩ᡂ࡛ࡁࡿ㢖ᗘࡣ㧗ࡃ

3 ࣨ᭶ᢞ୚ࡋࡓࠋヨ㦂๓࡟ OLM ࡶࡋࡃࡣ CAN ࢆ

࡞ࡃࠊ2JSH2014 ࡛ࡣࠊ༢๣࡛㝆ᅽ୙༑ศࡢሙྜࡣ

᪤࡟ᢞ୚ࡉࢀ࡚࠸ࡿሙྜ࡟ࡣࠊࡑࢀࡒࢀ CAN 8mg

ቑ㔞ࠊ࠶ࡿ࠸ࡣస⏝ᶵᗎࡢ␗࡞ࡿ௚ࡢ㝆ᅽ⸆࡬ࡢኚ

ࡶࡋࡃࡣ OLM 20mg ࡟๭ࡾ௜ࡅࡋࡓࠋኚ᭦๓ᚋ࡛

᭦ࡸే⏝ࡀዲࡲࡋ࠸࡜ࡉࢀ࡚࠸ࡿࠋ㝆ᅽ⸆ࡢ୰࡛ࠊ

ࡢ࢛࢘ࢵࢩࣗ࢔࢘ࢺᮇ㛫ࡣタࡅ࡚࠸࡞࠸ࠋኚ᭦᫬ࠊ

ࣞࢽ࣭ࣥ࢔ࣥࢪ࢜ࢸࣥࢩࣥ(RA)⣔㜼ᐖ⸆ࡢ୍ࡘ࡛࠶

3 ࢝᭶┠ࠊ6 ࢝᭶┠࡟デᐹᐊ⾑ᅽ ᐃ࠾ࡼࡧ⾑ᾮ࣭ࡿ࢔ࣥࢠ࢜ࢸࣥࢩࣥ II ཷᐜయᣕᢠ⸆(ARB)ࡣࠊᮏ㑥ᒀ᳨ᰝࢆ⾜ࡗࡓࠋヨ㦂ᮇ㛫୰ࠊRA ⣔㜼ᐖ⸆௨እࡢ

࡛ࡣࠊCa ᣕᢠ⸆࡟ḟ࠸࡛౑⏝ࡉࢀ࡚࠾ࡾࠊᚰࠊ⭈ࠊ㝆ᅽ⸆ࢆྵࡴ௚ࡢෆ᭹⸆ࡢኚ᭦ࡣ⾜ࡗ࡚࠸࡞࠸ࠋ

⬻ࡢ⮚ჾྜే⑕ࡸ⢾ᒀ⑓࡞࡝ࢆ᭷ࡍࡿ⑕౛࡛➨୍㑅
1 ౑⏝ࡉࢀࡿࡇ࡜ࡀከ࠸ࠋ
ᢥ⸆࡟఩⨨௜ࡅࡽࢀ࡚࠾ࡾࠊ

ᮏ㑥࡛ࡣ⌧ᅾ 7 ✀㢮ࡢ ARB ࡀୖᕷࡉࢀ࡚࠾ࡾࠊ㻝㻜㻜

ARB ࡢ⸆๣㛫࡟ࡣከᑡࡢᕪࡀㄆࡵࡽࢀ࡚࠸ࡿࡶࡢ

㻤㻜ࡢࠊࡑࡢヲ⣽࡟ࡘ࠸࡚ࡣ᫂ࡽ࠿࡛࡞࠸㒊ศࡀከ࠸ࠋ

㻢㻜

ᮾி㻌

ࡇࢀࡲ࡛ࠊ࢝ࣝࢩ࣒࢘ᣕᢠ⸆࡜࣓࢜ࣝࢧࣝࢱࣥࡸ࢝

㻠㻜

ྡྂᒇ㻌
኱㜰㻌

ࣥࢹࢧࣝࢱࣥࢆྵ᭷ࡍࡿ㝆ᅽ⸆(ࣞࢨࣝࢱࢫ®ࡸࣘ㻞㻜ࢽࢩ࢔®)ࡢ㛫࡟㝆ᅽຠᯝࡸෆศἪ࣭௦ㅰ࡬ࡢᙳ㡪࡟㻜㐪࠸ࡀ࠶ࡿࡇ࡜ࡣ▱ࡽࢀ࡚࠸ࡿࡶࡢࡢࠊࡑࡢ㐪࠸ࡀ

㻝㻌᭶㻌

㻞㻌᭶㻌

㻟㻌᭶㻌

㻠㻌᭶㻌

࢝ࣝࢩ࣒࢘ᣕᢠ⸆ࡶࡋࡃࡣ ARB ࡢ㐪࠸࡟ࡼࡿࡶࡢ
 ᅗ 1  ◊✲ࣉࣟࢺࢥ࣮ࣝ

࠿ࡣ᫂ࡽ࠿࡛࡞࠸ࠋࡑࡇ࡛ᮏ◊✲࡛ࡣࠊ㝆ᅽຠᯝࡢ୙༑ศ࡞ᮏែᛶ㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡟ࠊ
ARB ࡛࠶ࡿ࢜

RA: ࣞࢽ࣭ࣥ࢔ࣥࢠ࢜ࢸࣥࢩࣥ

࣓ࣝࢧࣝࢱࣥ 20mg ࡜࢝ࣥࢹࢧࣝࢱࣥ 8mg ࡢࠊ㝆

CAN 8mg: ࢝ࣥࢹࢧࣝࢱࣥ 8 mg

ᅽຠᯝ࡞ࡽࡧ࡟㟁ゎ㉁ࠊෆศἪ࣭௦ㅰࣃ࣓࣮ࣛࢱࠊ

OLM 20mg: ࣓࢜ࣝࢧࣝࢱࣥ 20 mg⭈ᶵ⬟ࡢኚ໬ࢆẚ㍑᳨࣭ウࡋࡓࠋデᐹᐊ⾑ᅽࡣࠊᗙ఩࡛ 5 ศ௨ୖᏳ㟼࡛ 1-2 ศ㛫㝸ϩ㸬ᑐ㇟࣭᪉ἲ

࡛ 2 ᅇ ᐃࡋࠊ1 ศ㛫ࡢᚰᢿᩘࢆ ᐃࡋ࡚ᖹᆒ್࡛1) ᑐ㇟ホ౯ࡋࡓࠋᐙᗞ⾑ᅽࡣࠊୖ⭎࢝ࣇ࣭࢜ࢩ࣓ࣟࢺࣜࢵ

ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮እ᮶㏻㝔୰࡛ࠊデᐹᐊࢡἲ࡟ᇶ࡙ࡃ⿦⨨ࢆ౑⏝ࡋࠊ᪩ᮅ㉳ᗋᚋ 1 ᫬㛫௨ෆ⾑ᅽ࠿ࡘ/࠶ࡿ࠸ࡣᐙᗞ⾑ᅽࡀ┠ᶆ⾑ᅽ࡟฿㐩ࡋ࡚ࡢ✵⭡᫬࡞ࡽࡧ࡟ᑵᐷ๓࡟ࠊࡑࢀࡒࢀ 1 ᅇࡎࡘ ᐃ࠸࡞࠸ᮏែᛶ㧗⾑ᅽᝈ⪅ 36 ྡࢆᑐ㇟࡜ࡋࡓࠋ

ࡋࠊ᮶㝔᪥๓ 7 ᪥㛫ࡢᖹᆒ್࡛ホ౯ࡋࡓࠋ᥇⾑࠾ࡼ

18ࡧ᪩ᮅᒀࡣࠊྛ᮶㝔᪥࡟✵⭡࡟࡚ᐇ᪋ࡋࠊ௦ㅰ࣭ෆ⾲㸯 ᝈ⪅⫼ᬒศἪ⣔ࣃ࣓࣮ࣛࢱ(ࢼࢺ࣒ࣜ࢘ࠊ࣒࢝ࣜ࢘ࠊ⥲ࢥࣞࢫ

ᖹᆒ±ᶆ‽೫ᕪࡶࡋࡃࡣᐇᩘ, CVD: ᚰ⾑⟶⣔⑌ᝈ, CKD: ៏ᛶࢸ࣮ࣟࣝࠊLDL ࢥࣞࢫࢸ࣮ࣟࣝࠊ⾑Ύᒀ㓟್ࠊ࣊ࣔ⭈⮚⑓, BMI: body mass index.

ࢢࣟࣅࣥ A1c[HbA1c]ࠊ✵⭡᫬⾑⢾ࠊ࢖ࣥࢫࣜࣥࠊ
ࢡࣞ࢔ࢳࢽࣥࠊᒀࢱࣥࣃࢡࠊᒀ୰࢔ࣝࣈ࣑ࣥࠊ⬻ᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳࢻ[BNP])ࢆ ᐃࡋࠊ
HOMA-index(Homeostasis model
assessment-Insulin Resistance) ࡸࠊ
CKD-EPI(Chronic Kidney Disease Epidemiology
Collaboration)ᘧ 3, 4 ࢆ⏝࠸࡚᥎ᐃ⣒⌫యℐ㐣㔞
(eGFR)ࢆ⟬ฟࡋࡓࠋ⢾ᒀ⑓ 5 ࡸ៏ᛶ⭈⮚⑓(CKD)6
ࡣࠊࡑࢀࡒࢀࡢ࢞࢖ࢻࣛ࢖ࣥ࡟ᇶ࡙࠸࡚デ᩿ࡋࡓࠋ㝆ᅽ⸆ࡢᢞ୚᪉ἲࡣࠊ࠸ࡎࢀࡶ 1 ᪥ᮅ 1 ᅇ᭹⏝࡜ࡋࡓࠋ┠ᶆ⾑ᅽ್ࡢ㐩ᡂࡣࠊJSH2014 ࡟ᇶ࡙࠸࡚デᐹᐊ⾑ᅽ࡜ᐙᗞ⾑ᅽࡢ཰⦰ᮇ⾑ᅽ(SBP)ࢆ⏝࠸࡚ホ౯ࡋࠊࡑࢀࡒࢀⱝ࣭୰ᖺ⪅ࠊ㧗㱋⪅࡛ࡣ 140mmHg
ᮍ‶ࠊ135mmHg ᮍ‶ࠊ⢾ᒀ⑓࣭⺮ⓑᒀ㝧ᛶࡢ៏ᛶ⭈⮚⑓(CKD)ᝈ⪅࡛ࡣ 130mmHg ᮍ‶ࠊ125mmHg
ᮍ‶ࠊ⬻⾑⟶㞀ᐖᝈ⪅࡛ࡣ 140mmHg ᮍ‶ࠊ135mmHg ᮍ‶࡜ࡋࡓࠋ12) 㝆ᅽຠᯝ

ᮏ◊✲ࡣࠊᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ࡢ೔⌮ጤဨኚ᭦๓ࡢ⾑ᅽ್࠾ࡼࡧኚ᭦ᚋࡢ⾑ᅽኚ໬ᗘࢆ⾲
⾲2఍࡟࡚ᢎㄆࡉࢀ࡚࠸ࡿࠋ

࡟♧ࡍࠋ᪩ᮅࡢᐙᗞ⾑ᅽࡣᑐ㇟⪅඲ဨࡀṇ☜࡟ ᐃ3) ⤫ィᏛⓗᡭἲ࡛ࡁ࡚࠸ࡓࡶࡢࡢࠊᑵᐷ๓ࡢᐙᗞ⾑ᅽࡀṇ☜࡟ ᐃྛ ᐃ㡯┠ࡢ್ࡣᖹᆒ್±ᶆ‽೫ᕪ(mean±SD)ࡶ

࡛ࡁࡓࡢࡣ 29 ྡ(80.6%)࡛࠶ࡗࡓࠋኚ᭦๓ࡢ㝆ᅽ┠ࡋࡃࡣᐇᩘ࡛⾲グࡋࡓࠋ㐃⥆ኚᩘࡢ࣮࣋ࢫࣛ࢖ࣥ࠿

ᶆࡢ㐩ᡂࡣࠊデᐹᐊ⾑ᅽ࡛ 36 ྡ୰ 18 ྡ(50.0%)ࠊ

ࡽࡢኚ໬࠾ࡼࡧ㐃⥆ኚᩘ㛫ࡢẚ㍑࡟ࡣ㸪ᑐᛂࡢ࠶ࡿ

᪩ᮅࡢᐙᗞ⾑ᅽ࡛ 15 ྡ(41.7%)ࠊᑵᐷ๓ࡢᐙᗞ⾑ᅽStudent t ᳨ᐃ࡛ẚ㍑ࡋࡓࠋ㝆ᅽ┠ᶆ㐩ᡂ⋡ࡣࠊࡑ

࡛ 12 ྡ(41.4%)࡛࠶ࡗࡓࠋ
OLM 20mg ࡜ CAN 8mg ࡜ࡶ࡟ࠊษࡾ᭰࠼࡟క

ࢀࡒࢀࡢ⾑ᅽ್࠿ࡽ⟬ฟࡋ࡚F2 ᳨ᐃࢆ⏝࠸࡚ẚ㍑ࡋ
ࡓࠋp<0.05 ࡢሙྜ࡟᭷ពᕪ࠶ࡾ࡜ุᐃࡋࡓࠋ

࠺๪స⏝⑕≧ࡸ᭷ᐖ஦㇟ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ㝆ᅽຠᯝࡣࠊኚ᭦๓࡟ẚ࡭࡚ࠊOLM 20mg ࡛ࡣデᐹᐊ௨እࡢ⾑ᅽࢆ᭷ព࡟పୗࡉࡏࡓࡶࡢࡢࠊCAN 8mg

Ϫ㸬⤖ ᯝ
1) ᝈ⪅⫼ᬒ࡛ࡣ᭷ព࡞ኚ໬ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓ(⾲ 2,)ࠋデᐹᐊ

⾲ 1 ࡟♧ࡍࠋ⥲ᩘ 36 ྡࢆᑐ㇟࡜ࡋࠊ
ᝈ⪅⫼ᬒࢆ⾲

ࡢᚰᢿᩘࡣࠊ୧἞⒪⩌࡜ࡶ࡟ኚ᭦๓࡟ẚ࡭࡚᭷ព࡞

ᖹᆒᖺ㱋 70.9 ṓࠊ⏨ᛶࡀ 19 ྡ࡛࠶ࡗࡓࠋ9 ྡ࡟ᚰኚ໬ࡣㄆࡵ࡞࠿ࡗࡓࠋ

➽᱾ሰࠊ
4ྡ࡟⬻᱾ሰࡢ᪤ ࡀ࠶ࡾࠊ16ྡ࡟⢾ᒀ⑓ࠊ
3 ྡ࡟⺮ⓑᒀ㝧ᛶࡢ៏ᛶ⭈⮚⑓(CKD)ࢆྜేࡋ࡚࠸3) 㟁ゎ㉁ࠊෆศἪ࣭௦ㅰࣃ࣓࣮ࣛࢱࠊ⭈ᶵ⬟ࡢኚࡓࠋࡲࡓࠊ36 ྡ୰ 32 ྡ࡟࢝ࣝࢩ࣒࢘ᣕᢠ⸆ࠊ31 ྡ໬࡟ RA ⣔㜼ᐖ⸆ࠊ8 ྡ࡟ࢧ࢖࢔ࢨ࢖ࢻ⣔฼ᒀ⸆ࠊ10

OLM 20mg ᢞ୚ᚋ࡜ CAN 8mg ᢞ୚ᚋ࡛ࡣࠊኚ

ྡ࡟ș㐽᩿⸆ࠊ2 ྡ࡟Ș㐽᩿⸆ࠊ1 ྡ࡟࢔ࣝࢻࢫࢸ

᭦๓࡟ẚ࡭࡚ࠊ࡜ࡶ࡟య㔜ࠊ㟁ゎ㉁ࠊ⬡㉁ࠊᒀ㓟್ࠊࣟࣥᣕᢠ⸆ࡀᢞ୚ࡉࢀ࡚࠸ࡓࠋኚ᭦๓ࡢ RA ⣔㜼ᐖ⢾௦ㅰ⣔ࣃ࣓࣮ࣛࢱࠊᒀ⺮ⓑࡣ᭷ព࡟ኚ໬ࡋ࡞࠿ࡗ

⸆ࡢෆヂ࡜ࡋ࡚ 1 ྡ࡟ OLM 10mg ࡀࠊ2 ྡ࡟ CAN

ࡓࡀࠊOLM 20mg ࡛ࡣᒀ୰࢔ࣝࣈ࣑ࣥࠊBNP ࡀ᭷

4mgࠊ1 ྡ࡟ CAN 6mg ࡀᢞ୚ࡉࢀ࡚࠸ࡓࠋRA 㜼ព࡟పୗࡋࡓ(⾲ 2)ࠋ

⾲ 1 ࡟♧ࡍࠋᐖ⸆ࡢෆヂ࡜⏝㔞ࢆ⾲

19 ⾲ 3 &$1PJ ᢞ୚ᚋ࡜ 2/0PJ ᢞ୚ᚋࡢ㝆ᅽຠᯝ࣭デᐹᐊ

⾲ 2 ኚ᭦๓ࡢయ㔜ࠊෆศἪ࣭௦ㅰࣃ࣓࣮ࣛࢱࠊ⭈ᶵ⬟࡜ࠊ&$1PJᚰᢿᩘ࣭ෆศἪ࣭௦ㅰࣃ࣓࣮ࣛࢱ࣭⭈ᶵ⬟ࡢኚ໬ࡢẚ㍑

ࡲࡓࡣ 2/0PJ ࡬ࡢษࡾ᭰࠼ᚋࡢኚ໬
ᖹᆒ±ᶆ‽೫ᕪࡶࡋࡃࡣᐇᩘࠋ CAN 8mg, OLM 20mg ࡣࠊኚ᭦

ᖹᆒ್±ᶆ‽೫ᕪ(95%ಙ㢗༊㛫)๓࠿ࡽࡢኚ໬㔞ࠋp<0.05, †p<0.01 versus baseline by paired t test,

CAN:࢝ࣥࢹࢧࣝࢱࣥ, OLM:࣓࢜ࣝࢧࣝࢱࣥ,SBP: ཰⦰ᮇ⾑ᅽ,

CAN:࢝ࣥࢹࢧࣝࢱࣥ,OLM:࣓࢜ࣝࢧࣝࢱ

DBP: ᣑ ᙇ ᮇ ⾑ ᅽ ,LDL: low density lipoprotein, HOMA:

ࣥ ,SBP: ཰ ⦰ ᮇ ⾑ ᅽ ,DBP: ᣑ ᙇ ᮇ ⾑ ᅽ ,LDL: low density

homeostasis model assessment, eGFR: ᥎ᐃ⣒⌫యℐ㐣㔞, BNP:

lipoprotein, HOMA: homeostasis model assessment, eGFR:᥎ᐃᚰᐊᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳࢻ.

¶ࣟࢢኚ᥮ࡋ࡚ẚ㍑.

⣒⌫యℐ㐣㔞,BNP:ᚰᐊᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳࢻ.

ϫ㸬⪃ ᐹ
4) OLM 20mg ࡜ CAN 8mg ࡢẚ㍑

デᐹᐊ⾑ᅽ࠿ࡘ/࠶ࡿ࠸ࡣᐙᗞ⾑ᅽࡀ┠ᶆ⾑ᅽ࡟୧ᢞ୚⩌㛫ࡢ㝆ᅽຠᯝࢆẚ㍑ࡋࡓ࡜ࡇࢁࠊデᐹᐊ฿㐩ࡋ࡞࠸ᮏែᛶ㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡟ࠊࢡࣟࢫ࣮࢜

⾑ᅽ࡟᭷ពᕪࡣ࡞࠿ࡗࡓࡶࡢࡢࠊᐙᗞ⾑ᅽࡢ཰⦰ᮇ

ࣂ࣮ἲ࡛࣓࢜ࣝࢧࣝࢱࣥ 20m ࡜࢝ࣥࢹࢧࣝࢱࣥ

⾑ᅽࡢ㝆ᅽຠᯝࡣࠊ᪩ᮅࠊᑵᐷ๓ࡢ࠸ࡎࢀࡶ OLM

8mg ࡟ኚ᭦ࡋࠊࡑࢀࡒࢀ 3 ࢝᭶㛫ᢞ୚ࡋࡓࠋษࡾ᭰

20mg ࡢ࡯࠺ࡀ᭷ព࡟኱ࡁ࠿ࡗࡓ(⾲ 3)ࠋኚ᭦ᚋࡢ㝆࠼࡟క࠺᭷ᐖ஦㇟ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࡶࡢࡢࠊ࢜ࣝ

ᅽ┠ᶆࡢ㐩ᡂ⋡ࡣࠊ࠸ࡎࢀࡶ᭷ព࡞ᨵၿࡣㄆࡵࡽࢀ

࣓ࢧࣝࢱࣥ 20mg ࡢኚ᭦᫬࠿ࡽࡢᐙᗞ⾑ᅽ࡛ࡢ཰⦰

࡞࠿ࡗࡓࡶࡢࡢ(ᅗ 2)ࠊ୧ᢞ୚⩌㛫࡛ࡢ㐩ᡂ⋡࡛ẚ㍑

ᮇ⾑ᅽࡢ㝆ᅽຠᯝࡣࠊ࢝ࣥࢹࢧࣝࢱࣥ 8mg ࡜ẚ㍑ࡍࡿ࡜ࠊ᪩ᮅࡢᐙᗞ⾑ᅽ࡛᭷ពᕪࢆㄆࡵࡓࠋ

ࡋ࡚኱ࡁࡃࠊ᪩ᮅࡢ┠ᶆ㝆ᅽ㐩ᡂ⋡࡟᭷ពᕪࢆㄆࡵ

୧ᢞ୚⩌㛫ࡢ㟁ゎ㉁ࠊෆศἪ࣭௦ㅰࣃ࣓࣮ࣛࢱࠊ

ࡓࠋ୧⸆๣࡜ࡶ࡟㟁ゎ㉁ࠊ⢾௦ㅰࠊ⬡㉁௦ㅰࠊᒀ㓟⭈ᶵ⬟ࡢኚ໬ࢆẚ㍑ࡋࡓ࡜ࡇࢁࠊᒀ୰࢔ࣝࣈ࣑ࣥ࡜

್࡟ᝏᙳ㡪ࢆ୚࠼ࡎࠊ࣓࢜ࣝࢧࣝࢱࣥ 20mg ࡣࠊ࢝

BNP ࡛᭷ពᕪࢆㄆࡵࡓ(⾲ 3)ࠋ

ࣥࢹࢧࣝࢱࣥ 8mg ࡼࡾࡶᒀ୰࢔ࣝࣈ࣑ࣥࡸࠊBNPࡢᨵၿ࡟ඃࢀ࡚࠸ࡓࠋ

㻝㻜㻜RA ⣔㜼ᐖ⸆ࠊ࡜ࡃ࡟ ARB ࡣࠊ࢔ࣥࢠ࢜ࢸࣥࢩࣥ

㻤㻜II ࢱ࢖ࣉ 1 ཷᐜయ࡟≉␗ⓗ࡟⤖ྜࡋࠊ⾑⟶཰⦰ࠊయ

㻢㻜

ᮾி㻌

ᾮ㈓␃ࠊ஺ឤ⚄⤒άᛶࢆᢚไࡍࡿࡇ࡜࡛㝆ᅽຠᯝࢆ

㻠㻜

ྡྂᒇ㻌

Ⓨ᥹ࡍࡿࠋࡇࢀࡲ࡛」ᩘࡢ ARB ࡀୖᕷࡉࢀ࡚࠸ࡿ

኱㜰㻌

ࡶࡢࡢࠊ
ARB 㛫ࡢ㐪࠸࡟ࡘ࠸࡚ࡣ୙᫂࡞㒊ศࡀከ࠸ࠋ

㻞㻜ᮏ◊✲࡛ࡣࠊ୧⸆๣ࡢ㏻ᖖ㔞࡛ࡢᐙᗞ⾑ᅽࡢ㝆ᅽຠ

㻜
㻝㻌᭶㻌

㻞㻌᭶㻌

㻟㻌᭶㻌

ᯝࡸࠊ᪩ᮅࡢᐙᗞ⾑ᅽࡢ㝆ᅽ┠ᶆ㐩ᡂ⋡ࡣ࣓࢜ࣝࢧ

㻠㻌᭶㻌ࣝࢱࣥࡢ࡯࠺ࡀඃࢀ࡚࠸ࡓࠋࡇࢀࡲ࡛ࠊ࣓࢜ࣝࢧࣝ
 ᅗ 2  ἞⒪๓ᚋ࡛ࡢ㝆ᅽ┠ᶆࡢ㐩ᡂ⋡࣭ㄝ᫂ᩥ CAN 8mg: ࢝ࢱࣥ࡜࢝ࣥࢹࢧࣝࢱࣥࡢ㝆ᅽຠᯝࢆ┤᥋ẚ㍑ࡋࡓ᳨

ࣥࢹࢧࣝࢱࣥ 8 mg, OLM 20mg: ࣓࢜ࣝࢧࣝࢱࣥ 20 mg

ウࡣ࠸ࡃࡘ࠿࠶ࡿࡶࡢࡢࠊ⤖ᯝࡣ୍⮴ࡋ࡚࠸࡞࠸ࠋ

20

7-9 ୍᪉࡛ࠊࣟࢧࣝࢱࣥࠊࣂࣝࢧࣝࢱࣥࠊ࢖ࣝ࣋ࢧࣝ

ϭ㸬◊✲༠ຊ⪅ࢱࣥࠊ࢝ࣥࢹࢧࣝࢱࣥࠊࢸ࣑ࣝࢧࣝࢱࣥࠊ࢚ࣉࣟࢧ

Ἑ㔝㞝ᖹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈ࣝࢱࣥ(ᮏ㑥࡛ࡣୖᕷࡉࢀ࡚࠸࡞࠸)ࠊ࣓࢜ࣝࢧࣝࢱ

⮚⛉࣭㒊㛗ࣥࡢ㝆ᅽຠᯝࢆ᳨ウࡋࡓ࣓ࢱゎᯒࡢ⤖ᯝ࡛ࡣࠊデᐹᯘ┿୍㑻࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈ᐊ⾑ᅽࠊ24 ᫬㛫⾑ᅽࡢᖹᆒ್ࠊ㉳ᗋ᫬୪ࡧ࡟ᑵᐷ୰

⮚⛉࣭་ဨ⾑ᅽࡢ඲࡚࡛࣓࢜ࣝࢧࣝࢱࣥࡢ㝆ᅽຠᯝࡣ࢝ࣥࢹࢧ

ᴋ༤࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㧗⾑ᅽ࣭⭈⮚⛉࣭ࣝࢱࣥࡼࡾඃࢀ࡚࠸ࡿࠋ10 ࣓࢜ࣝࢧࣝࢱࣥࡢ᪩ᮅࡢ

་ဨ㝆ᅽຠᯝࡣඃࢀ࡚࠾ࡾࠊ11 ࡲࡓࠊᮏ◊✲࡛ࡣ࡜ࡶ࡟

ᇼᑿṊྐ࣭ᕝᓮ་⛉኱Ꮫ࣭ᕝᓮ⑓㝔࣭ᩍᤵ

ᮅ 1 ᅇࡢෆ᭹࡜ࡋ࡚࠸ࡿࡀࠊ࣓࢜ࣝࢧࣝࢱࣥࡣࠊᮅ࣭
ኤࡢෆ᭹᫬㛫࡟㛵ಀ࡞ࡃ㝆ᅽຠᯝࡢᣢ⥆ᛶࡀඃࢀ࡚

Ϯ㸬ཧ⪃ᩥ⊩࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ 12ࠋࡇࡢᶵᗎ࡜ࡋ࡚ࡣࠊ

1)᪥ᮏ㧗⾑ᅽᏛ఍㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥసᡂ

᪥୰ࡢᒀ୰ࢼࢺ࣒ࣜ࢘ࢆቑຍࡉࡏࠊኪ㛫ࡢᒀ୰ࢼࢺ

ጤဨ఍. ᪥ᮏ㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ 2014࣒ࣜ࢘᤼ἥࢆῶᑡࡉࡏࡿࡇ࡜࡛ࠊኪ㛫⾑ᅽࡢ㝆ᅽࢆ

(JSH2014). ᪥ᮏ㧗⾑ᅽᏛ఍. 2014.

ࡶࡓࡽࡍࡇ࡜ࡀࠊCKDᝈ⪅ࢆᑐ㇟࡟♧ࡉࢀ࡚࠸ࡿࠋ

2)

Morgan TO, Anderson AI, MacInnis RJ.
ACE

13

inhibitors,

beta-blockers,

calcium

ARB ࡟ࡣࠊ㝆ᅽຠᯝࡢ௚࡟ࠊ⢾࣭⬡㉁௦ㅰ㛵㐃㡯

blockers, and diuretics for the control of┠ࢆᝏ໬ࡉࡏࡎࠊ⭈ಖㆤ࡟ࡣࡓࡽࡃࡇ࡜ࡀ♧ࡉࢀ࡚

systolic hypertension. Am J Hypertens.

࠸ࡿࠋ14-16 ᮏ◊✲࡛ࡶࠊ୧⸆๣࡜ࡶ࡟⢾࣭⬡㉁௦ㅰ

2001;14:241-247.
3)㛵㐃ࡢᝏ໬ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ୍᪉ࠊ࣓࢜ࣝࢧࣝ

Levey AS, Stevens LA, Schmid CH, et al. Aࢱࣥ࡬ࡢษࡾ᭰࠼࡟క࠸ࠊᚰ࣭⭈㞀ᐖࡢ࣐࣮࣮࡛࢝

new࠶ࡿࠊᒀ୰ᚤ㔞࢔ࣝࣈ࣑ࣥ࡜ BNP ࡢᨵၿࢆㄆࡵ࡚

filtration࠸ࡿࠋ࣓࢜ࣝࢧࣝࢱࣥࡣ AT1 ཷᐜయ࡜⤖ྜぶ࿴ᛶࡀ

2009;150:604-612.
4)㧗ࡃࠊᚰ࣭⭈ಖㆤࢆྵࡴከ㠃ⓗ࡞⮚ჾಖㆤస⏝ࡀᮇequation

to

rate.

estimateAnn

glomerularInternMed.

Horio M, Imai E, Yasuda Y, et al.

17 ௚ࡢ⭈ᶵ⬟ࡢ࣐࣮࣮࡛࢝࠶ࡿ eGFR ࡣࠊᚅ࡛ࡁࡿࠋ

Modification of the CKD epidemiology୧⸆๣࡜ࡶ࡟᭷ព࡞ኚ໬ࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࡀࠊ㏆

collaborationᖺᥦ♧ࡉࢀࡓᅜ㝿⭈⮚⑓࢞࢖ࢻࣛ࢖ࣥᶵᵓ

Japanese: accuracy and use for population(KDIGO: Kidney Disease㸸Improving Global

estimates. Am J Kidney Dis. 2010;56:32-38.

Outcomes)࡛ࡣࠊeGFR ࡜࢔ࣝࣈ࣑ࣥᒀࢆඹ࡟⏝࠸5)(CKD-EPI)

equationfor

Report of the expert committee on the

6 ࡇࢀࡲ࡛࣓࢜ࣝ
࡚⭈⮚⑓ࡢ㔜⑕ᗘࢆホ౯ࡋ࡚࠸ࡿࠋ

diagnosis and classification of diabetesࢧࣝࢱࣥࡢ⭈ಖㆤస⏝ࡣ኱つᶍ⮫ᗋヨ㦂࡛♧ࡉࢀ࡚

mellitus. Diabetes Care. 2003;26 Suppl

࠾ࡾࠊ18 ௚࡟ࡶࠊ࢝ࣥࢹࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱ

1:S5-20.
6)ࣥ࡬ࡢษࡾ᭰࠼࡟క࠺ᚰ⮚⫧኱ࡢ㏥⦰ຠᯝ 19 ࡸᒀ୰

Levey AS, de Jong PE, Coresh J, et al. The

࢔ࣝࣈ࣑ࣥῶᑡ 20 ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡇ࡜࠿ࡽࠊ࢜ࣝ

definition, classification, and prognosis of࣓ࢧࣝࢱࣥࡢᚰ࣭⭈ಖㆤຠᯝࡣ࢝ࣥࢹࢧࣝࢱࣥࡼࡾ

chronic

ࡶඃࢀ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋ

Controversies Conference report. Kidney Int.

kidneydisease:a

KDIGO

2011;80:17-28.
7)Ϭ㸬⤖ ㄽ

Hasegawa H, Takano H, Kameda Y, et al.
Effectデᐹᐊ⾑ᅽ࠿ࡘ/࠶ࡿ࠸ࡣᐙᗞ⾑ᅽࡀ┠ᶆ⾑ᅽ࡟

ofswitchingfromolmesartan,ortelmisartan,฿㐩ࡋ࡞࠸ᮏែᛶ㧗⾑ᅽᝈ⪅࡟࠾࠸࡚ࠊ࣓࢜ࣝࢧࣝ

valsartan,ࢱࣥ 20mg ࡬ࡢษࡾ᭰࠼ࡣࠊ࢝ࣥࢹࢧࣝࢱࣥ 8mg

candesartan on morning hypertension. Clin

࡜ẚ㍑ࡋ࡚ࠊⰋዲ࡞㝆ᅽຠᯝࢆࡶࡓࡽࡋࠊᚰ࣭⭈ಖ

Exp Hypertens. 2012;34:86-91.
8)ㆤⓗ࡟ാࡃྍ⬟ᛶࡀ♧ࡉࢀࡓࠋ┠ᶆ㝆ᅽࡀᚓࡽࢀ࡞

losartanto

Minatoguchi S, Aoyama T, Kawai N, et al.

࠸㧗⾑ᅽᝈ⪅࡟࠾ࡅࡿຠᯝⓗ࡞㑅ᢥ⸆ࡢ୍ࡘ࡛࠶ࡿ

Comparative effect of candesartan and࡜⪃࠼ࡽࢀࡿࠋ

amlodipine, and effect of switching fromvalsartan,

21

losartan,telmisartan

andolmesartan

9)

tocandesartan,

on

early

required, in the Anglo-Scandinavian Cardiac

morning hypertension and heart rate. Blood

Outcomes Trial-Blood Pressure Lowering

Press. 2013;22 Suppl 1:29-37.

Armᐑᕝᨻ᫛. ᪩ᮅᐙᗞ⾑ᅽࢆᣦᶆ࡜ࡋࡓ࢔ࣥࢪ

randomised࢜ࢸࣥࢩࣥ II ཷᐜయᣕᢠ⸆ 4 ๣ࡢ㝆ᅽຠᯝࡢ

2005;366:895-906.

ẚ㍑᳨ウ―᭱⤊ሗ࿌―. Therapeutic Research(ASCOT-BPLA):acontrolled

multicentre

trial.

Lancet.

16) Hasebe N, Kikuchi K. Controlled-release2009;30:1879-1882.
10) Fabia MJ, Abdilla N, Oltra R, et al.

nifedipine

andcandesartan

combination

therapylow-dosein patients with

Antihypertensive activity of angiotensin II

essential hypertension: the NICE Combi

AT1 receptor antagonists: a systematic(Nifedipine and Candesartan Combination)

review of studies with 24 h ambulatory blood

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17) Ikeda H, Hamamoto Y, Honjo S, et al.

2007;25:1327-1336.

Olmesartan reduced microalbuminuria in11) ࿴Ề௰ᗤ, ᢲ᪉ៅᘺ. ࣃࣝࢧࣝࢱ࡛ࣥ㝆ᅽຠᯝ

Japanese subjects with type 2 diabetes.

୙༑ศ࡞᪩ᮅ㧗⾑ᅽᝈ⪅࡟࠾ࡅࡿ࣓࢜ࣝࢧࣝ

Diabetes Res Clin Pract. 2009;83:117-118.

ࢱࣥ࡬ษࡾ᭰࠼࡟ࡼࡿ᭷ຠᛶ࡟㛵ࡍࡿ⮫ᗋヨ18) Haller H, Ito S, Izzo JL, Jr., et al.

Clinical trials on the efficacy ofOlmesartan for the delay or prevention of㦂

OLMesartan

byswitchingtomicroalbuminuria in type 2 diabetes. N Englpressure-lowering effect in hypertensive
patients

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J Med. 2011;364:907-917.

MORNING

19) Tsutamoto T, Nishiyama K, Yamaji M, et al.

inadequate -OLM MORNING Study- ⾑ᅽ.

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2012;19:300-306.

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angiotensin II and left ventricular mass

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pressure and cardiorenal protection between
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patients

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20) Daikuhara H, Fukunaga K, Ohshima T.

eveningDifference in the effects of switching fromadministration in hypertensive patients: thecandesartan to olmesartan or telmisartan to

COMPATIBLE

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type 2 diabetes: the COTO study. Drug Des

13) Fukuda M, Yamanaka T, Mizuno M, et al.

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15) Dahlof B, Sever PS, Poulter NR, et al
Prevention of cardiovascular events with anantihypertensive regimen of amlodipine
adding perindopril as required versus
atenolol adding bendroflumethiazide as22⏕ά⩦័⑓ࠊ㧗⾑ᅽ἞⒪࡟࠾ࡅࡿ
࣓࢜ࣝࢧࣝࢱࣥࡢ᭷ຠᛶ࡟㛵ࡍࡿ◊✲࣓̿࢜ࣝࢧࣝࢱࣥࡢ⮚ჾಖㆤຠᯝ̿
ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་ᖌ

ᯘ ┿୍㑻Ϩ㸬⥴ ゝᑐ㇟⪅ࡢ㑅ᢥ࡜ேᩘ 㧗⾑ᅽࡣ⨯ᝈ㢖ᗘࡢ㧗࠸⑌ᝈ࡛࠶ࡾࠊᚰ⾑⟶⑓ࡢ  ᖺ  ᭶ࡼࡾ  ᖺ  ᭶  ᪥ࡲ࡛࡟㧗⾑ᅽ࣭Ⓨ⑕ண㜵ࡢࡓࡵ࡟ࡣࠊ
ࡼࡾప࠸㝆ᅽ┠ᶆ࡜  ᫬㛫࡟⭈⮚⛉ࢆཷデࡋࠊ௨ୗࢆ‶ࡓࡍᝈ⪅࡜ࡍࡿ㸦௨ୗࠊ◊✲ᑐ㇟⪅࡜ࡍࡿ㸧ࠋࢃࡓࡿ㝆ᅽࡢ㔜せᛶࡀὀ┠ࡉࢀ࡚࠸ࡿ㸦-6+۵ ᐙᗞ⾑ᅽࢆグ㘓ࡋ࡚࠸ࡿࠋ

-6+㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ㸧ࠋࡑࡢ୍᪉࡛ࠊእ۵ 㸰✀㢮௨ୖࡢ㝆ᅽ⸆ࡢᢞ୚࡟ࡼࡾ⾑ᅽࢥࣥࢺࣟ

᮶⾑ᅽ࡜ᐙᗞ⾑ᅽ࡜ࡶ࡟㝆ᅽ┠ᶆࢆ㐩ᡂࡍࡿࡇ࡜ࡣ

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۵ ษࡾ᭰࠼๓ࡢ $5% ࡜ࡢే⏝㝆ᅽ⸆ࡣ &D ᣕᢠ⸆ࠊࡀ᥎ዡࡉࢀ࡚࠸ࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊ㝆ᅽ⸆ࡢ⤌ࡳྜ$&( 㜼ᐖ⸆ࠊࡲࡓࡣ฼ᒀ⸆࡜ࡍࡿࠋ

ࢃࡏ࡟ࡘ࠸࡚ࡢ࢚ࣅࢹࣥࢫࡣᑡ࡞ࡃࠊணࡵ᭷ຠ࡞⤌۵ ᖺ㱋㸸 ṓᮍ‶  ṓ௨ୖ࡜ࡍࡿࠋ۵ ᛶู㸸ᛶูࡣၥࢃ࡞࠸ࠋ

ࡳྜࢃࡏࢆண ࡍࡿࡇ࡜ࡣᮍࡔᅔ㞴࡛࠶ࡿࠋ㝆ᅽ⸆۵ ධ㝔࣭እ᮶㸸እ᮶㏻㝔ᝈ⪅ࠋే⏝⒪ἲ࡟ࡘ࠸࡚ࡉࡽ࡞ࡿ▱ぢࡢ㞟✚ࡀᮃࡲࢀࡿࠋホ౯㡯┠㸦࢔࢘ࢺ࣒࢝ᣦᶆ㸧࣓࢜ࣝࢧࣝࢱࣥࡣ࢔ࣥࢪ࢜ࢸࣥࢩࣥϩཷᐜయᣕᢠ⸆۵ ୺せ࢔࢘ࢺ࣒࢝Ѝ ◊✲ᑐ㇟⪅ࡢᐙᗞ⾑ᅽ࡞ࡽ

$5% ࡛ࠊ㝆ᅽస⏝࡟ຍ࠼ࠊ㧗⾑ᅽ࡟ࡼࡾ㞀ᐖࢆཷࡅࡧ࡟እ᮶⾑ᅽࡢኚ໬ࢆ୺せ࢔࢘ࢺ࣒࢝࡜ࡍࡿ

ࡿ⬻ࠊᚰࠊ⾑⟶ࠊ⭈࡞࡝୺せ⮚ჾࡢಖㆤస⏝ࢆᣢࡘ㸦ᩥ⊩㸯㸧ࠋ۵ ᮏ◊✲࡟࠾ࡅࡿࠕᐙᗞ⾑ᅽ࣭እ᮶⾑ᅽࠖࡢᐃ⩏ྍ⬟ᛶࡀ࠶ࡿࠋᮏ◊✲࡛ࡣࠊ ✀㢮௨ୖࡢ㝆ᅽ⸆ࢆЍ ᐙᗞ⾑ᅽ㸸ᐙᗞ⾑ᅽࢆ⏝࠸࡚ ᐃࡋࡓᮅෆ᭹ࡋࠊᐙᗞ⾑ᅽࢆグ㘓ࡋ࡚࠸ࡿ㧗⾑ᅽ࣭⭈⮚⛉እ㉳ᗋᚋ  ᫬㛫௨ෆࠊ᤼ᒀᚋࠊᗙ఩  ศࡢᏳ᮶ཷデᝈ⪅ࢆᑐ㇟࡟ࠊ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼

㟼ᚋࠊ㝆ᅽ⸆᭹⸆๓ࠊᮅ㣗๓ ࡜ࠊᬌ ᑵᐷ๓ࠊ࡟క࠺⾑ᅽ್࡞ࡽࡧ࡟⏕ά⩦័࡟㛵ࢃࡿ௦ㅰࠊᚰࠊᗙ఩  ศࡢᏳ㟼ᚋ ࡢ⾑ᅽ㸦ᩥ⊩㸰ࠊ㸱㸧ࠋ⾑⟶ࠊ⭈ᅉᏊࡢኚ໬ࡘ࠸᳨࡚ウࡍࡿࡇ࡜ࢆ┠ᶆ࡜ࡍ۵ እ᮶⾑ᅽЍ デᐹᐊ࡛ ᐃࡋࡓ  ᅇࡢᖹᆒ್ࠋࡿࠋ۵ ๪ḟⓗ࢔࢘ࢺ࣒࢝ࡢ ᐃࢆ┠ⓗ࡟᥇⏝ࡍࡿᑻᗘ

⭈ᶵ⬟㸸 య㔜࡞ࡽࡧ࡟⾑Ύࢡࣞ࢔ࢳࢽࣥ⃰ᗘϩ㸬ᑐ㇟࣭᪉ἲ
◊✲ࡢᴫせ ࡼࡾ⟬ฟࡉࢀࡿ᥎ᐃ⣒⌫యℐ㐣㔞ࠊ㝶᫬ᒀࡼࡾ ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ࡢ㧗⾑ᅽ࣭⭈⮚⛉እ᮶⬡㉁⣔㸸 ⥲ࢥࣞࢫࢸ࣮ࣟࣝࠊ୰ᛶ⬡⫫ࠊ+'/

࡟࠾࠸࡚ຍ⒪୰ࡢᝈ⪅㸦㝆ᅽ⸆㸰✀௨ୖࢆ౑⏝㸧ࢆࢥࣞࢫࢸ࣮ࣟࣝࠊ/'/ࢥࣞࢫࢸ࣮ࣟࣝ

ᑐ㇟࡟ࠊ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼࡟క࠺እ᮶࠾

⢾௦ㅰ⣔㸸 ⾑⢾ࠊ+E$Fࠊ✵⭡᫬࢖ࣥࢫࣜࣥ⃰ࡼࡧᐙᗞ⾑ᅽࠊ⬡㉁ࠊᚰ⭈ᶵ⬟ࡢኚ໬ࢆᚋࢁྥࡁ࡟

ᗘ཰㞟ࡍࡿࠋ

ࡑࡢ௚㸸 ⬻ᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳࢻ %13 ࠊ⾑Ύᒀ㓟್

ᚓࡓ⢾ࠊ⺮ⓑࠊ₯⾑ࠋ◊✲ࢹࢨ࢖ࣥ۵ ◊✲࡟⏝࠸ࡿ㈨ᩱ࠾ࡼࡧ཰㞟ࡍࡿ᝟ሗࡢ✀㢮Ѝ ほᐹⓗ◊✲㸦ᚋࢁྥࡁ⦪᩿◊✲㸧デ⒪㘓࠾ࡼࡧ᳨ᰝࢹ࣮ࢱ

23۵ ཰㞟ࡍࡿලయⓗ࡞ࢹ࣮ࢱ㡯┠Ѝ ⏕໬Ꮫࠊෆศ

పୗ࣭ୖ᪼࡜ࡶㄆࡵ࡞࠿ࡗࡓࠋ$5% ࡢ⮚ჾಖㆤຠᯝ

Ἢ᳨ᰝ➼ࡢྛ✀᳨ᰝ⤖ᯝࠊ᪤ Ṕࠊ⏕άṔ࣭ᐙ࡟ࡘ࠸࡚ࠊࢸ࣑ࣝࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢ

᪘Ṕࠊᢞ⸆ෆᐜࠊయ㔜࣭ᒀ㔞࣭⾑ᅽ್࣭ᚰᢿᩘࠊ

ษࡾ᭰࠼ࢆ⾜࡞ࡗࡓ⩌᳨࡛ウࢆ⾜࡞ࡗࡓ࡜ࡇࢁࠊ⾑ෆศἪࢹ࣮ࢱ

୰%13್ࡣᖹᆒSJPO࡜㍍ᗘࡢపୗ࡟࡜࡝ࡲࡗࡓ

◊✲᪉ἲ

ࡶࡢࡢࠊᒀ୰࢔ࣝࣈ࣑ࣥ㸭ࢡࣞ࢔ࢳࢽࣥẚࡣࠊᖹᆒ◊✲௦⾲⪅ ᐇ᪋㈐௵⪅ ࠾ࡼࡧ◊✲ศᢸ⪅࡟ࡼ

PJJ࣭&U పୗࡋࡓࠋ≉࡟⭈㞀ᐖࡢ࣐࣮࣮࢝ࡀప

ࡾデ⒪ࢹ࣮ࢱ࠿ࡽ཰㞟ࢆ⾜࠺ࠋୗഴྥࢆࡋࡵࡋࡓࠋ⬡㉁௦ㅰࠊᒀ㓟್ࠊ⢾௦ㅰ࡟࠾◊✲ᮇ㛫࠸࡚ࡣ⩌㛫ࡢᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ
ᖹᡂ  ᖺ  ᭶㹼ᖹᡂ  ᖺ  ᭶ϫ㸬⪃ ᐹ

⤫ィᏛⓗ஦㡯۵ 㝆ᅽ⸆ࡢษࡾ᭰࠼๓ᚋࡢእ᮶⾑ᅽ࣭ᐙᗞ⾑ᅽࡢ࢝ࣥࢹࢧࣝࢱࣥࡼࡾ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼

ኚ໬࡟ࡘ࠸࡚ࠊ3DLUHGGHVLJQ ࡟ࡼࡾ᳨ウࡍࡿࠋ࡟࠾࠸࡚ࡣࠊ཰⦰ᮇ⾑ᅽ࡛ᖹᆒ PP+J ࡢపୗࠊᣑ۵ ྜేࡍࡿ⑌ᝈ ⢾ᒀ⑓ࠊ⭈㞀ᐖࠊ㧗ᒀ㓟⾑⑕ ࡢᙇᮇ⾑ᅽ࡛ࡣᖹᆒ PP+J ࡢపୗࡀぢࡽࢀࠊᒀ୰࢔

᭷↓࡛๭ࡾᙜ࡚ࡋࠊ
⩌㛫࡛ࡢ㝆ᅽ࡟ࡘ࠸࡚ $129$

ࣝࣈ࣑ࣥ㸭ࢡࣞ࢔ࢳࢽࣥẚࡣࠊᖹᆒ PJJ࣭&Uศᩓศᯒࢆ⾜࠺ࠋపୗࠊࡲࡓ⾑୰ %13 ್ࡣᖹᆒ SJPO పୗࡋࡓࠋ࢜

۵ ྠᵝࡢゎᯒࢆࠊ㝆ᅽࡔࡅ࡛࡞ࡃࠊ
ࠕ⢾௦ㅰࡢኚ໬ࠖ
ࠊ࣓ࣝࢧࣝࢱࣥࡣ࢝ࣥࢹࢧࣝࢱࣥ࡟ẚࡋ࡚ࠊ㝆ᅽຠᯝࠕ⬡㉁௦ㅰࡢኚ໬ࠖ
ࠊࠕ⭈ᶵ⬟ࡢኚ໬ࠖࠊࠕᒀ㓟್ࡸᚰ⭈㞀ᐖࡢ࣐࣮࣮࢝ࡢపୗࠊࡍ࡞ࢃࡕ⮚ჾಖㆤຠࡢኚ໬ࠖ࡟࠾࠸࡚ࡶ⩌㛫ẚ㍑ࢆ⾜࠺㸦ᩥ⊩㸲ࠊᯝࡀᮇᚅ࡛ࡁࡿࠋ

㸳㸧ࠋࢸ࣑ࣝࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼

࡟࠾࠸࡚ࡣࠊ
཰⦰ᮇ⾑ᅽ࡛ᖹᆒ PP+J ࡜㍍ᗘపୗࠊϪ㸬⤖ ᯝ

ᣑᙇᮇ⾑ᅽ࡛ࡣᖹᆒ⾑ᅽᕪ PP+J ࡛࠶ࡾࠊ㝆ᅽຠ  ᖹᡂ  ᖺ  ᭶࠿ࡽᖹᡂ  ᖺ  ᭶ࡲ࡛ࡢᮏ◊ᯝࡣࢸ࣑ࣝࢧࣝࢱࣥ࡜ྠ➼࡜⪃࠼ࡽࢀࡓࠋࡲࡓࠊ⾑✲ᮇ㛫๓༙࡟࠾࠸࡚ࡣࠊ
$5% ࢝ࣥࢹࢧࣝࢱࣥ࠿ࡽ $5%

୰%13್ࡣᖹᆒSJPO࡜㍍ᗘࡢపୗ࡟࡜࡝ࡲࡗ࡚

࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼ࢆ⾜࡞ࡗࡓ⩌㸦&D ᣕᢠ࠾ࡾࠊ㧗⾑ᅽᝈ⪅࡟࠾ࡅࡿ $5% ࡢᚰಖㆤຠᯝ࡟ࡘ࠸

⸆ే⏝㸧᳨࡛ウࢆ⾜ࡗࡓࠋᖹᆒᖺ㱋  ṓࡢ  ྡࡀ࡚ࡶࠊࢸ࣑ࣝࢧࣝࢱࣥ࡜ྠ➼࡜⪃࠼ࡽࢀࡓࠋࡑࡢ୍

᭱⤊ⓗ࡞᳨ウᑐ㇟⪅࡜ࡋ࡚㑅ࡤࢀࠊ
$5% ษࡾ᭰࠼ᚋ ᪉࡛ࠊࢸ࣑ࣝࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ

ࣨ᭶ࡢ᫬Ⅼ࡛ࠊ◊✲᪉ἲ࡟グ㍕ࡢ࠶ࡿ࢔࢘ࢺ࣒࢝ࡢ

᭰࠼࡟ࡼࡾࠊᒀ୰࢔ࣝࣈ࣑ࣥ㸭ࢡࣞ࢔ࢳࢽࣥẚࡣࠊホ౯ࢆ⾜࡞ࡗࡓࠋ㝆ᅽຠᯝࡣ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษᖹᆒ PJJ࣭&U పୗࡋࡓࠋ࣓࢜ࣝࢧࣝࢱࣥࡣࢸࣝ

ࡾ᭰࠼࡟ࡼࡾࠊ཰⦰ᮇ⾑ᅽ࡛ᖹᆒ PP+J ࡢపୗࠊ࣑ࢧࣝࢱࣥ࡟ẚࡋ࡚ࠊ㝆ᅽຠᯝࡸᚰಖㆤస⏝ࡣྠ➼ᣑᙇᮇ⾑ᅽ࡛ࡣᖹᆒ PP+J ࡢపୗࡀぢࡽࢀࡓࠋ࢝

࡜⪃࠼ࡽࢀࡓࡀࠊ⭈ಖㆤຠᯝࡣࡼࡾᙉ࠸ࡶࡢ࡜⪃࠼ࣥࢹࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼࡟ࡼ

ࡽࢀࡓࠋࡾࠊ≉࡟㝆ᅽຠᯝぢࡽࢀࡓ᫬㛫ᖏ࡜ࡋ࡚ࡣࠊ᪩ᮅ࡜

ᮏ◊✲࡛ࡣࠊ⭈㞀ᐖࡢ࣐࣮࣮࢝࡜ࡋ࡚ᒀ୰࢔ࣝࣈ

ᑵᐷ๓࡛࠶ࡗࡓࠋ$5% ࡢ⮚ჾಖㆤຠᯝ࡟ࡘ࠸࡚ࠊ࢝

࣑ࣥࢆィ ࡋࡓࡀࠊ㏆ᖺࠊᒀ୰࢔ࣝࣈ࣑ࣥ࡜⾑⟶ෆࣥࢹࢧࣝࢱࣥ࠿ࡽ࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼ࢆ⾜⓶ᶵ⬟࡜ࡢ㛵㐃ࡀ♧၀ࡉࢀ࡚࠸ࡿࡇ࡜࠿ࡽ㸦ᩥ⊩㸵㸧ࠊ࡞ࡗࡓ⩌᳨࡛ウࢆ⾜࡞ࡗࡓ࡜ࡇࢁࠊᒀ୰࢔ࣝࣈ࣑ࣥ

$5% ࣓࢜ࣝࢧࣝࢱࣥࡢ⾑⟶ෆ⓶ᶵ⬟ࡢᨵၿຠᯝࡶᮇ

㸭ࢡࣞ࢔ࢳࢽࣥẚࡣࠊᖹᆒ PJJ࣭&U పୗࡋࠊࡲ

ᚅࡉࢀࡿࠋ
ࡓ⾑୰ %13 ್ࡣᖹᆒ SJPO పୗࡋࡓࠋᚰ⭈㞀ᐖࡢϬ㸬⤖ ㄽ

࣐࣮࣮࢝ࡀ࡜ࡶ࡟పୗഴྥࢆࡋࡵࡋࡓ㸦ᩥ⊩㸴㸧ࠋ◊✲ᮇ㛫ᚋ༙࡛ࡣࠊ࢝ࣥࢹࢧࣝࢱࣥ࡟ẚࡋ࡚ᣢ⥆◊✲ᑐ㇟ࡢேᩘ࡜ࡋ࡚ࡣ༑ศ࡛ࡣ࡞࠸ࡀࠊᮏ◊✲ᛶࡢ㝆ᅽຠᯝࡀᮇᚅࡉࢀ࡚࠸ࡿࢸ࣑ࣝࢧࣝࢱࣥ࠿ࡽ

࡛ᚓࡽࢀࡓ $5% ࡢ⮚ჾಖㆤຠᯝࡸ㝆ᅽຠᯝࡢഴྥ࡟

࣓࢜ࣝࢧࣝࢱࣥ࡬ࡢษࡾ᭰࠼ࢆ⾜࡞ࡗࡓ⩌࡟࠾࠸࡚ࡘ࠸୍࡚ᐃࡢ⤖ㄽࢆ♧ࡍࡇ࡜ࡀ࡛ࡁࡓࠋ

ᚋࢁྥࡁほᐹࢆ⾜࠸ࠊ࢔࢘ࢺ࣒࢝ᣦᶆࡢኚ໬࡟ࡘ࠸

࡚ࡢ᳨ウࢆ⾜ࡗࡓ㸦ᖹᆒᖺ㱋  ṓࠊ ྡ㸧ࠋ$5% ษ

ϭ㸬◊✲༠ຊ⪅ࡾ᭰࠼ᚋ ࣨ᭶ࡢ᫬Ⅼ࡛ࠊ཰⦰ᮇ⾑ᅽ࡛ᖹᆒPP+Jᒾᔱ⩏㞝࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་㛗

࡜㍍ᗘపୗࠊᣑᙇᮇ⾑ᅽ࡛ࡣᖹᆒ⾑ᅽᕪ PP+J ࡜Ἑ㔝㞝ᖹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭㒊㛗24Ϯ㸬ཧ⪃ᩥ⊩1) Trend of office and home blood pressure control
in treated hypertension patients: changes inantihypertensive medication and salt intake.
Ohta Y,Iwashima Y, Hayashi S, Kawano Y௚.

Clin Exp Hypertens 36, 103-107, 2014.
2) ⾑ᅽ ᐃ. ᯘ┿୍㑻ࠊἙ㔝㞝ᖹ. ⾑⟶デ⒪ࢸ࢟ࢫࢺ㸦Vasular Labู෉㸧240-246, 2015.
3㸧἞⒪᢬ᢠᛶ㧗⾑ᅽ࡜ࡣࠊᐃ⩏࡜㢖ᗘ. ᯘ┿୍㑻ࠊἙ㔝㞝ᖹ. ⾑ᅽ 20, 10-13. 2013.
4) Effect of bezafibrate on office, home andambulatory blood pressure in hypertensive
patients with dyslipidemia. Ohta Y, Kawano Y,
Iwashima Y, Hayashi S௚. J Hum Hypertens
27, 417-420, 2013.
5) Comparison of efficacy of intensive versus mild
pitavastatin

therapy

on

lipid

and

inflammation biomarkers in hypertensive
patients with dyslipidemia. Yamasaki T,
Iwashima Y, Hayashi S, Kawano Y௚. Plos

One. 19, e89057, 2014.
6) ࢥࣥࢺ࣮ࣟࣝ୙Ⰻ㧗⾑ᅽᝈ⪅ࢆᑐ㇟࡟ࡋࡓ࢜ࣝ
࣓ࢧࣝࢱࣥ㸭࢔ࢮࣝࢽࢪࣆࣥ㸭㓄ྜ๣࡜࢝ࣥࢹ
ࢧࣝࢱࣥ㸭࢔࣒ࣟࢪࣆࣥ㓄ྜ㘄ࡢ㝆ᅽຠᯝ࡟㛵ࡍࡿẚ㍑ヨ㦂. ᒾᔱ⩏㞝ࠊᯘ┿୍㑻ࠊᇼᑿṊྐࠊἙ㔝㞝ᖹ. ⾑ᅽ. 19,48-53, 2012.
7) Reversal of impaired endothelial function in apatient with malignant hypertension. Hayashi
S, Kawano Y௚. 㧗⾑ᅽᏛ఍㸦meeting abstract㸧
ࠊ
2014.

25

៏ᛶ⭈⮚⑓ᝈ⪅࡛ࡢ⢾ᒀ⑓⟶⌮ࡢᐇែ࡜⸆≀⒪ἲࡢ᭷⏝ᛶ࡟ࡘ࠸࡚ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮㧗⾑ᅽ࣭⭈⮚⛉ ་㛗 ୰ ᮧ ᩄ ᏊϨ㸬⥴ ゝᅽ࣭⭈⮚⛉እ᮶ࢆཷデࡋࠊ௨ୗࡢ᮲௳ࢆ‶ࡓࡍ៏ᛶ ៏ᛶ⭈⮚⑓(CKD)ࡣࠊᡃࡀᅜࡢᡂேࡢ⣙ 13%࡟ㄆ

⭈⮚⑓ᝈ⪅⣙ 50 ྡࠋࡵࡽࢀࠊ᪂ࡓ࡞ᅜẸ⑓࡜ࡶ⪃࠼ࡽࢀࠊᮎᮇ⭈୙඲ࡸձᖺ㱋 20 ṓ௨ୖ 80 ṓᮍ‶ᚠ⎔ჾ⑌ᝈࡢཎᅉ࡜ࡋ࡚ࡶὀ┠ࡉࢀ࡚࠸ࡿ(1)ࠋ㏱ᯒ

ղ⢾ᒀ⑓ࢆ᭷ࡋࠊᮇ㛫୰࡟⾑ᾮ᳨ᰝࠊᒀ᳨ᰝࢆ 2 ᅇᝈ⪅ᩘࡣቑຍࡋࠊ᪂つࡢ㏱ᯒᑟධࡢཎᅉࡢ➨ 1 ఩ࢆ௨ୖ⾜ࡗࡓᝈ⪅ࠋ⢾ᒀ⑓ࡀ༨ࡵ࡚࠾ࡾࠊ20 ᖺ๓ࡢ 1.6 ಸ࡟ቑຍࡋ࡚࠸
ࡿ(2)ࠋCKD ᝈ⪅ࡢ⭈ᶵ⬟పୗᢚไࡢⅭ࡟ࡣࠊ㞟Ꮫホ౯㡯┠ⓗ἞⒪ࡀᚲせ࡛࠶ࡾࠊ≉࡟㧗⾑ᅽ࣭⢾ᒀ⑓࣭⬡㉁␗

 ࢔࢘ࢺ࣒࢝ᣦᶆ

ᖖ⑕࣭㧗ᒀ㓟⾑⑕࣭㈋⾑ࡢ⟶⌮ࡣ㔜せ࡛࠶ࡿ(1,3)ࠋ

୺せ࢔࢘ࢺ࣒࢝㸸⢾ᒀ⑓⸆ࡢ✀㢮࡜⾑ᅽࠊ⺮ⓑᒀࠊ⭈ᶵ ᪥ᮏ⭈⮚Ꮫ఍ࡢCKDデ⒪࢞࢖ࢻ2012࡛ࡣࠊ
CKD⬟ࠊ⾑⢾್ࠊHbA1c ࡢ㛵ಀ࡟ྜేࡋࡓ⢾ᒀ⑓ࡢ⟶⌮࡟ࡣཝ᱁࡞⾑⢾ࢥࣥࢺ࣮ࣟ

ࣝࡀ᥎ዡࡉࢀࠊ⾑⢾ࢥࣥࢺ࣮ࣟࣝ┠ᶆ್ࡣ HbA1c

 ࢔࢘ࢺ࣒࢝ࡢ ᐃࢆ┠ⓗ࡟᥇⏝ࡍࡿᑻᗘ

࡛ 6.9%ᮍ‶࡜ࡉࢀ࡚࠸ࡿ(1)ࠋ

 ᥎⟬⣒⌫యℐ㐣⋡ H*)5 㸸ᖺ㱋ࠊᛶูࠊ⾑Ύࢡࣞ࢔ࢳ CKD ࡟࠾ࡅࡿ⢾ᒀ⑓⸆≀἞⒪ࡢὀពⅬࡣࠊ⭈ᶵࢽ್ࣥ &U ࡟ࡼࡿ᥎⟬ᘧ⬟࡟ᛂࡌ࡚ៅ㔜ᢞ୚ࡸ⚗ᚷ࡜࡞ࡿ⸆๣ࡀ࠶ࡿࡇ࡜࡛

⏨ᛶ H*)5 POศP ;&U; ᖺ㱋࠶ࡿࠋCKD ࢫࢸ࣮ࢪ 4 ௨ୖ࡛ࡣࠊࢳ࢔ࢰࣜࢪࣥ⸆ࠊ

ዪᛶ H*)5 POศP ;&U; ᖺ㱋;

ࣅࢢ࢔ࢼ࢖ࢻ⸆ࠊSU ⸆ࡣࠊ౑⏝ࡀ່ࡵࡽࢀ࡞࠸ࠋ ᒀ࢔ࣝࣈ࣑ࣥ㸸㝶᫬ᒀ࡛ࡢᒀ୰࢔ࣝࣈ࣑ࣥࢡࣞ࢔ࢳࢽ

୍᪉ࠊȘࢢࣝࢥࢩࢲ࣮ࢮ㜼ᐖ⸆ࡸ࢖ࣥࢩࣗࣜࣥ➼ࡢ

ࣥẚ㸦PJJ࣭&U㸧౑⏝ࡣྍ⬟࡛࠶ࡿࠋDPP-4 㜼ᐖ⸆ࡶᢞ୚ྍ⬟࡛࠶ࡾࠊ ៏ᛶ⭈⮚⑓ࡢᐃ⩏ձ⭈㞀ᐖࢆ♧၀ࡍࡿᡤぢ㸦᳨ᒀ␗ᖖࠊ

⏝㔞ㄪ⠇ࡀᚲせ࡞⸆๣(ࣅࣝࢲࢢࣜࣉࢳࣥࠊ࢔ࣟࢢࣜ

⏬ീ␗ᖖࠊ⑓⌮ᡤぢ࡞࡝㸧ࡢᏑᅾࠊղ*)5P/ศP

ࣉࢳࣥࠊࢩࢲࢢࣜࣉࢳࣥ)ࡸࠊ⏝㔞ㄪ⠇ࡀ୙ᚲせ࡞⸆ᮍ‶ࡢ⭈ᶵ⬟పୗࡀ  ࣨ᭶௨ୖᣢ⥆ࡍࡿ஦࡛ᐃ⩏ࡉࢀࡿࠋ๣(ࣜࢼࢢࣜࣉࢳࣥࠊࢸࢿࣜࢢࣜࣉࢳࣥ)࡞࡝ࠊᵝࠎ࡛࠶ࡿࠋࡲࡓࠊ㧗㱋⪅࡛ࡣప⾑⢾ࣜࢫࢡࡀ㧗ࡲࡿࡇ ◊✲࡟⏝࠸ࡿ㈨ᩱ࠾ࡼࡧ཰㞟ࡍࡿ᝟ሗࡢ✀㢮࡜ࡶ▱ࡽࢀ࡚࠸ࡿࠋ㈋⾑ࡸప࢔ࣝࣈ࣑ࣥ⾑⑕ࡀ࠶ࡿデ⒪㘓࠾ࡼࡧ᳨ᰝࢹ࣮ࢱ

᫬࡟ࡣࠊHbA1c ࡸࢢࣜࢥ࢔ࣝࣈ࣑ࣥࡀ⾑⢾ࡢ⟶⌮≧ែࢆṇ☜࡟཯ᫎࡋ࡞࠸஦࡛࠶ࡿࠋ ཰㞟ࡍࡿලయⓗ࡞ࢹ࣮ࢱ㡯┠ ᮏ◊✲࡛ࡣࠊ⢾ᒀ⑓ࢆ᭷ࡍࡿ CKD ᝈ⪅࡛ࡢ⢾ᒀᖺ㱋ࠊᛶูࠊ㌟㛗ࠊయ㔜⑓἞⒪⸆㸦ෆ᭹⸆ࠊὀᑕ⸆㸧ࢆㄪᰝࡋࠊ⾑ᅽ࣭ᒀࢱ⏕άṔࠊ᪤ Ṕࠊྜే⑕

ࣥࣃࢡ࣭⭈ᶵ⬟࣭⾑⢾࣭HbA1c ࡜ࡢ㛵㐃ᛶࢆ᳨ウࡍ⏕໬Ꮫࠊᮎᲈ⾑ࠊෆศἪࠊᒀ᳨ᰝ

ࡿࠋ⾑ᅽ್ࠊ⬦ᢿᩘ

ϩ㸬ᑐ㇟࣭᪉ἲ

◊✲᪉ἲ

ᑐ㇟⪅ࡢ㑅ᢥ࡜ேᩘ

◊✲௦⾲⪅ ᐇ᪋㈐௵⪅㸧
࡟ࡼࡾデ⒪ࢹ࣮ࢱ࠿ࡽ཰㞟 ᑐ㇟ᝈ⪅ࢆ⾜࠺ࠋ2010 ᖺ 1 ᭶ࡼࡾ 2014 ᖺ 3 ᭶ࡲ࡛࡟ᙜࢭࣥࢱ࣮㧗⾑

26

66s6

71s9

71s9

66s12 67s11

㝶᫬⾑⢾

112s

132s

148s

136s

123s

⤫ィᏛⓗ஦㡯(mg/dl)

14

48

32

44

26

(1)៏ᛶ⭈⮚⑓ࡢࢫࢸ࣮ࢪ࡜⾑ᅽࠊ⺮ⓑᒀࠊ⭈ᶵ⬟ࠊ

HbA1c (%)

6.6s

7.2s

6.9s

6.3s

6.5s

1.0

1.0

0.7

1.2

0.6

◊✲ᮇ㛫ᣑᙇᮇ⾑ᅽ ᖺ  ᭶㹼 ᖺ  ᭶

(mmHg)

⾑⢾್ࠊHbA1c ࢆ᳨ウࡍࡿࠋ

9Vࢫࢸ࣮ࢪ  ⩌ 

(2) ⢾ᒀ⑓἞⒪⸆ࡢ᭷↓ࡸ᭹⸆ᩘ࡜⾑ᅽࠊ⺮ⓑᒀࠊ⭈ᶵ⬟ࠊ⾑⢾್ࠊHbA1c ࡢኚ໬ᗘࢆ᳨ウࡍࡿࠋ  ⢾ᒀ⑓἞⒪⸆࡜⢾ᒀ⑓⟶⌮࣭⭈ᶵ⬟࣭ࢱࣥࣃࢡᒀࡢ㛵㐃 ៏ᛶ⭈⮚⑓ࡢࢫࢸ࣮ࢪ࡛ࡢẚ㍑ࡣ ANOVAࠊ2 ⩌ ⢾ᒀ⑓἞⒪⸆ࡢෆヂࡣࠊȘࢢࣜࢥࢩࢲ࣮ࢮ㜼ᐖ⸆ࠊ㛫࡛ࡢẚ㍑ࡣ t-᳨ᐃࢆ⏝࠸ࡿࠋࢳ࢔ࢰࣜࢪࣥㄏᑟయࠊ68 ⸆ࠊࣅࢢ࢔ࢼ࢖ࢻ⸆ࠊ'33㜼ᐖ⸆ࠊ࢖ࣥࢫࣜࣥ〇๣ࡀࡑࢀࡒࢀ ࠊࠊࠊ

Ϫ㸬⤖ ᯝ

ࠊࠊ࡟ᢞ୚ࡉࢀ࡚࠸ࡓࠋ⢾ᒀ⑓἞⒪⸆ࡢ᭹⸆ ᝈ⪅⫼ᬒ

ᩘࡣࠊ༢๣ ࠊ ๣ෆ᭹ ࠊ ๣௨ୖෆ᭹ ࡛࠶ ᑐ㇟࡜࡞ࡗࡓ  ౛ࡢ≉ᚩࡣ⏨ᛶࡀ ࠊᖹᆒᖺ㱋ࡗࡓࠋࡢᝈ⪅ࡀࠊ㣗஦⒪ἲࡢࡳ࡛࠶ࡗࡓࠋ

s ṓࠊ⏕ά⩦័࡛ࡣ㐣ཤ࣭⌧ᅾࡢႚ↮⪅ࡀ ࠊ ෆ᭹⸆ࡢ᭷↓࡜ᝈ⪅ࡢ≉ᚩࢆ᳨ウࡋࡓ࡜ࡇࢁࠊ⾲㣧㓇Ṕ ࡛࠶ࡗࡓࠋ⏕ά⩦័⑓࡛ࡣࠊ㧗⾑ᅽࠊ⢾ ࡟♧ࡍࡼ࠺࡟ࠊ㠀ෆ᭹⩌࡛ࡣࠊෆ᭹⩌࡟ẚ࡭࡚ࠊᒀ⑓࡜៏ᛶ⭈⮚⑓ࢆ඲౛ࡀ᭷ࡋࠊ⬡㉁␗ᖖ⑕ ࠊ⭈ᶵ⬟ࡀపࡃࠊ⾑⢾ࢥࣥࢺ࣮ࣟࣝࡣⰋዲ࡞ഴྥࡀㄆ

㧗ᒀ㓟⾑⑕ ࡀ᭷ࡋ࡚࠸ࡓࠋ៏ᛶ⭈⮚⑓ࡢෆヂࡣࡵࡽࢀࡓࠋࢫࢸ࣮ࢪ  H*)5 ௨ୖ ࡀ ࠊࢫࢸ࣮ࢪ  H*)5㸸
ࠥ ࡀ ࠊࢫࢸ࣮ࢪ㸱 H*)5㸸ࠥ ࡀ ࠊ⾲ ⢾ᒀ⑓἞⒪⸆ෆ᭹ࡢ᭷↓࡜⢾ᒀ⑓⟶⌮࣭⭈ᶵ⬟ࡢ㛵ಀࢫࢸ࣮ࢪ H*)5ࠥ ࡀࠊ
ࢫࢸ࣮ࢪ H*)5⢾ᒀ⑓἞⒪⸆

⢾ᒀ⑓἞⒪⸆ᮍ‶ ࡀ ࢆ༨ࡵ࡚࠸ࡓࠋ
ྜే⑕࡛ࡣࠊ⊃ᚰ⑕ ࠊ

ෆ᭹⩌

㠀ෆ᭹⩌

21

37

Ns

P್

ᚰ➽᱾ሰࡢ᪤  ࠊ⬻᱾ሰࡢ᪤  ࠊ⬻ฟ⾑ࡢ᪤ேᩘ  ࠊୗ⫥㛢ሰᛶື⬦◳໬⑕ࡢ᪤  ࠊ኱ື⬦⑌

ᖺ㱋㸦ṓ㸧

69s9

70s12

Ns

ᝈࡢ᪤  ࡀ᭷ࡋ࡚࠸ࡓࠋᚠ⎔ჾ⑌ᝈᑓ㛛⑓㝔ࡢ㝶᫬⾑⢾ (mg/dl)

145s37129s37Ns

HbA1c (%)

7.1s0.8

6.5s0.9

0.07

eGFR

49s25

37s23

0.09

1216s1931

328s440ns㧗⾑ᅽ࣭⭈⮚⛉࡟㏻㝔ࡍࡿ⢾ᒀ⑓ࢆ᭷ࡍࡿ៏ᛶ⭈⮚ᝈ⪅࡛࠶ࡾࠊ㧗㱋⪅ࡀከࡃࠊ⏕ά⩦័⑓࣭ᚠ⎔ჾྜే⑕ࢆከᩘ᭷ࡋ࡚࠸ࡓࠋ

(ml/min/1.73m2)

ᒀ࢔ࣝࣈ࣑ࣥ ៏ᛶ⭈⮚⑓ࡢࢫࢸ࣮ࢪ࡜⢾ᒀ⑓࣭㧗⾑ᅽ⟶⌮(mg/g࣭Cr)⾲  ࡟♧ࡍࡼ࠺࡟ࠊྛࢫࢸ࣮ࢪ㛫࡛ᖺ㱋࡟᭷ពᕪࡣ
࡞࠿ࡗࡓࠋእ᮶ࡢ཰⦰ᮇ⾑ᅽࠊᣑᙇᮇ⾑ᅽࡣࠊྛࢫ ⢾ᒀ⑓἞⒪⸆᭹⸆ᩘ࡜⢾ᒀ⑓⟶⌮࣭⭈ᶵ⬟࣭ࢱࣥࢸ࣮ࢪ࡜ࡶ࡟Ⰻዲ࡟ࢥࣥࢺ࣮ࣟࣝࡉࢀ࡚࠸ࡓࠋ㝶᫬ࣃࢡᒀࡢ㛵㐃⾑⢾ࡸ +E$F ್࡟᭷ពᕪࡣ࡞࠿ࡗࡓࠋ ⾲  ࡟♧ࡍࡼ࠺࡟ࠊ༢๣ෆ᭹࡟ẚ࡭࡚ࠊ ๣௨ୖ⾲ &.' ࢫࢸ࣮ࢪ࡜ᖺ㱋࣭እ᮶⾑ᅽ࣭⢾ᒀ⑓⟶⌮&.' ࢫࢸ

ࡢෆ᭹ࢆᚲせ࡜ࡍࡿᝈ⪅࡛ࡣࠊ⾑⢾ࢥࣥࢺ࣮ࣟࣝࡀ





















୙༑ศ࡛࠶ࡗࡓࠋᒀ࢔ࣝࣈ࣑ࣥ࡟ࡣ᭷ពᕪࡣ࡞࠿ࡗ

࣮ࢪ
ேᩘ

ࡓࠋ

ᖺ㱋㸦ṓ㸧

70s3

65s16 67s12

73s6

70s13

཰⦰ᮇ⾑ᅽ

136s

126s

134s

124s

129s

༢๣

2๣

3๣

(mmHg)

11

18

11

19

24

ෆ᭹⩌

ෆ᭹⩌

ෆ᭹⩌

⾲ ᭹⸆ᩘ࡜⢾ᒀ⑓⟶⌮࣭⭈ᶵ⬟ࡢ㛵ಀ

27

14

4

3

ᖺ㱋㸦ṓ㸧

71s6

62s15

68s11

㝶 ᫬ ⾑ ⢾

140s35144s22

187s71HbA1c (%)

6.7s0.8

7.6s0.5

7.7s0.2

eGFR(ml/min

47s29

53s17

55s18

ᒀ ࢔ ࣝ ࣈ࣑ ࣥ

1165s

1757s

537s320(mg/g࣭Cr)

2190

1433

ேᩘ

(mg/dl)/1.73m2)

9V༢๣ෆ᭹⩌  ๣ෆ᭹⩌

ϫ㸬⪃ ᐹ ៏ᛶ⭈⮚⑓ࠊ㧗⾑ᅽࢆྜేࡋࡓ⢾ᒀ⑓ᝈ⪅ࡣࠊ㧗㱋࡛௚ࡢ⏕ά⩦័⑓ࡸᚠ⎔ჾ⑌ᝈࢆከᩘྜేࡋ࡚࠸
ࡓࠋ㝶᫬⾑⢾ࠊHbA1c ࡣ࠾࠾ࡴࡡⰋዲ࡟ࢥࣥࢺ࣮ࣟ
ࣝࡉࢀ࡚࠸ࡓࠋ⣙ 60%ࡀ㣗஦⒪ἲ࡛ࢥࣥࢺ࣮ࣟࣝࡉ
ࢀࠊ⣙ 40%࡛⸆≀἞⒪ࡀ⾜ࢃࢀ࡚࠸ࡓࠋ2 ๣௨ୖࡢ⢾ᒀ⑓἞⒪⸆ࡢෆ᭹ࢆせࡍࡿ⩌࡛ࡣࠊ⾑⢾ࢥࣥࢺ࣮ࣟࣝࡀ୙Ⰻ࡛࠶ࡗࡓࠋ ⢾ᒀ⑓἞⒪⸆࡛ࡣࠊȘࢢࣜࢥࢩࢲ࣮ࢮ㜼ᐖ⸆ࠊ68
⸆ '33 㜼ᐖ⸆ࡀ᭹⸆⪅ࡢ༙ᩘ㏆ࡃ࡛౑⏝ࡉࢀ࡚࠸ࡓࠋCKD ࢫࢸ࣮ࢪ㸲௨ୖ࡛ࡣ㣗஦⒪ἲࡀ⾜ࢃࢀࠊ⢾ᒀ⑓἞⒪⸆ෆ᭹⪅ࡣᑡ࡞࠿ࡗࡓࠋ ⭈ᶵ⬟ࡀⰋዲࡔࡀࠊ⾑⢾ࢥࣥࢺ࣮ࣟࣝ࡟㞴῰ࡋ࡚࠸ࡿ⑕౛࡟ࡣ 2 ๣௨ୖࡢෆ᭹ࡀᚲせ࡛࠶ࡗࡓࡀࠊࢥ
ࣥࢺ࣮ࣟࣝ≧ែࡣⰋዲ࡛ࡣ࡞࠿ࡗࡓࠋ
Ϭ㸬⤖ ㄽ ᙜ㝔࡟㏻㝔ࡍࡿ៏ᛶ⭈⮚⑓ࠊ㧗⾑ᅽࢆྜేࡋࡓ⢾ᒀ⑓ᝈ⪅ࡣࠊ」ᩘࡢ⏕ά⩦័⑓࣭ᚠ⎔ჾ⑌ᝈࢆ᭷ࡋ
࡚࠸ࡓࠋ⢾ᒀ⑓ࡢ἞⒪ࡣࠊ୺࡟㣗஦⒪ἲࡀ⾜ࢃࢀࠊෆ᭹⸆ࡣẚ㍑ⓗ⭈ᶵ⬟ࡢⰋ࠸⑕౛࡟౑⏝ࡉࢀ࡚࠸ࡓࠋ

ϭ㸬ཧ⪃ᩥ⊩1)᪥ᮏ⭈⮚Ꮫ఍⦅㸸CKDデ⒪࢞࢖ࢻ 2012. ᮾி㸸ᮾி་Ꮫ♫㸹2012. 1-99
2)᪥ᮏ㏱ᯒ་Ꮫ఍⤫ィㄪᰝጤဨ఍ࠊ⤫ィゎᯒᑠጤဨ఍㸸ᡃࡀᅜࡢ៏ᛶ㏱ᯒ⒪ἲࡢ⌧ἣ(2012 ᖺ 12 ᭶ 3
1 ᪥⌧ᅾ). ᪥ᮏ㏱ᯒ་Ꮫ఍㞧ㄅ 2014; 47: 1~56
3)᪥ᮏ㧗⾑ᅽᏛ఍㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥసᡂጤဨ
఍⦅㸸㧗⾑ᅽ἞⒪࢞࢖ࢻࣛ࢖ࣥ 2014. ᮾி㸸ࣛ࢖ࣇࢧ࢖࢚ࣥࢫฟ∧㸹2014. 1-234

28 ᛴᛶᮇ⬻ฟ⾑࡟࠾ࡅࡿ⤒ཱྀ㝆ᅽ⸆ࢆ⏝࠸ࡓ㝆ᅽຠᯝ࡟㛵ࡍࡿ◊✲ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭⬻⚄⤒ෆ⛉་㛗 ᒣ ୖ  ᏹϨ㸬⥴ ゝ⾑ᅽ⟶⌮ࢆ⾜࠺ࡓࡵࠊ࢔ࢮࣝࢽࢪࣆࣥෆ᭹ࡢ἞⒪ຠ

ࢃࡀᅜ࡟࠾࠸࡚⬻༞୰ࡣṚᅉࡢ➨ 4 ఩ࠊせ௓ㆤ⑌ᯝࢆ᳨ウࡍࡿࡇ࡜࡛࠶ࡿࠋ

ᝈࡢ㤳఩࡛࠶ࡿࠋ࡜ࡃ࡟⬻ฟ⾑ࡣ⬻༞୰ࡢ 17㸣㹼
30㸣ࢆ༨ࡵࠊⓎ⑕⋡ࡀḢ⡿ㅖᅜࡢᩘಸ㧗࠸ࡀࠊᛴᛶ

ϩ㸬ᑐ㇟࣭᪉ἲ

ᮇ⬻ฟ⾑࡟ᑐࡍࡿ᭷ຠ࡞἞⒪ἲࡣ࡯࡜ࢇ࡝࡞࠸ࠋ⾑

ᑐ㇟ࡣࠊⓎ⑕ 3 ᪥௨ෆ࡟ᙜࢭࣥࢱ࣮⬻⚄⤒ෆ⛉࡟ᅽࡣ⬻ฟ⾑ࡢ᭱ࡶ㔜せ࡞ཎᅉ࡛࠶ࡾࠊⓎ⑕᫬ࡢ⾑ᅽධ㝔ࡋࡓᛴᛶᮇ⬻ฟ⾑ᝈ⪅࡛ࠊⓏ㘓᫬࡟཰⦰ᮇ⾑ᅽ㧗್ࡣ⾑⭘ᣑ኱ࠊ⑕ೃቑᝏࠊ㌿ᖐ୙ⰋࠊṚஸࡢ㔜せ140mmHg ௨ୖࡲࡓࡣࢽ࢝ࣝࢪࣆࣥ࡟ࡼࡿ㝆ᅽ⒪࡞ỴᐃᅉᏊ࡛࠶ࡿࠋࡋࡓࡀࡗ࡚ࠊྛᅜࡢ἞⒪࢞࢖ࢻ

ἲࢆ᪋⾜୰ࡢᝈ⪅࡛࠶ࡿࠋ᪤▱ࡢ⬻⭘⒆ࠊ⬻ື㟼⬦ࣛ࢖࡛ࣥࡣࠊ཰⦰ᮇ⾑ᅽ㸦systolic blood pressure:ወᙧࡲࡓࡣ⬻ື⬦⒗࡟ᅉࡿ⬻ฟ⾑ࠊ⬻ෆ⾑⭘ࡀእയ

SBP㸧180mmHg ࡶࡋࡃࡣᖹᆒ⾑ᅽ 130mmHg ࢆ࡟ࡼࡿࡶࡢ࡜⪃࠼ࡽࢀࡿᝈ⪅ࠊ⥭ᛴࡢ⾑⭘㝖ཤᡭ⾡㉸࠼ࡿሙྜ࡟㝆ᅽࢆ⪃៖ࡍࡿࡇ࡜ࡀ᥎ዡࡉࢀ࡚࠸ࡿࠋ

ࡸ⬻ᐊࢻࣞࢼ࣮ࢪ⾡ࢆཷࡅࡿᝈ⪅ࠊ࢔ࢮࣝࢽࢪࣆࣥ

ᛴᛶᮇ⬻ฟ⾑౛࡟ᑐࡍࡿ㝆ᅽ἞⒪࡜ࡋ࡚ࢽ࢝ࣝࢪ

࡟ᑐࡍࡿ㐣ᩄ⑕ࡢ᪤ ࡀ࠶ࡿᝈ⪅ࡣ㝖እࡋࡓࠋࣆࣥ㟼ὀࡀᗈࡃ⾜ࢃࢀ࡚࠾ࡾࠊࢃࡀᅜ࡟࠾ࡅࡿ඲ᅜ

⬻ฟ⾑Ⓨ⑕ 72 ᫬㛫௨ෆ࡟࢔ࢮࣝࢽࢪࣆࣥ 16mg/

࢔ࣥࢣ࣮ࢺㄪᰝ࡛ࡶࠊᛴᛶᮇ⬻ฟ⾑ࡢ㝆ᅽ⒪ἲ࡜ࡋ᪥ᢞ୚ࢆ㛤ጞࡋࡓࠋព㆑㞀ᐖࡸᄟୗ㞀ᐖࡢࡓࡵ⤒ཱྀ࡚ࢽ࢝ࣝࢪࣆࣥ㟼ὀࡀ᭱ࡶከ࠿ࡗࡓ 1ࠋࡋ࠿ࡋ࡞ࡀ

࡛ࡢෆ᭹ࡀᅔ㞴࡞ᝈ⪅࡟࠾࠸࡚ࡣࠊヨ㦂⸆ࢆ⢊○ࡲࡽࠊࢽ࢝ࣝࢪࣆࣥ㟼ὀࡢ㛗ᮇ㛫ࡢ⥅⥆ࡣࠊ㟼⬦⅖ࠊࡓࡣᠱ⃮ᾮ࡜ࡋ࡚⤒㰯⤒⟶ᰤ㣴ࡼࡾὀධࡋࡓࠋᢞ୚

ឤᰁ⑕ࠊ㢖⬦࡞࡝ࡢྜే⑕ࢆ⏕ࡌࡿ༴㝤ᛶࡀ࠶ࡾࠊ

ᚋ 72 ᫬㛫ࡢ⾑ᅽ࡞ࡽࡧ࡟⬦ᢿࡢ᥎⛣࡟ࡘ࠸࡚ㄪᰝ

㏿ࡸ࠿࡟⤒ཱྀ㝆ᅽ⸆࡟ࡼࡿ㝆ᅽࢆ㛤ጞࡍࡿᚲせࡀ࠶ࡋࡓࠋᢞ୚㛤ጞ࠿ࡽ 3 ᪥㛫ࡣࠊ௚ࡢෆ᭹㝆ᅽ⸆ࡢేࡿ࡜⪃࠼ࡽࢀࡿࡀࠊᛴᛶᮇ⬻ฟ⾑౛࡛ࡢ㐺ษ࡞⤒ཱྀ⏝ࡣ⚗Ṇࡋࠊ⾑ᅽୖ᪼᫬ࡣࢽ࢝ࣝࢪࣆࣥ㟼ὀ࡟ࡼࡿ㝆ᅽ⸆ࡢ㛤ጞ᫬ᮇࠊᢞ୚㔞ࠊᢞ୚᪉ἲ࡞࡝࡟ࡘ࠸࡚

ࢥࣥࢺ࣮ࣟࣝࢆ⾜ࡗࡓࠋࡣࠊᮍࡔ᫂ࡽ࠿࡛ࡣ࡞࠸ࠋ

Ϫ㸬⤖ ᯝ

ᛴᛶᮇ⬻ฟ⾑࡟࠾ࡅࡿ⌮᝿ⓗ࡞⤒ཱྀ㝆ᅽ⸆ࡣࠊ㏿ࡸ࠿࡞㝆ᅽຠᯝࡀᚓࡽࢀࡿ୍᪉࡛ࠊ஺ឤ⚄⤒㈿ά࡟

2013 ᖺ 9 ᭶ࡼࡾ⑕౛Ⓩ㘓ࢆ㛤ጞࡋࠊ2015 ᖺ 2 ᭶ࡼࡿ㢖⬦ࡸࠊ⬻⾑ὶࡢపୗࡀᑡ࡞࠸ࠊ⢊○ࡋᠱ⃮ᾮᮎࡲ࡛࡟ 20 ౛ࡀⓏ㘓ࡉࢀ࡚ࡓࠋ⏨ᛶࡀ 15 ౛ࠊᖹᆒ࡜ࡋ࡚⤒㰯⫶⟶࠿ࡽࡢᢞ୚ࡀྍ⬟࡞࡝ࡢ᮲௳ࡀ⪃࠼ᖺ㱋ࡣ 68.2s10.7 ṓࠊ⬻ฟ⾑㒊఩ࡣどᗋฟ⾑ 10 ౛ࠊࡽࢀࡿࠋ࢔ࢮࣝࢽࢪࣆࣥࡣ༑ศ࡞㝆ᅽస⏝ࢆ᭷ࡋࡘ⿕Ẇฟ⾑ 5 ౛ࠊΰྜᆺฟ⾑ 1 ౛ࠊ⓶㉁ୗฟ⾑ 2 ౛ࠊࡘࠊື≀ᐇ㦂࡟࠾ࡅࡿ஺ឤ⚄⤒άᛶࡢᢚไࡸ 2ࠊ㧗ᶫฟ⾑ 1 ౛ࠊᑠ⬻ฟ⾑ 1 ౛࡛ࠊ18 ౛ࡀ㧗⾑ᅽᛶ⬻ฟ⾑ᅽᝈ⪅࡟࠾ࡅࡿ⬻⾑ὶணഛ⬟ࡢ⥔ᣢ 3ࠊ⬻᱾ሰᝈ⾑࡛࠶ࡗࡓࠋධ㝔᫬⾑ᅽࡣ 177.2s21㸭96.4s19.6⪅࡟࠾ࡅࡿ⬻⾑ὶࡢ⥔ᣢ 4 ࡞࡝ࡀ♧ࡉࢀ࡚࠸ࡿࠋࡲ

mmHgࠊ⬦ᢿࡣ 74.3s12.8/ศࠋ඲౛࡛ධ㝔ᚋ࡟ࢽࡓࠊ⢊ᮎ໬ࡋ࡚ࡶ▷ᮇ㛫࡛ࡣస⏝ࡢῶᙅࡀ࡞࠸ࡇ࡜

࢝ࣝࣆࣥᣢ⥆㟼ὀࡀ㛤ጞࡉࢀࠊ4 ౛࡛࢔ࢮࣝࢽࢪࣆ

ࡶ☜ㄆࡉࢀ࡚࠸ࡿࠋࡑࡇ࡛ࠊᛴᛶᮇ⬻ฟ⾑౛࡟࠾࠸ࣥ㛤ጞ๓࡟⤊஢ࡉࢀࡓࡀࠊ௚ࡢ 16 ౛࡛ࡣ⥅⥆ࡉࢀ࡚ࠊࢽ࢝ࣝࢪࣆࣥ㟼ὀ࠿ࡽࡢ㞳⬺࡜ࠊ☜ᐇ࡞㝆ᅽࡀ

࡚࠸ࡓࠋ
Ⓩ㘓᫬Ⅼ࡛ࡢ⾑ᅽ್ࡣ 141.6s10.6/77.6s11.5

ᚓࡽࢀࠊᏳ඲࡞⾑ᅽ⟶⌮ࡀྍ⬟࡛࠶ࡿ࡜⪃࠼ࡽࢀࠊmmHg㺂⬦ᢿࡣ 80.3s15.3/ศ࡛࠶ࡗࡓࠋ඲౛࡛࢔ࢮ

ᮏ◊✲ࢆィ⏬ࡋࡓࠋᮏ◊✲ࡢ┠ⓗࡣࠊⓎ⑕ᚋ 3 ᪥௨ෆࡢᛴᛶᮇ⬻ฟ⾑ࣝࢽࢪࣆࣥ 16mg/᪥ࡢᢞ୚ࡀ㛤ጞࡉࢀࠊ࢔ࢮࣝࢽࢪ

ᝈ⪅࡟ᑐࡋ࡚ࠊ⤒ཱྀ㝆ᅽ⒪ἲ࡟ࡼࡿ㏿ࡸ࠿࡛Ᏻ඲࡞

ࣆࣥᢞ୚ 24 ᫬㛫௨ෆ࡟ 16 ౛࡛ࠊ72 ᫬㛫௨ෆ࡟ 1729౛࡛ࢽ࢝ࣝࣆࣥᣢ⥆㟼ὀࡀ⤊஢࡜࡞ࡗࡓࠋ࢔ࢮࣝࢽ

ࢪࣆࣥᢞ୚ᚋ 24ࠊ48ࠊ72 ᫬㛫࠾ࡼࡧ 7 ᪥ᚋࡢ⾑ᅽϮ㸬ཧ⪃ᩥ⊩

ࡢᖹᆒ್ࡣࠊ139.4/82.4ࠊ137.8/80.6ࠊ148.4/71.8ࠊ

1)Koga M, Toyoda K, Naganuma M, et al.

136.2/78.8 mmHgࠊ⬦ᢿࡢᖹᆒ್ࡣࠊ75.9ࠊ74.4ࠊ

Nationwide survey of antihypertensive tre

71.8ࠊ70.6/ศ࡜᥎⛣ࡋ࡚࠸ࡓࠋ7 ᪥ᚋࡲ࡛࡟ࠊ20 ౛

atment for acute intracerebral hemorrhag

୰ 18 ౛࡛⤒ཱྀ㝆ᅽ⸆ࡢ㏣ຍ࠶ࡿ࠸ࡣኚ᭦ࡀ⾜ࢃࢀe in japan. Hypertens Res. 2009;32:759-76

࡚࠸ࡓࠋᢞ୚ 7 ᪥ᚋ࡟ࡣ 19 ౛୰ 12 ౛࡛⾑ᅽ 140/90

42)௨ୗࢆ㐩ᡂࡋ࡚࠸ࡓࡀࠊ⮫ᗋୖၥ㢟࡜࡞ࡿప⾑ᅽࡸ

Konno S, Hirooka Y, Araki S, et al.

࢔ࢮࣝࢽࢪࣆࣥࡀཎᅉ࡜ᛮࢃࢀࡿ๪స⏝ࡢฟ⌧ࡣㄆ

Azelnidipine decreases sympathetic nerveࡵ࡞࠿ࡗࡓࠋ2 ౛࡛ࢽ࢝ࣝࢪࣆࣥࡀཎᅉ࡜⪃࠼ࡽࢀ

activity via antioxidant effect in the rostralࡿ㟼⬦⅖ࠊ1 ౛࡛ཎ⑌ᝈࡢྜే⑕࡜⪃࠼ࡽࢀࡿㄗᄟ

ventrolateralᛶ⫵⅖ࢆ⏕ࡌࡓࡀࠊ࠸ࡎࢀࡶ㏥㝔᫬࡟ࡣ㍍ᛌࡋࡓࠋ

spontaneously

medullaofhypertensive

stroke-prone
rats.

J

Cardiovasc Pharmacol. 2008;52:555-560
3)ϫ㸬⪃ ᐹ

Kimura Y, Kitagawa K, Oku N, et al. Hem⬻ฟ⾑Ⓨ⑕ 7 ᪥௨ෆ࡟࢔ࢮࣝࢽࢪࣆࣥ 16mg/᪥ࢆ

odynamic influences of azelnidipine, a novelᢞ୚ࡍࡿࡇ࡜࡟ࡼࡿ㔜⠜࡞᭷ᐖ஦㇟ࡣⓎ⏕ࡋ࡞࠿ࡗ

calcium channel blocker, on cerebral circulatiࡓࠋࡲࡓࠊ20 ౛୰ 16 ౛࡛࢔ࢮࣝࢽࢪࣆࣥ㛤ጞ 24

on in hypertensive patients with ischemic w᫬㛫௨ෆ࡟ࢽ࢝ࣝࣆࣥࡢᢞ୚ࢆ⤊஢ฟ᮶࡚࠾ࡾࠊ㟼hite matter lesions. Hypertens Res. 2008;31:⬦⅖ࢆⓎ⏕ࡋࡓ 2 ౛࡛ࡣࠊࢽ࢝ࣝࣆࣥᢞ୚ࡀ 7 ᪥ᚋ2147-2154

4)ࡲ࡛⥅⥆ࡉࢀ࡚࠸ࡓࠋ

Watanabe M, Hirano T, Okamoto S, et al.

୍᪉࡛ࠊ࢔ࢮࣝࢽࢪࣆࣥᢞ୚ᚋ 7 ᪥௨ෆ࡟ 20 ౛

Azelnidipine, a long-acting calcium channel

୰18 ౛࡛㝆ᅽ⸆ࡢᙉ໬ࡲࡓࡣኚ᭦ࡀ⾜ࢃࢀ࡚࠾ࡾࠊ

blocker, could control hypertension withoutᛴᛶᮇ⬻ฟ⾑౛࡟࠾࠸࡚ 140/90mmHg ௨ୗࡢ඘ศ

decreasing࡞㝆ᅽࢆᚓࡿࡓࡵ࡟ࡣࠊᙉຊ࡞㝆ᅽ἞⒪ࡀᚲせ࡛࠶

post-ischemic stroke patients. A 123i-impࡿࡇ࡜ࡀ᥎ᐹࡉࢀࡓࠋ

spect follow-up
2010;33:43-48

Ϭ㸬⤖ ㄽ
Ⓨ⑕ 3 ᪥௨ෆࡢᛴᛶᮇ⬻ฟ⾑౛࡟࠾࠸࡚ࠊ࢔ࢮࣝ
ࢽࢪࣆࣥ 16mg/᪥ࡢᢞ୚ࡣࠊᏳ඲࡞㝆ᅽ἞⒪ࡀ⾜࠼ࡿྍ⬟ᛶࡀ࠶ࡿࠋ

ϭ㸬◊✲༠ຊ⪅㛗᮰୍⾜࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮⬻⚄⤒ෆ⛉࣭㒊㛗ᮡᾆ⏤⌮࣭ྠ࣭ᑓ㛛ಟ⦎་ᐑୗගኴ㑻࣭ྠ࣭་㛗⊦ཎ໷ྐ࣭ྠ࣭་㛗Ლᮏ຾ᩥ࣭ྠ࣭་ᖌ
ᩧ⸨ࡇࡎ࠼࣭ྠ࣭་ᖌ
⏣୰ᬛ㈗࣭ྠ࣭་ᖌ
ᮏᒣࡾ࠼࣭ྠ࣭ࣞࢪࢹࣥࢺ
㧗ᮡ⣧ྖ࣭ྠ࣭ࣞࢪࢹࣥࢺ
ᮌୗ┤ே࣭ྠ࣭ࣞࢪࢹࣥࢺ
⚟㛫୍ᶞ࣭ྠ࣭ࣞࢪࢹࣥࢺ
Ẋᮧಟ୍࣭ྠ࣭ࣞࢪࢹࣥࢺ

30

cerebral

blood

flow

in

study. Hypertens Res.

ᛴᛶᚰ➽᱾ሰ࡟࠾ࡅࡿᛴᛶᮇ㧗⾑⢾࡜៏ᛶ⭈⮚⑓ࡢ㝔ෆணᚋཬࡧ㛗ᮇணᚋ࡟ཬࡰࡍᙳ㡪࡟㛵ࡍࡿ◊✲ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉ 㔝 ཱྀ ᬦ ኵϨ㸬⥴ ゝ
ࡣࡌࡵ࡟


┠ ⓗ

ᛴᛶᚰ➽᱾ሰ࡟࠾ࡅࡿ primary PCI ࡣࡑࡢணᚋ

ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ᚰ⮚⾑⟶ෆ⛉㒊㛛࡟࠾ࢆ኱ࡁࡃᨵၿࡋࡓࡀࠊ✀ࠎࡢᅉᏊࡀࡑࡢ▷ᮇ୪ࡧ࡟ࡅࡿᛴᛶᚰ➽᱾ሰࡢࢹ࣮ࢱ࣮࣋ࢫࢆࡶ࡜࡟ࠊධ㝔᫬㛗ᮇணᚋ࡟ᙳ㡪ࢆ୚࠼࡚࠾ࡾࠊࡑࡢᙳ㡪ࢆ᳨ドࡍࡿࡢ⾑⢾್࡜⟬ฟࡉࢀࡓ eGFR ್࠿ࡽࠊᛴᛶ㧗⾑⢾࡜ࡇ࡜ࡣ᭦࡞ࡿணᚋࡢᨵၿࡢࡓࡵ࡟୙ྍḞ࡛࠶ࡿࠋ៏ᛶ⭈⮚⑓ࡢ㢖ᗘ࡜ࠊࡑࡢ᱾ሰࢧ࢖ࢬࠊᛴᛶ⭈㞀ᐖከࡃࡢᅉᏊࡢ୰࡛ࡶᛴᛶᮇ㧗⾑⢾ࡣࠊᚑ᮶࠿ࡽࡢ⢾ࡢⓎ⏕㢖ᗘཬࡧ㝔ෆṚஸ⋡࡬ࡢᙳ㡪ࢆ᳨ウࡍࡿࠋࡉᒀ⑓ࡸ HbA1c ࡞࡝ࡢ៏ᛶ㧗⾑⢾࡜ࡣ␗࡞ࡗࡓᶵᗎ

ࡽ࡟㛗ᮇணᚋࢆ㏣㊧ࡋࠊᛴᛶ㧗⾑⢾࡜៏ᛶ⭈⮚⑓࡟࡟ࡼࡾᚰ➽᱾ሰࡢணᚋ࡟ᙳ㡪ࢆ୚࠼ࡿࡇ࡜ࡀ▱ࡽࢀຍ࠼ࠊ៏ᛶ㧗⾑⢾ࡢᣦᶆ࡛࠶ࡿ HbA1c ࡢ㛗ᮇணᚋ࡚࠸ࡿࠋࡍ࡞ࢃࡕࠊᛴᛶ㧗⾑⢾ࡣ㓟໬ࢫࢺࣞࢫࢆ௓

࡟ཬࡰࡍᙳ㡪ࡢ┦஫㐃㛵࡟ࡘ࠸᳨࡚ウࡍࡿࠋ

ࡋ࡚⅖⑕ࢆច㉳ࠊ࢔࣏ࢺ࣮ࢩࢫࢆㄏᑟࠊෆ⓶ᶵ⬟ࢆࡲࡓᛴᛶᮇࠊ៏ᛶᮇࡢ἞⒪௓ධࡀࡑࢀࡒࢀࡢ㝔ෆയᐖࠊ⾑ᾮจᅛࢆάᛶ໬ࡋࠊࡉࡽ࡟ෆᅉᛶࡢᚰಖㆤ

ணᚋཬࡧ㛗ᮇணᚋ࡟ཬࡰࡍᙳ㡪࡟ࡘ࠸᳨࡚ウࡍࡿࠋస⏝࡛࠶ࡿ⹫⾑ࣉࣞࢥࣥࢹ࢕ࢩࣙࢽࣥࢢస⏝ࢆῶᙅࡉࡏࡿࡇ࡜࡟ࡼࡾࠊᚤᑠᚠ⎔㞀ᐖ࠿ࡽ no-reflow ⌧ϩ㸬ᑐ㇟࣭᪉ἲᑐ ㇟㇟ࢆ⏕ࡌࠊࡲࡓ┤᥋ⓗ࡟ࡶ෌℺ὶᚋࡢᚰ➽ࢆയᐖࡍⓎ⑕ᚋ 48 ᫬㛫௨ෆ࡟ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ࡿ࡜⪃࠼ࡽࢀࡿࡼ࠺࡟࡞ࡗࡓࠋ᪥ᮏᚠ⎔ჾᏛ఍࡞࡝
㛵㐃11Ꮫ఍ࡢSTୖ᪼ᆺᛴᛶᚰ➽᱾ሰࡢデ⒪࡟㛵ࡍ࡟ධ㝔ࡋࡓ AMI ᝈ⪅ 760 ౛ࢆᑐ㇟࡜ࡋࡓࠋ

ࡿ࢞࢖ࢻࣛ࢖ࣥ㸦2013 ᖺᨵゞ∧㸧࡟࠾࠸࡚ࡶᛴᛶ㧗


᪉ ἲ

⾑⢾ࡀ᪂ࡓ࡞㡯┠࡜ࡋ࡚㏣ຍࡉࢀࡿ࡞࡝ࠊ⌧ᅾࠊᛴධ㝔᫬ eGFR <60mL/min/1.73m2 ࢆ CKD(+)࡜

ᛶᚰ➽᱾ሰࡢᛴᛶᮇࡢ༴㝤ᅉᏊ࡜ࡋ࡚ὀ┠ࢆ㞟ࡵ࡚ࡋࠊAKI ࢿࢵࢺ࣮࣡ࢡࡢᇶ‽࡟ࡼࡾ AKI(+)ࢆデ᩿࠸ࡿࠋ୍᪉ࠊᚰ⑌ᝈ࡜⭈⮚⑓࡜ࡢ┦஫㐃㛵㸦ᚰ⭈㐃㛵㸧ࡋࡓࠋࡢ㔜せᛶࡀ㏆ᖺࠊᣦ᦬ࡉࢀ࡚࠸ࡿࠋ≉࡟⮫ᗋ㠃࡛ࡣᚑ᮶ࡢࢡࣞ࢔ࢳࢽࣥ࠿ࡽࠊ⡆᫆ἲ࡟ࡼࡾ⣒⌫యℐ㐣Ϫ㸬⤖ ᯝ

⋡ࢆ⟬ฟࡍࡿ eGFR ࡀ⏝࠸ࡽࢀࡿࡼ࠺࡟࡞ࡾࠊከᩘCKD(+)ࡣ 268 ౛(35%)࡟ㄆࡵࠊAKI(+)ࡣ 95 ౛౛࡟࠾ࡅࡿࡼࡾヲ⣽࡞᳨ウࡀྍ⬟࡜࡞ࡗࡓࠋᛴᛶᚰ

(13%)࡟⏕ࡌࡓࠋ㝔ෆṚஸ⋡ࡣ AKI(-)࡟࠾࠸࡚ࡣ

➽᱾ሰࡢᛴᛶᮇ࡟ࡣ primary PCI ࡟ࡼࡿ㐀ᙳ๣ࡢCKD(+)࡛᭷ព࡟㧗ࡃࠊAKI(+)࡛ࡶ CKD(+)࡛㧗࠸ࡳ࡞ࡽࡎࠊ㓟໬ࢫࢺࣞࢫࡸ⅖⑕࡞࡝ࡀᚰ⮚࣭⭈⮚ࡢഴྥ࡟࠶ࡗࡓ(ᅗ)ࠋከኚ㔞ゎᯒ࡛ࡣࠊAKI(-)࡟࠾࠸୧⪅ࡢ┦஫㐃㛵࡟㛵୚ࡍࡿࡀࠊࡇࡇ࡟ࡶᛴᛶᮇ㧗⾑࡚ CKD(+)ࡣ㝔ෆṚஸࡢ⊂❧ࡋࡓண ᅉᏊ࡛࠶ࡗࡓ

⢾ࡀᙉࡃᙳ㡪ࡍࡿྍ⬟ᛶࡀ࠶ࡿࠋ

(OR 3.1, 95%CI 1.01-10.2; p=0.047)ࠋ

௒ᅇᡃࠎࡣࠊࡇࢀࡽᛴᛶ㧗⾑⢾࡜៏ᛶ⭈⮚⑓ࡀᛴᛶᚰ➽᱾ሰࡢணᚋ࡟ཬࡰࡍᙳ㡪ࢆ⮫ᗋ㠃࠿ࡽ㞟Ꮫⓗ࡟᳨ドࡋࡓࠋ


31

3㸧 Ishihara M, Kojima S, Sakamoto T, Asada Y, Tei C,
Kimura K, Miyazaki S, Sonoda M, Tsuchihashi K,
Yamagishi M, Ikeda Y, Shirai M, Hiraoka H, Inoue
T, Saito F, Ogawa H, on behalf of the Japanese
Acute

Coronary

Syndrome

Study(JACSS)

Investigators. Acute hyperglycemia is associatedwith adverse outcome after acute myocardial
infarction in the coronary intervention era. Am
Heart J 2005; 150: 814-820.



4㸧 Ishihara M, Inoue I, Kawagoe T, Shimatani Y,ϫ㸬⪃ ᐹ

Kurisu S, Hata T, Nakama Y, Kijima Y, Kagawa E.

AMI ࡟ ࠾ ࠸ ࡚ ⭈ ᶵ ⬟ 㞀 ᐖ ࡣ cardio-renalIsadmission

hyperglycemia

innon-diabetic

interaction ࡟ࡼࡗ࡚┦஫࡟ணᚋࢆᝏ໬ࡉࡏࡿࡇ࡜

patients with acute myocardial infarction aࡀ▱ࡽࢀࠊ᭱㏆ὀ┠ࡉࢀ࡚࠸ࡿࠋᮏ◊✲࡛ࡣ៏ᛶⓗsurrogate for previously undiagnosed abnormal࡟Ꮡᅾࡍࡿ CKD ࡜ AMI ࡢᛴᛶᮇ࡟⏕ࡌࡿ AKI ࡀ

glucose tolerance? Eur Heart J 2006; 27:ࡑࢀࡒࢀ⊂❧ࡋ࡚ AMI ࡢ▷ᮇணᚋࡢᝏ໬࡜㛵ಀࡋ

2413-2419.

࡚࠸ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋࡇࢀࡽࡢࡇ࡜ࡣ AMI ࡢ᭦

5㸧 Ishihara M, Kojima S, Sakamoto T, Asada Y,࡞ࡿணᚋࡢᨵၿ࡟㔜せ࡞♧၀ࢆ୚࠼ࡿࡶࡢ࡜⪃࠼ࡽ

Kimura K, Kosuge M, Miyazaki S, Yamagishi M,

ࢀࡿࠋ

Tei C, Hiraoka H, Sonoda M, Tsuchihashi K,Ϭ㸬⤖ ㄽ

Shinoyama N, Honda T, Ogata Y, Ogawa H, on
behalf of the Japanese Acute Coronary Syndrome

AMI ࡟࠾࠸࡚ CKD ࡣ AKI ࡢⓎ⑕࡜ࡣ㛵ಀ࡞ࡃ

Study (JACSS) Investigators. Comparison of bloodணᚋࢆᝏ໬ࡉࡏࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ

glucose values on admission for acute myocardialϭ㸬◊✲༠ຊ⪅

infarction in patients with versus without diabetes
mellitus. Am J Cardiol 2009; 104: 769-774.
6㸧 Moriyama N., Ishihara M., Noguchi T., Sakamoto▼ཎṇ἞ රᗜ་⛉኱Ꮫ 

H., Nakanishi M., Kotani J., Arakawa T., Asaumiෆ⛉Ꮫㅮᗙෙ⑌ᝈ⛉࣭୺௵ᩍᤵ

Y., Kumasaka L., Adachi T., Yamane T., Miyagi T.,⸨㔝㞞ྐ ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮

Nagai T., Fujino M., Matsumoto M., Honda S.,ᚰ⮚⾑⟶ෆ⛉࣭་ᖌϮ㸬ཧ⪃ᩥ⊩Yagyu T., Fujiwara R., Fujino A., Anzai T.,

1㸧 Ishihara M, Inoue I, Kawagoe T, Shimatani Y,

hyperglycemia is an independent predictor of acute

Kurisu S, Nishioka K, Kouno Y, Umemura T,

kidney injury in patients with acute myocardial

Nakamura T, Yoshida M. Effect of acuteinfarction. Annual meeting of American College ofhyperglycemia on the ischemic preconditioning

Cardiology. San Francisco, U.S.A., 2013

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an anterior wall first acute myocardial infarction.

H., Nakanishi M., Arakawa T., Asaumi Y.,

Am J Cardiol 2003; 92: 288-291.

Kumasaka L., Kanaya T., Miyagi T, Nagai T.,

2㸧 Ishihara M, Inoue I, Kawagoe T, Shimatani Y,

Yamane T., Fujino M., Honda S., Fujiwara R.,

Kurisu S, Nishioka K, Kouno Y, Umemura T,

Anzai T., Kusano A., Goto Y., Yasuda S., Ogawa H.

Nakamura T, Yoshida M. Impact of acute

Early as compared to late development of acute

hyperglycemia on left ventricular function after

kidney injury is a strong predictor of in-hospitalreperfusion therapy in patients with a firstmortality in patients with acute myocardial

anterior wall acute myocardial infarction. Am

infarction. Annual meeting of American Heart

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Association, Dallas, U.S.A., 201332ᚰᡣ⣽ື࡜ᚰཎᛶሰᰦ⑕࡟ᑐࡍࡿ
⸆≀࣭㠀⸆≀⒪ἲࡢໟᣓⓗ἞⒪ᡓ␎ࡢ᳨ウᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉㒊㛗 ⲡ 㔝 ◊ ࿃Ϩ㸬⥴ ゝ

Kaplan-Meier ゎᯒ࡟࡚ࠊE/e’Ӎ15 ࡀ᭷ព࡟෌Ⓨ㧗㱋໬♫఍ࢆ㏄࠼࡚ࠊᚰᡣ⣽ື (AF)ࡸࠊࡑࢀ࡟

ࡢ᭷↓࡜㛵㐃ࡋ࡚࠸ࡓ㸦P<0.001㸧
ࠋከኚ㔞ゎᯒ࡛ࡣ E/e’ࡀ⊂❧ࡋࡓ AF ෌Ⓨࡢᣦᶆ࡜㉳ᅉࡍࡿᚰཎᛶሰᰦ⑕ࡢ㔜せᛶࡀቑࡋ࡚࠸ࡿࠋ
㏆ᖺࠊ

࡞ࡗࡓࠋ

ᚰᡣ⣽ື࡟ᑐࡍࡿ㠀⸆≀἞⒪ࡀ኱ࡁࡃ㐍Ṍࡋ࡚࠸ࡿࡀࠊ⫧኱ᆺᚰ➽⑕(HCM)࡛ࡣ෌Ⓨࡀከ࠸ࡇ࡜ࡀሗ࿌

Figure 1 AF ෌Ⓨ࡜ E/e’ࡢ Kaplan-Meier ゎᯒࠋE/e’Ӎ15 ࡀ AFࡉࢀ࡚࠸ࡿ㸦㸯㸧
ࠋࡋ࠿ࡋ෌Ⓨ࡟㛵㐃ࡍࡿᅉᏊࡣᮍࡔ

ࡢ෌Ⓨ࡟ᙉࡃ㛵㐃ࡋ࡚࠸ࡓࠋ

୙࡛᫂࠶ࡿࠋ

ϩ㸬ᑐ㇟࣭᪉ἲ
22 ேࡢ AF ࢆྜేࡋࡓ HCM ᝈ⪅ࢆᑐ㇟࡟㸦ዪᛶ
12 ேࠊᖹᆒᖺ௧ 65 ṓࠊ17 ேࡀᣢ⥆ᛶ AF㸧ࠊ࢝ࢸ࣮ࢸࣝ࢔ࣈ࣮ࣞࢩࣙࣥ࡜ྠ᫬࡟ࠊᕥᐊᣑᙇ⬟ࠊᕥᡣᚄ࡞࡝ࡢ࢚ࢥ࣮ᣦᶆࢆグ㘓ࡋࠊAF ෌Ⓨ࡜࢚ࢥ࣮ᣦ
ᶆࡢ㛵㐃ࢆ᳨ウࡋࡓࠋ
Table 1 ᝈ⪅⫼ᬒ
Table 2 AF ෌Ⓨ࡟㛵㐃ࡍࡿᅉᏊࡢከኚ㔞ゎᯒࠋϫ㸬⪃ ᐹ
HCM ࡟క࠺ AF ࡣࠊᚰཎᛶ⬻ሰᰦࡢ㧗ࣜࢫࢡ⩌࡜ࡋ࡚▱ࡽࢀ࡚࠸ࡿ୍᪉ࠊᡣᐊఏᑟࡀ᪑⾜࡛ࡋࡤࡋࡤ㢖ᢿࢆక࠸ࡸࡍࡃࠊ⮫ᗋⓗ࡟㠀ᖖ࡟ࡸࡗ࠿࠸࡞⑌
ᝈ࡛࠶ࡿࠋ㐣ཤ࡟ࡣࠊᕥᡣࡢ volume ࡸᣑᙇ⬟ࡀ AF
෌Ⓨࡢண ᅉᏊ࡛࠶ࡗࡓࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡀࠊ
௒ᅇࡢ◊✲㸦㸰㸧ࡢ⤖ᯝࠊᕥᡣᅽ࡜┦㛵ࡍࡿ E/e’࡜Ϫ㸬⤖ ᯝ
෌Ⓨ౛ (n=9)࡜෌Ⓨ࡞ࡋ(n=13)ࡢ㛫࡟ࠊᖺ㱋ࠊAF

AF ෌Ⓨࡢ㛫࡟ᴟࡵ࡚Ⰻዲ࡞㛵㐃ࡀ♧၀ࡉࢀࡓࠋ

ࡢ✀㢮ࠊAF ⨯ᝈᮇ㛫ࠊᕥᐊ཰⦰ᶵ⬟࡟᭷ពᕪࡣㄆ

HCM ࡟క࠺ AF ࡟ᑐࡍࡿ⫵㟼⬦㝸㞳⾡ࢆࡍࡿ㝿࡟ࡵࡽࢀ࡞࠿ࡗࡓࡀࠊᣑᙇ⬟ࡢᣦᶆ࡛࠶ࡿ e’࠶ࡿ࠸ࡣࡣࠊE/e’<15 ࡀࡦ࡜ࡘࡢ⪃៖ࡍ࡭ࡁᣦᶆ࡜࡞ࡿ࡜⪃E/e’࡜ࠊὶฟ㊰⊃✽ࡢ㢖ᗘ࡟᭷ពᕪࡀㄆࡵࡽࢀࡓࠋ

࠼ࡽࢀࡿࠋ

33

Ϭ㸬⤖ ㄽHCM ࡟క࠺ AF ࡢ἞⒪࡟ࡣࠊᕥᐊᣑᙇ⬟ࡢᣦᶆ
ࡢ࠺ࡕࠊE/e’ࡀ෌Ⓨண ᅉᏊ࡜ࡋ࡚᭱ࡶ᭷⏝࡛࠶ࡿࠋϭ㸬◊✲༠ຊ⪅┦ᗞṊྖ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་㛗㔝⏣ ᓫ࣭
ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་㛗ᒸᮧⱥኵ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་㛗ᐑᮏᗣ஧࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་ᖌ୰ᓥ⫱ኴ㑻࣭
ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་ᖌ▼ᶫ⪔ᖹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་ᖌ࿴⏣ ᬸ࣭
ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་ᖌᑠཱྀὈᑦ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ᚰ⮚⾑⟶ෆ⛉་ᖌϮ㸬ཧ⪃ᩥ⊩1)

Kilicaslan F, Verma A, Saad E, et al. Efficacy
of catheter ablation of atrial fibrillation inpatients

withhypertrophic

obstructive

Heart

Rhythm.

cardiomyopathy.
2006;3:275-280.
2)

Okamatsu H, Ohara T, Kanzaki H, et al.
Impactofleftventricular

diastolicdysfunction on outcome of catheter ablation
for atrial fibrillation in patients withhypertrophic

cardiomyopathy.

Circ

J.

2015;79:419-424

   34㉳❧㈇Ⲵ᫬ᚰᢿኚືゎᯒ࡟ࡼࡿ⮬ᚊ⚄⤒ᶵ⬟࡜ෙື⬦⑌ᝈࡢ┦㛵ゎᯒ ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ື⬦◳໬⢾ᒀ⑓ෆ⛉⋢㑣ぞ ẸᏊϨ㸬⥴ ゝϪ㸬⤖ ᯝ
 (%)㻌
⮩఩㻌࣭Ᏻ㟼᫬ࡢᚰᢿኚືࡣຍ㱋࡟ࡼࡗ࡚ῶᑡࡋࠊ⮬ᚊ⚄⤒㞀ᐖࡀ⏕ࡌࡿ࡜ࠊ⮬ᚊ⚄⤒ࡢࣂࣛࣥࢫࡣ஺ឤ⚄2⤒ඃ఩࡬೫఩ࡍࡿࠋ

R =0.009㻌

ᚰᢿኚືࢆ࿘Ἴᩘ࡟ศࡅࡿࢫ࣌ࢡࢺࣝศᯒ࡟࠾࠸
࡚ࠊ㧗࿘Ἴᇦ(HF;;HighFrequency,>0.15Hz)ࡣ 3 ⛊࠿ࡽ 4 ⛊⛬ᗘࡢ࿘ᮇࢆᣢࡘ࿧྾ࢆಙྕ※࡜ࡍࡿኚື
Ἴ࡛࠶ࡾ๪஺ឤ⚄⤒ࡢᙳ㡪ࢆཷࡅࡿࠋప࿘Ἴᇦ
(LF;LowFrequency,0.04㹼0.15Hz)ࡣࠊMeyer Ἴ࡟ࡼࡿ⣙ 10 ⛊࿘ᮇࡢ⾑ᅽኚືࢆಙྕ※࡜ࡍࡿἼື࡛(ṓ)㻌

࠶ࡾ஺ឤ⚄⤒࡜๪⚄⚄⤒άືࡢᙳ㡪ࢆཷࡅࡿ 1)ࠋ
࣭⮬ᚊ⚄⤒㞀ᐖࡣࠊQOL ࡢపୗࡸṚஸ⋡ቑຍࡢ

(%)㻌

ᗙ఩㻌

ཎᅉ࡜࡞ࡿࠋ⢾ᒀ⑓ᝈ⪅࡛㉳❧㈇Ⲵ᫬ࡢᚰᢿኚືゎ2ᯒ࡛ࡢ⮬ᚊ⚄⤒ᶵ⬟ࡢホ౯ࢆ⾜ࡗࡓࠋ

R =0.13㻌ϩ㸬ᑐ㇟࣭᪉ἲ
ᑐ㇟ࡣ⢾ᒀ⑓ᝈ⪅ 46 ே(⏨ᛶ 68㸣ࠊᖹᆒᖺ㱋 65.2

 ṓ)࡟࠾࠸࡚ 1)⨯⑓ᮇ㛫ࠊHbA1cࠊ⥙⭷⑕ࡢ᭷↓ࠊ
CreࠊLDL-CࠊHDL-CࠊTGࠊBNPࠊෙື⬦⑌ᝈࡢ᭷↓ࢆㄪᰝࠋ2)CVRRࠊHFࠊLF ࢆ㉳❧㈇Ⲵ๓ᚋ࡛
ᐃࡋࠊୖグㄪᰝ㡯┠࡜ࡢ㛵㐃ࢆ᳨ウࡋࡓࠋࡲࡓෙ(ṓ)㻌

      ❧  (%)㻌ື⬦⑌ᝈࡢ᪤ ࡢ᭷↓࡛ࡢ CVRRࠊHFࠊLF ࡜ࡢ㛵㐃࡟ࡘ࠸᳨࡚ウࡋࡓࠋ  ⾲㸯㸬ᝈ⪅⫼ᬒ

5 㻌ᅗ 1  ᖺ㱋࡜ CVRR

㸨ࢹ࣮ࢱࡣ౛ᩘ(%)ࡲࡓࡣᖹᆒ್sᶆ‽೫ᕪ(SD)㻌

35

(ṓ

(%)㻌

⮩఩㻌

(%)㻌

ᗙ఩㻌



5 㻌

5 㻌

ᖺ㻌
(%)㻌

(%)㻌

ᗙ఩㻌
(%)㻌



❧

5 㻌

5 㻌

ᖺ㻌
(%)㻌

❧

(%)㻌
ᅗ 3 HbA1c ࡜ CVRR

5 㻌

ࡲ࡜ࡵ(1)ձ

CVRR ࡣࠊ⮩఩࡛ࡣᖺ㱋ࠊ⨯⑓ᮇ㛫࡜┦㛵ࡀㄆࡵࡽࢀ࡞࠿ࡗࡓࡀࠊ❧఩࡛ࡣᖺ㱋(R2=0.21)ࠊ
⨯⑓ᮇ㛫(R2=0.25)࡜┦㛵ࡀㄆࡵࡽࢀࡓࠋᖺ㻌ղ

CVRR ࡣࠊHbAc1 ࡜┦㛵ࡀㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ

ᅗ 2 ⨯⑓ᮇ㛫࡜ CVRR
⾲ 2㸬ᝈ⪅⫼ᬒࠊෙື⬦⑌ᝈࡢ᪤ ࡢ᭷↓

(%)㻌

⮩఩㻌


5 㻌(%)㻌㸨ࢹ࣮ࢱࡣ౛ᩘ(%)ࡲࡓࡣᖹᆒ್sᶆ‽೫ᕪ(SD)㻌

36

ᗙ఩㻌

2

(ms )㻌

ᗙ఩㻌

LF㻌

&955㻌

(%)㻌

࡞ࡋ㻌
࠶ࡾ㻌
ෙື⬦⑌ᝈࡢ᪤ 㻌ෙ

2(ms )㻌 ❧఩㻌

LF㻌

CVRR㻌

(%)㻌

࡞ࡋ㻌
࠶ࡾ㻌
ෙື⬦⑌ᝈࡢ᪤ 㻌
ෙ
❧఩㻌

࡞ࡋ㻌
࠶ࡾ㻌
ෙື⬦⑌ᝈࡢ᪤ 㻌࡞ࡋ㻌࠶ࡾ㻌ෙື⬦⑌ᝈࡢ᪤ 㻌 ᅗ 4 ෙື⬦⑌ᝈࡢ᪤ ࡢ᭷↓࡜ CVRR
2

ᗙ఩㻌

HF㻌

(ms )㻌

ᅗ 6 ෙື⬦⑌ᝈࡢ᪤ ࡢ᭷↓࡜ LF

ᅗ 7 ෙື⬦⑌ᝈࡢ᪤ ࡢ᭷↓࡟࠾ࡅࡿ㉳❧㈇Ⲵ

࡞ࡋ㻌

࠶ࡾ㻌

࡟ࡼࡿ CVRR, HF, LF ࡢኚ໬ෙື⬦⑌ᝈࡢ᪤ 㻌ࡲ࡜ࡵ(2)
࣭ෙື⬦⑌ᝈࡢ᪤ ࠶ࡾ⩌(21 ౛)࡜࡞ࡋ⩌(25 ౛)࡛

2(ms )㻌 ❧఩㻌ձ ᪤ ࠶ࡾ⩌ࡣࠊ⨯⑓ᮇ㛫ࡀ㛗ࡃࠊ⢾ᒀ⑓ᛶ⥙⭷⑕ࡢྜే⑕ࡀ᭷ព࡟ከ࠿ࡗࡓࠋղ CVRR ࡣࠊᗙ఩(P=0.0054)ࠊ❧఩(P=0.0100)

HF㻌࡜ࡶ᭷ពᕪࢆㄆࡵࡓࠋ
ճ HF ࡣࠊᗙ఩(P=0.0343)ࠊ❧఩(P=0.0421)࡜ࡶ
᭷ពᕪࢆㄆࡵࡓࠋ࡞ࡋ㻌࠶ࡾ㻌ϫ㸬⪃ ᐹ

ෙື⬦⑌ᝈࡢ᪤ 㻌Ᏻ㟼᫬ࡢᚰᢿኚືࡣຍ㱋࡟ࡼࡗ࡚ῶᑡࡋࠊ⮬ᚊ⚄⤒㞀ᐖࡀ⏕ࡌࡿ࡜ࠊ⮬ᚊ⚄⤒ࡢࣂࣛࣥࢫࡣ஺ឤ⚄⤒ඃ

ᅗ 5 ෙື⬦⑌ᝈࡢ᪤ ࡢ᭷↓࡜ HF

఩࡬೫఩ࡍࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿࠋᮏ◊✲࡟࠾࠸࡚ࠊ
⢾ᒀ⑓ᝈ⪅࡛ࡶྠᵝ࡟ᖺ㱋࡜๪஺ឤ⚄⤒ࡢᣦᶆ࡜ࡋ࡚ࡢCVRRࡣᖺ㱋࡜㈇ࡢ┦㛵ࢆㄆࡵࡓࠋࡲࡓ⢾ᒀ⑓37ࡢ⨯⑓ᮇ㛫࡜ࡶ┦㛵ࡀㄆࡵࡽࢀࡓࠋ

human by heart rate spectal analysis. Am J

ᚰᢿኚືࡢLFᡂศ࠾ࡼࡧHFᡂศࡢ᣺ᖜࡣࠊຍ㱋࡟

Physiol 1985;248:H151-H153
2)ࡼࡗ࡚ῶᑡࡍࡿࠋ

Vybrial T, Bryg RJ, Maddens ME, et al.

㉳❧ࡍࡿ࡜㔜ຊ㈇Ⲵ࡟ࡼࡾࠊୗ⫥࠾ࡼࡧయᖿࡢᐜ✚Effect of passive tilt on sympathetic and㟼⬦࡬ࡢ⾑ᾮࡢ㈓␃ࡀ㉳ࡇࡾࠊ኱ື⬦ᘪ࠾ࡼࡧ㢕ື⬦parasympathetic components of heart rateᑠయࡢᅽཷᐜయࡣࠊ㏿ࡸ࠿࡟⾑ᅽࢆṇᖖ໬ࡉࡏࡿ⮬ᚊvariability in normal subjects. Am J Cardiol⚄⤒཯ᑕࢆಁ㐍ࡉࡏࠊ஺ឤ⚄⤒ࢆஹ㐍ࠊ๪஺ឤ⚄⤒ࢆ

1989;63:1173-1120
3)ᢚไࡍࡿࡇ࡜࡛ࠊᚰᢿᩘ࠾ࡼࡧ཰⦰ຊࢆቑ኱ࡉࡏࠊᐜ

Hayano J, Yamada A, Mukai S, et al.
Severity✚⾑⟶ࢆ཰⦰ࡉࡏࠊ⾑ᅽࢆ⥔ᣢࡍࡿࠋ

ofcoronary

atherosclerosis

correlates with the respiratory component of㉳❧࡟ࡼࡿ㔜ຊ᪉ྥࡢኚ໬ࡢᙳ㡪ࢆࡳࡿ᪉ἲ࡜ࡋ
࡚ࡣ Head-up tilt ヨ㦂ࡀ࠶ࡿࠋ㹆ead-up tilt ࡟ࡼࡗ

heart࡚ࠊᖹᆒ R-R 㛫㝸ࡣ▷⦰ࡋࠊHF ᡂศࡢ᣺ᖜࡣῶᑡ

1991;121:1070-1079
4)ࡍࡿࠋࡇࢀࡽኚ໬ࡣ㟼⬦㑏ὶࡢῶᑡ࡟ᑐࡍࡿᚰ⮚㏞ratevariability.

Am

Heart

J

஭ୖ ༤. ෙື⬦⑌ᝈ. In: ᪩㔝 ୍㑻㸦⦅㸧.

㉮⚄⤒άືࡢᢚไࢆ཯ᫎࡍࡿ 2)ࠋᮏ◊✲࡟࠾࠸࡚ࡣࠊ

ᚠ⎔ჾ⑌ᝈ࡜⮬ᚊ⚄⤒ᶵ⬟. ➨ 2 ∧. ᮾி: ་ᗙ఩࡟㍑࡭❧఩࡛ࡣࠊCVRR ࡢ▷⦰ࡀㄆࡵࡽࢀࡓࠋ
Ꮫ᭩㝔; 2010.p.149-151

ෙື⬦⑌ᝈ࡛ࡣࠊᚰ➽᱾ሰࡢ᪤ ࡀ࡞ࡃ࡚ࡶࠊ㧗⋡࡟ᚰ⮚㏞㉮⚄⤒ᶵ⬟㞀ᐖࢆㄆࡵ 3)ࠊཎᅉࡣႚ↮ࠊ⫧‶ࠊ⢾ᒀ⑓ࠊ㐠ື୙㊊ࠊࢫࢺࣞࢫ࡞࡝ࡢෙື⬦༴㝤ᅉᏊࡀሗ࿌ࡉࢀ࡚࠸ࡿ 4)ࠋෙື⬦⑌ᝈᝈ⪅࡟࠾࠸࡚ࠊHead-up tilt ࡛ࡢ㉳❧࡟ᑐࡍࡿ HF ࡢῶᑡࡸ LF ࡢቑຍࢆ♧ࡋࠊ஺ឤ⚄⤒ࡢ㐣⥭ᙇࡣෙື⬦⑌ᝈࡢணᚋ࡜ࡢ㛵㐃ࡢሗ࿌ࡀ࠶ࡿࠋ
ᮏ◊✲࡛ࡣࠊෙື⬦⑌ᝈᝈ⪅࡟࠾࠸࡚ HF ࡢῶᑡࢆㄆࡵࡓࡀࠊLF ࡶῶᑡࡋ࡚࠸ࡓࠋșࣈࣟࢵ࣮࢝ෆ
᭹ࡢ㛵㐃ࢆ᳨ウࡋࡓࡀࠊ᫂ࡽ࠿࡞ᙳ㡪ࡣㄆࡵࡽࢀ࡞
࠿ࡗࡓࠋ௒ᚋෙື⬦⑓ኚࡢᩘࡸ㒊఩࡞࡝࡜ࡢ㛵㐃࡟ࡘ࠸᳨࡚ウࡀᚲせ࡛࠶ࡿࠋϬ㸬⤖ ㄽ࣭ ⮬ᚊ⚄⤒ᶵ⬟ࡢホ౯࡛ࡣࠊ❧఩㈇Ⲵࡣ᭷⏝࡛࠶ࡿࠋ࣭ ⮬ᚊ⚄⤒ᶵ⬟㞀ᐖ࡜ෙື⬦⑌ᝈ࡟࠾࠸࡚┦㛵ࡀㄆࡵࡽࢀࡓࠋ

ϭ㸬◊✲༠ຊ⪅ᓊᮏ ୍㑻࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་㛗ᵐ㔝 ஂኈ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་㛗኱⏿ ὒᏊ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་ဨᶶ㇂ ┿⏤࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭་ဨ⫧ሯ ㄹ࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ࣞࢪࢹࣥࢺ
⳻⏣ ⸛࣭ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭ࣞࢪࢹࣥࢺ

Ϯ㸬ཧ⪃ᩥ⊩
1)

Pomeranz B, Macaulay RJB, Caudill MA, etal. Assessment of autonormic function in38୙ᩚ⬦⑌ᝈ࡛ࡢ࢝ࢸ࣮ࢸࣝ἞⒪࠾ࡼࡧࢹࣂ࢖ࢫ἞⒪ࡢ᭷⏝ᛶ࡜ྜే⑕࡟㛵ࡍࡿ◊✲ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࣭୙ᩚ⬦⛉ ་㛗 㔝 ⏣  ᓫϨ㸬⥴ ゝ୙ᩚ⬦἞⒪࡟ࡣᢠ୙ᩚ⬦࡞࡝࡟ࡼࡿ⸆≀἞⒪ࠊ࢝
ࢸ࣮ࢸࣝ࢔ࣈ࣮ࣞࢩࣙࣥ(RFCA)ࡸ᳜㎸ࡳᆺ㝖⣽ືჾ(ICD)࡞࡝ࡢ㠀⸆≀἞⒪ࡀ⏝࠸ࡽࢀࡿࡀ᭷ຠᛶࡸ
๪స⏝ࠊྜే⑕࠿ࡽỴᐃⓗ࡞᰿἞἞⒪࡜ࡣ࡞ࡾᚓ࡚
࠸࡞࠸ࠋᙜ஦ᴗࡢ┠ⓗࡣ⑓㝔ࢹ࣮ࢱ࣮࣋ࢫࢆ⏝࠸࡚ࠊ୙ᩚ⬦⑌ᝈ࡛ࡢ⸆๣ࡸRFCA࠾ࡼࡧICD࡞࡝ࡢ᳜㎸ࡳࢹࣂ࢖ࢫ࡛ࡢ᭷ຠᛶࡸ๪స⏝࠾ࡼࡧྜే⑕ࢆ᳨ウࡍࡿࡇ࡜࡛࠶ࡿࠋ
RFCA ࡣ 91㸣࡛ᡂຌࡋࠊ⤒㐣୰㸦⤒㐣ᮇ㛫୰ኸ
್ 9.2 ᖺ㸧࡟ 8 ౛࡟࡚෌Ⓨࢆㄆࡵࡓࡀࠊ෌࢔ࣈ࣮ࣞ

ϩ㸬ᑐ㇟࣭᪉ἲ
⾡ᚋඛኳᛶᚰ⑌ᝈᝈ⪅࡟࠾ࡅࡿRFCAࡢ᭷⏝ᛶࡢࢩࣙࣥ࡟ࡼࡾࠊ᭱⤊ⓗ࡟ 2 ౛ࡢࡳ AT ࡀṧᏑࡋࡓࠋ᳨ウࢆ⾜࠺ࡓࡵࠊ2000 ᖺ 1 ᭶㹼07 ᖺ 12 ᭶࡟ඛኳᛶ

ࡲࡓᡭᢏ୰࡟ࡣ୺せ࡞ྜే⑕ࢆㄆࡵࡎࠊᏳ඲࡟ᡭᢏ

ᚰ⑌ᝈ࡛⾡ᚋ࡟࣐ࢡ࢚ࣟࣜࣥࢺ࣮ࣜᛶᚰᡣ㢖ᢿ(AT)ࢆ⾜࠺ࡇ࡜ࡀྍ⬟࡛࠶ࡗࡓࠋ

ࢆ㉳ࡇࡋ㸪
RFCA ࢆ᪋⾜ࡋࡓ 32 ౛㸦ᖺ㱋 45s18 ṓ㸪⏨ᛶ 18 ౛㸪ዪᛶ 14 ౛㸧࡟ࡘ࠸࡚ᛴᛶᮇࡢᡂຌ⋡࠾ϫ㸬⪃ ᐹ

ࡼࡧྜే⑕࡞ࡽࡧ࡟៏ᛶᮇࡢ෌Ⓨ⋡࡟ࡘ࠸᳨࡚ウࢆ⾡ᚋඛኳᛶᚰ⑌ᝈᝈ⪅࡟࠾ࡅࡿAT ࡬ࡢRFCA ࡟ࡘ⾜ࡗࡓࠋ࠸࡚ࡣ▷ᮇ㛫ࡢᡂᯝ࡟ࡘ࠸࡚ࡢሗ࿌ࡣ࠶ࡗࡓࡀ 1)ࠊ
୰ኸ್9.2 ᖺ࡜࠸࠺㛗ᮇ࡟࠾࠸࡚ࡶ88㸣ࡢ⑕౛࡟࡚

Ϫ㸬⤖ ᯝ

Ὕㄪᚊࢆ⥔ᣢࡋ࡚࠾ࡾࠊ⾡ᚋඛኳᛶᚰ⑌ᝈᝈ⪅࡟࠾32 ⑕౛ࡢ 44 ࡢ࣐ࢡ࢚ࣟࣜࣥࢺ࣮ࣜᛶ AT ࢆᑐ㇟ࡅࡿ AT ࡬ࡢ RFCA ࡣᏳ඲࡛ࠊຠᯝⓗ࡛࠶ࡿ࡜⪃࠼

࡜ࡋࡓࠋ

ࡽࢀࡓࠋ

⾲㸯 ࣐ࢡ࢚ࣟࣜࣥࢺ࣮ࣜᛶ AT ࡢ✀㢮࡜ᡂຌ⋡

✀㢮

ᡂຌ⋡

Ϭ㸬⤖ ㄽ

ᚰᡣ⢒ື (n=20)

19/20 (95%)⾡ᚋඛኳᛶᚰ⑌ᝈᝈ⪅࡟࠾ࡅࡿ AT ࡬ࡢ RFCA ࡣࠊ⒕⑞㛵㐃 AT (n=20)

18/20 (90%)᭷⏝࡛࠶ࡾࠊᏳ඲࡟᪋⾜ྍ⬟࡛࠶ࡿࠋࢲࣈ࣮ࣝࣝࣉ AT (n=4)

4/4 (100%)ϭ㸬◊✲༠ຊ⪅ⲡ㔝◊࿃ ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮ᚰ⮚⾑⟶ෆ⛉㒊㛗㙊಴ྐ㑻 ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮⮫ᗋ᳨ᰝ㒊㒊㛛㛗Ϯ㸬ཧ⪃ᩥ⊩
1)

Nakagawa H et al. Circulation. 2001; 103:
699-70939