ࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉ
ࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉ

ࠉࠉࠉᖹᡂ࣭ᖺᗘࠉཌ⏕ປാ⛉Ꮫ◊✲㈝⿵ຓ㔠ࠉࠉࠉࠉࠉࠉ
ࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉ

ᚠ⎔ჾ⑌ᝈ࣭⢾ᒀ⑓➼⏕ά⩦័⑓ᑐ⟇⥲ྜ◊✲᥎㐍஦ᴗࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉࠉ
ࠉ◊ࠉ✲ࠉሗࠉ࿌ࠉ㞟‫ؙ‬බ┈㈈ᅋἲேࠉᚠ⎔ჾ⑓◊✲᣺⯆㈈ᅋ

┠    ḟᖹᡂ  ᖺᗘϨ እᅜே◊✲⪅ᣍ࡬࠸஦ᴗձ ⤒ᖺⓗྛ✀೺デࢹ࣮ࢱࢆά⏝ࡋࡓಖ೺ᣦᑟ஦ᴗࡢホ౯࡟㛵ࡍࡿ◊✲ᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊♫఍ண㜵་Ꮫᩍᐊ ᩍᤵ  Ỉᔱ ᫓᭾  ࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭
࣭ࣜ࢜ࢢࣛࣥࢸ࣭ࢻ࣭ࢫ࣮ࣝᕞ㐃㑥኱Ꮫ་Ꮫ㒊኱Ꮫ㝔 ᩍᤵ  ࢚࣑ࣜ࢜ ⚽ᖾ ᳃ཱྀ  ࣭࣭࣭ϩ ⱝᡭ◊✲⪅⫱ᡂά⏝஦ᴗ㸦ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺ㸧ձ ኱つᶍࢥ࣮࣍ࢺඹྠ◊✲࡟ࡼࡿ⏕ά⩦័⑓Ⓨ⑕ண㜵ࢹ࣮ࢱ࣮࣋ࢫᵓ⠏࡜ࡑࡢ㧗ᗘ་⒪࡟㛵ࡍࡿ◊✲  ᮾ໭኱Ꮫ኱Ꮫ㝔⸆Ꮫ◊✲⛉  ᘅ℩ ༟⏨  ࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭ղ ኱つᶍࢥ࣮࣍ࢺࢆ⏝࠸ࡓ⏕ά⩦័⑓ࡢ୍ḟண㜵ࡢࡓࡵࡢ㐠ື㔞⟇ᐃ࡟㛵ࡍࡿ㐠ື␿Ꮫ◊✲஑ᕞ኱Ꮫ೺ᗣ⛉Ꮫࢭࣥࢱ࣮  㔝⸨ ᝆ  ࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭ᖹᡂ  ᖺᗘϨ ⱝᡭ◊✲⪅⫱ᡂά⏝஦ᴗ㸦ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺ㸧ձ ᚠ⎔ჾ⑌ᝈ➼ࡢᩆ࿨⋡ྥୖ࡟㈨ࡍࡿຠᯝⓗ࡞ᩆᛴ⸽⏕ἲࡢᬑཬၨⓎ࡟㛵ࡍࡿ◊✲ ி㒔኱Ꮫ⎔ቃᏳ඲ಖ೺ᶵᵓ೺ᗣ⛉Ꮫࢭࣥࢱ࣮  ໭ᮧ ဴஂ  ࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭࣭

㻝ᖹᡂ㸰㸰ᖺᗘศϨ እᅜே◊✲⪅ᣍ࡬࠸஦ᴗ㻞            ◊✲ᐇ⦼ሗ࿌᭩
㸯㸬ᣍ࡬࠸ࡉࢀࡓእᅜே◊✲⪅ᅜ   ྡ 㸸ࣈࣛࢪࣝ
ᡤᒓ࣭⫋ྡ 㸸࣭ࣜ࢜ࢢࣛࣥࢹ࣭ࢻ࣭ࢫ࣮ࣝᕞ㐃㑥኱Ꮫ་Ꮫ㒊኱Ꮫ㝔 ᩍᤵẶ   ྡ 㸸࢚࣑ࣜ࢜ ⚽ᖾ ᳃ཱྀ㸰㸬◊✲௦⾲⪅ᡤᒓ࣭⫋ྡ 㸸ᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊♫఍ண㜵་Ꮫᩍᐊ ᩍᤵẶ   ྡ 㸸Ỉᔱ ᫓᭾ཷධ◊✲⪅
ᡤᒓ࣭⫋ྡ 㸸ᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊♫఍ண㜵་Ꮫᩍᐊ ᩍᤵẶ   ྡ 㸸Ỉᔱ ᫓᭾㸱㸬ᣍ࡬࠸ᮇ㛫ᖹᡂᖺ᭶᪥ 㹼 ᖹᡂᖺ᭶᪥ 㸦᪥㛫㸧㸲㸬◊✲௦⾲⪅ࡢ◊✲ㄢ㢟ྛ✀೺デࢹ࣮ࢱ࡜ࣞࢭࣉࢺࢹ࣮ࢱ➼࡟ࡼࡿಖ೺஦ᴗࡢホ౯࡟㛵ࡍࡿ◊✲㸳㸬ᣍ࡬࠸◊✲⪅࡜ࡢඹྠ◊✲ࢸ࣮࣐⤒ᖺⓗྛ✀೺デࢹ࣮ࢱࢆά⏝ࡋࡓಖ೺ᣦᑟ஦ᴗࡢホ౯࡟㛵ࡍࡿ◊✲㸴㸬◊✲άືࡢᴫせ⁫ᅾᮇ㛫୰ࠊᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊♫఍ண㜵་Ꮫᩍᐊ࡟࠾࠸࡚ࠊᣍᚅഃ◊✲⪅㸦Ỉᔱᩍᤵࠊ⸨ᕝ
ຓᩍࠊ኱Ꮫ㝔⏕㸧ࢆ஺࠼࡚ࠊࣈࣛࢪࣝ᪥⣔Ọఫ⪅ᕠᅇ೺デࢹ࣮ࢱ࣮࣋ࢫࡢᵓ⠏ࠊࣈࣛࢪࣝ᪥⣔Ọఫ⪅ᕠᅇ೺デࢹ࣮ࢱ㸦ᖺ㸧ࡢศᯒ᳨ウࠊ೺ᣦᑟຠᯝࠊ௒ᚋࡢゎᯒ᪉ἲࡢ᳨ウࢆ⾜ࡗࡓࠋ ᭶  ᪥ࡣඛ➃་⛉Ꮫ◊✲ࢭࣥࢱ࣮୺ദ⮫ᗋ◊✲ࢥࣥ࣌ࢸ࢕ࢩࣙࣥ࡟ཧຍࡋࠊᑂᰝဨ࡜ࡋ࡚ྛ
Ⓨ⾲࡟ᑐࡍࡿㅮホࠊ㆟ㄽࢆ⾜ࡗࡓࠋ᭶᪥ࡣࠊᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔⮫ᗋㅮᇽ࡟࠾࠸࡚ࠊᶓ὾ᕷ❧኱Ꮫᾏእࣇ࢕࣮ࣝࢻ࣡
࣮ࢡᨭ᥼ࣉࣟࢢ࣒ࣛࠊࣈࣛࢪࣝ᪥⣔Ọఫ⪅ᕠᅇデ⒪೺デᐇ⩦㸦ᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊་Ꮫ⛉♫఍ண㜵་Ꮫᩍᐊࠊ┳ㆤᏛ⛉ᆅᇦ┳ㆤ㡿ᇦྜྠࣉࣟࢢ࣒ࣛ㸧ࡢሗ࿌఍㸦ཧຍ⪅ྡ㸧࡟ཧຍࡋࠊࣈࣛࢪ
ࣝ᪥⣔Ọఫ⪅ࡢ೺ᗣ࡟㛵ࡍࡿㅮ₇ࢆ⾜࠸ࠊ᪥⣔Ọఫ⪅ࡢ೺デ⤖ᯝ࡟ࡘ࠸࡚ཧຍ⪅࡜࡜ࡶ࡟᳨ウࡋࡓࠋ᭶᪥࡟ࡣᶓ὾ᕷ❧኱Ꮫ་Ꮫ㒊་Ꮫ⛉ᖺ⏕㸦ྡ㸧࡟ᑐࡋࠊࣈࣛࢪࣝ᪥⣔Ọఫ⪅ࡢ೺ᗣ࡟㛵ࡍࡿ≉ูㅮ⩏ࢆ⾜ࡗࡓࠋ᭶᪥ࠊ᪥ࡣࣈࣛࢪࣝ᪥⣔Ọఫ⪅ᕠᅇ೺デࢹ࣮ࢱ㸦ࠊᖺ㸧ࡢศᯒ᳨ウࠊಖ೺ᣦᑟ
ຠᯝࡢ᳨ウࢆ⾜ࡗࡓࠋ㻟㸵㸬ඹྠ◊✲ㄢ㢟ࡢᡂᯝࣈࣛࢪࣝ᪥⣔Ọఫ⪅ࡢ೺デ⤖ᯝࡢ᳨ウࢆ㞟୰ⓗ࡟ᐇ᪋ࡋࡓࠋ
ᖺࣈࣛࢪࣝ༡㒊ࡢࢧࣥࢱ࢝ࢱ࣮ࣜࢼᕞ㸦6&㸧࣭ࣜ࢜ࢢࣛࣥࢹࢻࢫࣝᕞ㸦56㸧࡛᳃ཱྀ࢚࣑ࣜ࢜
⚽ᖾᩍᤵࡢᐇ᪋ࡍࡿᕠᅇデ⒪࣭೺デ࡟ཧຍࡋࡓ᪥⣔Ọఫ⪅ࡢ࠺ࡕࠊ࢔ࣥࢣ࣮ࢺㄪᰝ࡟ྠពࢆᚓࡓ
ྡࢆᑐ㇟࡜ࡋࡓ೺デ⤖ᯝࡢ᳨ウࢆ⾜ࡗࡓࠋᖺ࡟ᐇ᪋ࡋࡓྠᵝࡢ೺デ⤖ᯝ࡜ࡢಶே࣮࣋ࢫࡢ
ࢹ࣮ࢱ✺ྜࠊ᳨ウࢆ⥅⥆ⓗ࡟㐍ࡵ࡚࠸ࡿࠋ
㸦㸯㸧᪉ἲ
ㄪᰝᮇ㛫㸸ᖹᡂᖺ᭶᪥࠿ࡽ᭶᪥
ㄪᰝ㡯┠㸸௨ୗࡢ࡜࠾ࡾࠋ
ᇶᮏᒓᛶ㸸ᛶูࠊᖺ㱋ࠊฟ㌟ࡢ㒔㐨ᗓ┴ࠊ⛣ఫᖺࠊࣈࣛࢪ࡛ࣝࡢᩍ⫱ࠊᑵᴗ≧ἣࠊྠᒃ⪅ࡢ᭷↓᪤ Ṕ➼㸸೺ᗣデᰝཷデ≧ἣࠊ࠿࠿ࡾࡘࡅ་ࠊ᪤ Ṕࠊ೺ᗣ┦ㄯࡢ┦ᡭࠊ୺ほⓗ೺ᗣ≧ែ⏕ά⩦័㸸㐠ື࣭㌟యάືࠊఇ㣴࣭╧╀ࠊႚ↮ࠊ࢔ࣝࢥ࣮ࣝࠊᰤ㣴   ㌟య ᐃ㸸㌟㛗ࠊయ㔜ࠊ⭡ᅖࠊ⾑ᅽ㸦㸰ᅇ ᐃࡋᖹᆒ್ࢆ᥇⏝㸧⾑ᾮ᳨ᰝ⤖ᯝ㸸⾑⢾ࠊ⬡㉁ࠊࢡࣞ࢔ࢳࢽࣥࠊ
ᒀ᳨ᰝ㸸ࡓࢇࡥࡃࠊ₯⾑࡞࡝ᑐ㇟⪅ࡢෆヂ ṓ௨ୖࡢ༨ࡵࡿ๭ྜࡣ⏨ᛶ࡛ࠊዪᛶ࡛࡛࠶ࡗࡓࠋ
೺デࢆཷデࡋࡓேࡢ࠺ࡕ⏨ᛶࡢ㸣ࠊዪᛶࡢ㸣ࡀ᪥⣔୍ୡ࡛༨ࡵࡽࢀ࡚࠾ࡾࠊᖺ㹼ᖺ
ࡢᖺ㛫࡟ᑐ㇟⪅ࡢ㸣࡟࠶ࡓࡿேࡀ⛣ఫࡋ࡚࠸ࡓࠋᑵ⫋⪅࡛ࡣ㎰ᯘ⁺ᴗࡢ๭ྜࡀ኱ࡁ࠿ࡗࡓ
ࡀࠊ⏨ᛶࡢࠊዪᛶࡢࡀ↓⫋࡛࠶ࡗࡓࠋ
㸦㸰㸧⤖ᯝ
㸯㸧⫧‶⫧‶㸦%0,௨ୖ㸧ࡢ๭ྜࡣࠊ⏨ᛶ࡛ࡣ඲య㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦඲య㸣㸧ࡼࡾࡶ࠸ࡎ
ࢀࡢୡ௦࡟࠾࠸࡚㧗࠿ࡗࡓࠋዪᛶ࡛ࡣ඲య㸣࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦඲య㸣㸧ࡼࡾࡸࡸ㧗࠿ࡗࡓࠋ

㻠



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㸰㸧⭡ᅖ
᪥ᮏࡢ≉ᐃ೺デ≉ᐃಖ೺ᣦᑟ࡛᥇⏝ࡉࢀ࡚࠸ࡿ⭡ᅖᇶ‽㸦⏨ᛶFPࠊዪᛶFP㸧௨ୖࡢ๭ྜࡀࠊ
⏨ᛶ㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧ࠊዪᛶ㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡼࡾ࠸ࡎࢀࡢᖺ௦࡟࠾࠸࡚ࡶ㧗࠿ࡗࡓࠋ㻡㸱㸧㧗⾑ᅽ
཰⦰ᮇ⾑ᅽPP+J௨ୖ࠶ࡿ࠸ࡣᣑᙇᮇ⾑ᅽPP+J௨ୖࢆ♧ࡋࡓ࠿ࠊ㝆ᅽ๣᭹⏝⪅ࢆྵࡵࡓ㧗⾑ᅽࡢ᭷ᡤぢ⪅ࡢ๭ྜࡣࠊ⏨ᛶ㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧ࠊዪᛶ㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡼࡾࠊ඲య࡛㧗ࡃࠊ࠸ࡎࢀࡢᖺ௦࡟࠾࠸࡚ࡶ㧗࠸ഴྥ࡟࠶ࡗࡓࠋ

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

㻢

㸲㸧⢾ᒀ⑓
✵⭡᫬⾑⢾್ࡀPJGO௨ୖࢆ♧ࡋࡓ⪅ࡢ๭ྜࡣࠊ⏨ᛶࠊዪᛶ࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢ+E$F ௨ୖࡢሗ࿌್㸦⏨ᛶࠊዪᛶ㸧࡜ẚ࡭ࠊ࠶ࡲࡾኚࢃࡽ࡞࠿ࡗࡓࠋ
ࡋ࠿ࡋࠊ࢖ࣥࢫࣜࣥὀᑕࡲࡓࡣ⾑⢾㝆ୗ⸆ࡢ᭹⸆⪅ࡢ๭ྜࡣࠊ⏨ᛶࠊዪᛶ࡛ࠊᖹᡂ
ᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢ+E$F ௨ୖࡢሗ࿌್㸦⏨ᛶࠊዪᛶ㸧࡜ẚ࡭㧗࠿ࡗࡓࠋ
㸳㸧⬡㉁␗ᖖ
✵⭡᫬୰ᛶ⬡⫫ࡀࠊPJGO௨ୖࢆ♧ࡋࡓ⪅ࡢ๭ྜࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛ࠊᖹᡂᖺᗘ
ᅜẸ೺ᗣᰤ㣴ㄪᰝሗ࿌್㸦⏨ᛶࠊዪᛶ㸧࡜ẚ㍑ࡋ࡚ྠ⛬ᗘ࡛࠶ࡗࡓࠋࡲࡓ+'/ࢥࣞࢫࢸ್࣮ࣟࣝࡀPJGOᮍ‶ࢆ♧ࡋࡓ⪅ࡢ๭ྜࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝሗ࿌್㸦⏨ᛶࠊዪᛶ㸧࡜ẚ㍑ࡋ࡚㧗࠸ഴྥ࡟࠶ࡗࡓࠋ
㸴㸧࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ
࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ㸸⭡ᅖࡀ⏨ᛶFPࠊዪᛶFP௨ୖ࡛ࠊࡘࡢ㡯┠㸦⾑୰⬡㉁ࠊ⾑ᅽࠊ⾑⢾㸧ࡢ࠺ࡕࡘ௨ୖࡢ㡯┠࡟ヱᙜࡍࡿ⪅ࠋ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟணഛ⩌㸸⭡ᅖࡀ⏨ᛶFPࠊዪᛶFP௨ୖ࡛ࠊࡘࡢ㡯┠㸦⾑୰⬡㉁ࠊ⾑ᅽࠊ⾑⢾㸧ࡢ࠺ࡕࡘ௨ୖࡢ㡯┠࡟ヱᙜࡍࡿ⪅ࠋ࡜ࡋࡓ࡜ࡁࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟヱᙜ⪅ࡣࠊ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣ࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ
࣮࣒ࣟணഛ⩌ヱᙜ⪅ࡣࠊ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛ࠊࡑࢀࡒࢀᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦⏨ᛶ㸣ࠊ㸣ࠊዪᛶ㸣ࠊ㸣㸧ࡼࡾࡶ๭ྜࡀ㧗࠿ࡗࡓࠋ

㸵㸧⊃ᚰ⑕࣭ᚰ➽᱾ሰ᪤ Ṕᚰ⮚⑓㸦⊃ᚰ⑕࣭ᚰ➽᱾ሰ㸧ࡢ᪤ ࡀ࠶ࡿ࡜ᅇ⟅ࡋࡓࡶࡢࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣ࣭ᰤ㣴ㄪᰝሗ࿌㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡼࡾከ࠿ࡗࡓࠋ㻣㸶㸧ႚ↮
ႚ↮⪅ࡢ๭ྜࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛࠶ࡗࡓࠋ㐣ཤ࡟྾ࡗ࡚࠸ࡓࡀ⌧ᅾࡣ⚗↮ࡋ࡚࠸ࡿே
ࡢ๭ྜࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛࠶ࡗࡓࠋᖹᡂᖺᗘᅜẸ೺ᗣ࣭ᰤ㣴ㄪᰝሗ࿌࡛ࡣࠊႚ↮⪅ࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣ࠊ㐣ཤ࡟྾ࡗ࡚࠸ࡓࡀ⌧ᅾࡣ⚗↮ࡋ࡚࠸ࡿேࡢ๭ྜࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛࠶ࡗࡓࠋᕠᅇデ⒪೺デཷデ⪅ࡢႚ↮⋡ࡣపࡃࠊ⚗↮ᣦᑟࡢᚭᗏࡢຠᯝࡀࡳࡽࢀࡓࠋ

㸷㸧㐠ື⩦័
ᅇศ௨ୖࡢờࢆ࠿ࡃ㐠ືࢆ㐌ᅇ௨ୖࠊᖺ௨ୖᐇ᪋ࡋ࡚࠸ࡿ㐠ື⩦័ࢆ᭷ࡍࡿ⪅ࡢ๭ྜࡣࠊ⏨ᛶ࡛㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧ࠊዪᛶ㸣㸦௦㸣ࠊ௦㸣ࠊ௦㸣ࠊ௦௨ୖ㸣㸧࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡼࡾࠊ඲య࡛㧗ࡃࠊ࠸ࡎࢀࡢᖺ௦࡟࠾࠸࡚ࡶ㧗࠸ഴྥ࡟࠶ࡗࡓࠋ
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㸯㸮㸧㣗஦
ϸ㸬⫗㢮ࡸࡑࡢຍᕤရࡢᦤྲྀ㢖ᗘ࡯ࡰẖ᪥㣗࡭ࡿ࡜⟅࠼ࡓࡶࡢࡢ๭ྜࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛࠶ࡗࡓࠋ

Ϲ㸬㨶௓㢮ࡸࡑࡢຍᕤရࡢᦤྲྀ㢖ᗘ࡯ࡰẖ᪥㣗࡭ࡿ࡜⟅࠼ࡓࡶࡢࡢ๭ྜࡣ⏨ᛶ࡛㸣ࠊዪᛶ࡛㸣࡛࠶ࡗࡓࠋᖺ㱋ࡀ࠶ࡀࡿ࡟ࡘ
ࢀ࡚㨶௓㢮ࢆᦤྲྀࡍࡿ㢖ᗘࡀ㧗ࡃ࡞ࡿഴྥ࡟࠶ࡗࡓࠋ

㻥㸯㸯㸧㣧㓇࡯ࡰẖ᪥㣧㓇ࡍࡿ࡜ᅇ⟅ࡋࡓ๭ྜࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛ࠊᖹᡂᖺᗘᅜẸ೺ᗣᰤ㣴ㄪᰝࡢሗ࿌್㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡼࡾᑡ࡞࠿ࡗࡓࠋ
㸯㸰㸧ಖ೺ᣦᑟࡢᶵ఍ࢆ฼⏝ࡍࡿពᛮ
⏕ά⩦័ᨵၿࡢࡓࡵࡢಖ೺ᣦᑟࡢᶵ఍ࢆ฼⏝ࡋࡓ࠸࡜ᅇ⟅ࡋࡓ๭ྜࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛࠶ࡗࡓࠋᡃࡀᅜࡢ≉ᐃ೺デࡢᶆ‽ⓗ࡞ၥデ࡟᥇⏝ࡉࢀ࡚࠸ࡿ㡯┠࡛࠶ࡿࡀࠊࡲࡔ᪥ᮏࡢ௦⾲㞟ᅋ࡟࠾ࡅࡿሗ࿌ࡀ࡞࠸ࡢ࡛ࠊẚ㍑࡛ࡁ࡞࠸ࡀࠊ㧗࠸ഴྥ࡟࠶ࡿࡢ࡛ࡣ࡞࠸࠿࡜ᛮࢃࢀࡿࠋ┦ㄯ࡛
ࡁࡿ་⒪㛵ಀ⪅ࡀ࠸ࡿ࡜⟅࠼ࡓேࡢ๭ྜࡣ⏨ዪྜィ࡛㸣࡛࠶ࡗࡓࠋ
㸦㸱㸧⪃ᐹ
᪥⣔Ọఫ⪅࡟࠾࠸࡚ࡣࠊ⫧‶⪅ %0,NJP㸰௨ୖ 㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࠊ⭡ᅖᇶ‽㸦⏨ᛶFPࠊዪᛶFP㸧ࢆ㉸࠼ࡿ⪅㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡀከࡃࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟヱᙜ⪅࠾ࡼࡧணഛ⩌ࡀ㠀ᖖ࡟ከ࠸㸦⏨ᛶࠊዪᛶ㸧ࡇ࡜ࡀ≉ᚩ࡛࠶ࡗࡓࠋࡲࡓ㧗⾑ᅽ⪅㸦௨ୖ㸧ࡢ㢖ᗘࡀከ࠸㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡇ࡜ࡶ┠❧ࡗࡓࠋ⫧‶࡟㉳ᅉࡋࡓ」ᩘࡢࣜ
ࢫࢡࡢ㞟✚ࡢ⤖ᯝࠊᚰ⮚⑓㸦⊃ᚰ⑕࣭ᚰ➽᱾ሰ㸧ࡢ᪤ ࡀ࠶ࡿ࡜ᅇ⟅ࡋࡓࡶࡢ๭ྜ㸦⏨ᛶ㸣ࠊዪᛶ㸣㸧ࡶ㧗ࡃ࡞ࡗ࡚࠸ࡿࡇ࡜ࡀ࠺࠿ࡀ࠼ࡿࠋ
⫗㣗ࡢ㢖ᗘࡀ㧗ࡃ㸦๭ࡢேࡀ㐌ᅇ㸦࠺ࡕ๭ࡢேࡀ࡯ࡰẖ᪥㸧ᦤྲྀ㸧ࠊᙉ࠸ሷ࿡ࡢㄪ⌮᪉ἲ࡛࠶ࡿࢩࣗࣛࢫࢥ㸦ࣈࣛࢪࣝࡢ⫗ᩱ⌮ࠊ㸯ᅇ࡟㹥⛬ᗘᦤྲྀࡍࡿ㸧࡟ࡼࡿ⫗ࡢᦤྲྀ࡟ࡼࡾࠊ㧗࣮࢝ࣟࣜࠊ㧗㣗ሷᦤྲྀࡢഴྥ࡟࠶ࡿࡇ࡜ࡀ࠺࠿ࡀ࠼ࡓࠋ∵⫗ࡀNJ෇⛬ᗘ࡜ẚ㍑ⓗᏳࡃࠊ㨶௓㢮ࡣᒣ㛫㒊ࡢධ᳜ᆅ࡛ࡣ࡜࡚ࡶ㧗౯࡛࠶ࡾࠊ࠶ࡲࡾ㣗࡭ࡿᶵ఍࡟ࡵࡄࡲࢀ࡞࠸࡜࠸࠺஦᝟ࡀ⫼ᬒ࡟࠶ࡿࠋ⏕ά⩦័࡛ࡣࠊ᪥⣔Ọఫ⪅࡟࠾࠸࡚ࠊႚ↮ႚ↮⋡ ⏨ᛶ ዪᛶ ࡀపࡃࠊ㣧㓇⩦័ࡣᑡ࡞࠸㸦࡯࡜ࢇ࡝㓇ࢆ㣧ࡲ࡞࠸⏨ᛶࠊዪᛶ㸣 ࡇ࡜ࡀ≉ᚩⓗ࡛࠶ࡾࠊ⏕ά⩦័ᨵၿࡢࡓ
ࡵࡢಖ೺ᣦᑟࡢᶵ఍ࢆ฼⏝ࡋࡓ࠸࡜ᅇ⟅ࡋࡓ๭ྜࡣࠊ⏨ᛶ㸣ࠊዪᛶ㸣࡛࠶ࡗࡓࠋ
㸦㸲㸧ࡲ࡜ࡵ
᪥⣔Ọఫ⪅࡟࠾࠸࡚ࡣࠊ⫧‶ࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟヱᙜ⪅ࡢ๭ྜࡀ㧗ࡃࠊ⊃ᚰ⑕࣭ᚰ➽᱾ሰ㸧ࡢ᪤ Ṕࢆ᭷ࡍࡿࡶࡢࡀከࡃࠊ⫗㣗ࢆ୰ᚰ࡜ࡋࡓ㣗⏕ά࡟㉳ᅉࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋႚ
↮⋡ࡸ㣧㓇⩦័ࡢ࠶ࡿࡶࡢ๭ྜࡀపࡃࠊ⏕ά⩦័ࡢᨵၿࡢࡓࡵࡢಖ೺ᣦᑟࢆ฼⏝ࡋࡓ࠸࡜ࡍࡿ⪅ࡢ๭ྜࡀ㧗࠿ࡗࡓࠋẖᖺࠊྠࡌ་ᖌ㸦࢚࣑ࣜ࢜⚽ᖾ᳃ཱྀᩍᤵ㸧࡟ࡼࡿ᪥ᮏㄒ࡜࣏ࣝࢺ࢞ࣝㄒ࡛ࡢࠊ
ᕠᅇデ⒪೺デ࡟⤒ᖺⓗ࡟ཷデࡋࠊಖ೺ᣦᑟࢆཷࡅࡿࡇ࡜࡟ࡼࡿຠᯝࡀ኱ࡁ࠸ࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ
ࡉࡽ࡟」ᩘᖺ࡟ࢃࡓࡗ࡚ࡢࢹ࣮ࢱ࣮࣋ࢫࢆᵓ⠏ࡋ࡚ࠊಖ೺ᣦᑟࡢຠᯝࡢホ౯ࢆඹྠ◊✲࡜ࡋ࡚㐍ࡵ࡚࠸ࡃணᐃ࡛࠶ࡿࠋ
እᅜே◊✲⪅ࢆᣍ࡬࠸ࡋࡓࡇ࡜࡟ࡼࡗ࡚ᚓࡽࢀࡓຠᯝ㸦ᡂᯝ㸧ࡣࠊྠࡌ㑇ఏయ㉁ࢆ᭷ࡍࡿ᪥⣔Ọఫ⪅ࡢ⏕ά⩦័⑓೺デࡢࢹ࣮ࢱࢆヲ⣽࡟᳨ウࡍࡿࡇ࡜࡟ࡼࡗ࡚ࠊ⫧‶㛵㐃ࣜࢫࢡࢆ」ᩘ᭷ࡍࡿ㞟ᅋࡢ≉ᚩࡸಖ೺ᣦᑟࡢຠᯝࡢྍ⬟ᛶࢆ᫂ࡽ࠿࡟ࡋࡓࡇ࡜࡛࠶ࡿࠋ
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㸶㸬ᡂᯝࡢホ౯⤒ᖺⓗ೺デ⤖ᯝࡢࢹ࣮ࢱ࣮࣋ࢫ໬࡟ࡼࡗ࡚ࠊ⏕ά⩦័࡟㛵ࡍࡿಖ೺ᣦᑟࢆཷࡅࡿពᛮࠊྠࡌ་⒪⪅࠿ࡽ೺デ࠾ࡼࡧಖ೺ᣦᑟࢆཷࡅࡿࡇ࡜࡟ࡼࡿ⏕ά⩦័ኚᐜࡢຠᯝࠊ㞟ᅋ඲య࡜ࡋ࡚ࡢ⏕ά⩦័ࡢࡼ࠸᪉ྥ࡬ࡢࢩࣇࢺ㸦࣏ࣆ࣮ࣗࣞࢩࣙࣥࢫࢺࣛࢸࢪ࣮㸧ࡢྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋྛ✀೺デࢹ࣮ࢱ࡜ࣞࢭࣉࢺࢹ࣮ࢱ➼࡟ࡼࡿಖ೺஦ᴗࡢホ౯࡟㛵ࡍࡿ◊✲࡟࠾ࡅࡿゎᯒࣔࢹࣝᵓ⠏࡟኱ࡁ࡞ព
⩏ࡀ࠶ࡗࡓࠋලయⓗ࡟ࡣࠊ⫧‶㛵㐃ࣜࢫࢡࢆ᭷ࡍࡿ⫼ᬒせᅉࡢᢕᥱࠊᨵၿྍ⬟ᛶࡢ☜ㄆࠊ⥅⥆ⓗ࡞௓ධ࢔ࣉ࣮ࣟࢳࠊࡑࡋ࡚㛵㐃ࡍࡿ㔜⑕໬࣭ྜే⑕ࡢ㍍ῶࡢホ౯ࢆ㍈࡜ࡋࡓಖ೺஦ᴗࡢホ౯ࡢࡓࡵࡢゎᯒࣔࢹࣝᵓ⠏ࢆ㐍ࡵࡿࡇ࡜ࡀ࡛ࡁࡿࠋ
◊✲௦⾲⪅ Ỉᔱ ᫓᭾ 
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Research Report
Program for the Invitation of Foreign Researchers to Japanese Institutes

Researcher
Institution

:Graduate Course in Cardiology, School of Medicine, Federal

University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Name : Emilio Hideyuki Moriguchi
Professor

Invitation period: October 4-15, 2010

Subject/Purpose of Research Visit
To contribute to Prof Mizushima’s Research Project on evaluation of health service programusing annual physical assessment screening data and medical receipt, especially including
non-pharmacological intervention for lifestyle modification against prevention and control of
Metabolic Syndrome.
Research Activities in Japan
Analysis of annual physical assessment screening data from 243 Japanese migrant population
in south Brazil, Santa Catalina State and Rio Grand do Sul State.
Discussion on possible framework for assessment of effective lifestyle modificationintervention program paying attention to individuals motivation and attitude for healthy life.
Lecture on prevention and control of cardiovascular diseases in Japanese migrant populationin Brazil.
Result of the Research Visit
Japanese migrant population showed higher prevalence of obesity, especially central obesity,
hypertension and metabolic syndrome by Japanese criteria compared to representative
Japanese population. Their dietary pattern is characterized by high consumption of meat andlow consumption of fish, which leads to high calorie and high salt intake. Prevalence ofsmokers and daily drinker are relatively low compared to representative Japanese population.
Consecutive participation to annual physical assessment screening might encourage
participants towards positive attitude for healthy lifestyle.

Building up database ofconsecutive data from several years to decade is important to evaluate effectiveness ofintervention for prevention and control of non-communicable diseases.

㻝㻞ᖹᡂ㸰㸰ᖺᗘศϩ ⱝᡭ◊✲⪅⫱ᡂά⏝஦ᴗ㸦ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺ㸧㻝㻟◊✲ᐇ⦼ሗ࿌᭩

㸯㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺẶྡᘅ℩ ༟⏨
㸰㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺᮇ㛫ᖹᡂ㸰㸰ᖺ㸲᭶㸯᪥ 㹼 ᖹᡂ㸰㸰ᖺ㸷᭶㸱㸮᪥㸱㸬ཷධᶵ㛵
ྡ⛠㸸ᮾ໭኱Ꮫ኱Ꮫ㝔⸆Ꮫ◊✲⛉ᡤ ᅾ ᆅ㸸ᐑᇛ┴௝ྎᕷ㟷ⴥ༊ⲨᕳᏐ㟷ⴥ㸴㸫㸱㸲㸬◊✲ᣦᑟ⪅ᡤᒓ㸸ᮾ໭኱Ꮫ኱Ꮫ㝔⸆Ꮫ◊✲⛉་⸆㛤Ⓨᵓ᝿ᐤ㝃ㅮᗙ

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Ặ

ྡ㸸௒஭ ₶

㸳㸬◊✲ㄢ㢟኱つᶍࢥ࣮࣍ࢺඹྠ◊✲࡟ࡼࡿ⏕ά⩦័⑓Ⓨ⑕ண㜵ࢹ࣮ࢱ࣮࣋ࢫᵓ⠏࡜ࡑࡢ㧗ᗘ฼⏝࡟㛵ࡍࡿ◊✲㸴㸬◊✲άືձᴫ せᖹᡂ㸰㸰ᖺ㸲᭶㸯᪥ࡼࡾୖグ㸲ࡢ◊✲ᣦᑟ⪅ࡢୗ࡟࠾࠸࡚ࠊ◊✲ㄢ㢟͂኱つᶍࢥ࣮࣍ࢺඹྠ◊✲࡟ࡼࡿ⏕ά⩦័⑓Ⓨ⑕ண㜵ࢹ࣮ࢱ࣮࣋ࢫᵓ⠏࡜ࡑࡢ㧗ᗘ฼⏝࡟㛵ࡍࡿ◊✲̓࡟ࡘ࠸࡚ࠊ≉࡟୍͂⯡ᆅᇦఫẸࢆᑐ㇟࡜ࡋࡓ⾑ᅽ࣭៏ᛶ⭈⮚⑓࡟㛵ࡍࡿࢥ࣮࣍ࢺ◊✲㸦኱㏕◊✲㸧̓࡟㛵ࡍࡿ◊✲ࢆ㛤
ጞࡋࡓࠋ
ղෆ ᐜ
◊✲࡟╔ᡭᚋࠊ⌧ᆅ་⒪ᶵ㛵㸦኱㏕デ⒪ࢭࣥࢱ࣮㸧㛵ಀ⪅ࠊಖ೺ᖌ➼࡜ᡴྜࡏࢆ⾜࠸ࠊᮏᖺᗘ
ࡢ኱㏕⏫࡟࠾ࡅࡿᐙᗞ⾑ᅽ ᐃ஦ᴗࠊ⢾ᒀ⑓᳨デࠊMRI ᳨デ➼ࡢணᐃࢆㄪᩚࡋࡓࠋࡲࡓࠊ⌧ᆅ་⒪ᶵ㛵㛵ಀ⪅࡜㐃ᦠࡋࠊ኱㏕◊✲ཧຍ⪅ࡢෆ㧗⾑ᅽデ⒪ࢆཷデࡋ࡚࠸ࡿᑐ㇟⪅ࡢデ⒪ࢹ࣮ࢱࠊᐙ
ᗞ⾑ᅽᐃ஦ᴗཧຍ⪅ࡢᐙᗞ⾑ᅽ್ࢆ཰㞟ࡋࢹ࣮ࢱ࣮࣋ࢫ໬ࡋࡓࠋຍ࠼࡚ࠊ኱㏕◊✲ࡢࢹ࣮ࢱࢆ

⏝࠸࡚ࠊ࢔ࢻࣞࣀ࣓ࢹࣗࣜࣥ 2/࢖ࣥࢱ࣮࣓ࢪࣥ[AM2/IMD]㑇ఏᏊࡸ㸦ࣉࣟ㸧ࣞࢽࣥཷᐜయ[(P)RR]㑇ఏᏊୖ࡟Ꮡᅾࡍࡿ㑇ఏᏊከᆺ࡜⾑ᅽࠊ⭈ᶵ⬟ࠊ㧗⾑ᅽᛶ⬻ᚰ⾑⟶㞀ᐖ࡜ࡢ㛵㐃ࡸࠊࣞࢽ࣭ࣥ࢔
ࣥࢪ࢜ࢸࣥࢩࣥ⣔ࡸ⭈ᶵ⬟࡜↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢ㛵㐃ࢆ᳨ウࡋࡓࠋ㻝㻠ճᡂ ᯝ
኱㏕◊✲ࡢ⌧ᆅ㛵ಀ⪅࡜Ⰻዲ࡞㛵ಀࢆ⠏ࡃ࡜࡜ࡶ࡟ࠊ㧗⾑ᅽデ⒪ཷデ⪅ࡢฎ᪉ෆᐜࠊᐙᗞ⾑ᅽ್ࠊ⏕໬Ꮫ᳨ᰝ್ࢆྵࡴࢹ࣮ࢱ࣮࣋ࢫࢆసᡂࡋࡓࠋຍ࠼࡚ࠊ኱㏕◊✲ࡢࢹ࣮ࢱゎᯒ࡟ࡼࡾࠊ௨ୗ
ࡢ⤖ᯝࢆᚓࡓࠋ
1. ࢔ࢻࣞࣀ࣓ࢹࣗࣜࣥ 2/࢖ࣥࢱ࣮࣓ࢪࣥ[AM2/IMD]㑇ఏᏊከᆺ㸦ㄽᩥⓎ⾲ 1ࠊᏛ఍Ⓨ⾲ 2. 4.㸧
AM2/IMD 㑇ఏᏊ⩻ヂ㡿ᇦ࡟ࡣᤄධ(I)࣭Ḟኻ(D)ከᆺ(rs3840963)ࡀᏑᅾࡋࠊD ᆺ࡛ࡣᡂ⇍࣌ࣉࢳࢻࡢ୍ࡘ࡛࠶ࡿ AM2/IMD-53 ࡀḞኻࡋࠊAM2/IMD ࢆ௓ࡋࡓ⮚ჾಖㆤస⏝࡟ᙳ㡪ࢆཬࡰࡍࡇ࡜ࡀ
ணࡉࢀࡿࠋࡑࡇ࡛ࠊAM2/IMD 㑇ఏᏊከᆺ࡜⾑ᅽࠊ⭈ᶵ⬟ࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖ࡜ࡢ㛵㐃ࢆ᳨ウࡋࡓࠋ⾑ᅽ

ᐃཬࡧ㑇ఏᏊゎᯒ࡟ᑐࡋྠពࡀᚓࡽࢀࡓ኱㏕◊✲ཧຍ⪅ࡢෆࠊ⾑ᅽཬࡧ⭈ᶵ⬟ࡣᚲ㡲㡯┠࡟Ḟᦆࡢ࡞࠸ 40 ṓ௨ୖࡢ 1073 ྡࢆᑐ㇟࡜ࡋࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡣ⬻༞୰᪤ ࡢ࡞࠸
55 ṓ௨ୖࡢ 794 ྡࢆᑐ㇟࡜ࡋࡓࠋ24 ᫬㛫⮬⏤⾜ືୗ⾑ᅽࡀ DD ⩌࡛᭷ព࡟㧗್ࢆ♧ࡋ(཰⦰ᮇ⾑ᅽ P㸻0.009ࠊᣑᙇᮇ⾑ᅽ P㸻0.002)ࠊࡇࡢ㛵㐃ࡣྛ✀ᅉᏊ࡛⿵ṇᚋࡶ᭷ព࡛࠶ࡗࡓࠋ⭈ᶵ⬟ࡣDD ⩌࡛⾑Ύࢡࣞ࢔ࢳࢽ್ࣥࡀ᭷ព࡟㧗್ࢆ♧ࡋࠊ᪥ᮏ⭈⮚Ꮫ఍ࡢ᪥ᮏேࡢ᥎ᐃ⣒⌫యℐ㐣⋡(GFR)᥎⟬ᘧࡼࡾồࡵࡓ GFR ᥎ᐃ್ࡀప್ࢆ♧ࡋࡓ(ྛ✀ᅉᏊ࡛⿵ṇᚋྛࠎࠊP=0.0001ࠊ
P=0.04)ࠋ
៏ᛶ⭈⮚⑓(CKD)ࢆ GFR㸺60 ml/min/1.73m2 ࡲࡓࡣᒀ⺮ⓑ㝧ᛶ࡛ᐃ⩏ࡋࡓሙྜࠊከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒ࡟࠾࠸࡚ CKD ࢆ᭷ࡍࡿ࢜ࢵࢬẚࡣࠊII ⩌࡜ẚ㍑ࡋ࡚ࠊ
ID ⩌࡛ 1.1 (95㸣CI:0.7-1.7ࠊ
P=0.6)ࠊDD ⩌࡛ 2.7 (95㸣CI:1.4-5.2ࠊP=0.003)࡛࠶ࡗࡓࠋࡲࡓࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࢆ᭷ࡍࡿ
๭ྜࡶ DD ⩌࡛᭷ព࡟㧗ࡃ࡞ࡗ࡚࠸ࡓ(ࣛࢡࢼ᱾ሰ P=0.003ࠊ⬻ⓑ㉁⑓ኚ P=0.001)ࠋከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒ࡟࠾࠸࡚ࠊII ⩌࡜ẚ㍑ࡋ࡚ࠊID ⩌࡛ࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 1.0 (95㸣
CI:0.7-1.5ࠊP=0.9)ࠊ⬻ⓑ㉁⑓ኚࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 1.0 (95㸣CI:0.7-1.4ࠊP=0.9)࡛࠶ࡾࠊDD ⩌࡛ࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 2.4 (95㸣CI:1.2-4.7ࠊP=0.01)ࠊ⬻ⓑ㉁⑓ኚࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ
2.7 (95㸣CI:1.4-5.4ࠊP=0.003)࡛࠶ࡗࡓࠋ௨ୖࡼࡾࠊ᪥ᮏே࡟࠾࠸࡚ࠊAM2/IMD 㑇ఏᏊ I/D ከᆺࡢ DD ᆺࢆ᭷ࡍࡿࡇ࡜ࡀࠊ⾑ᅽ㧗್ࠊ⭈ᶵ⬟పୗࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢࣜࢫࢡ࡜࡞ࡿྍ⬟ᛶࡀ♧ࡉࢀࡓࠋ
2.㸦ࣉࣟ㸧ࣞࢽࣥཷᐜయ[(P)RR]㑇ఏᏊከᆺ㸦ㄽᩥⓎ⾲ 2ࠊᏛ఍Ⓨ⾲ 1. 5.㸧
ࣞࢽࣥ-࢔ࣥࢪ࢜ࢸࣥࢩࣥ⣔ࡣ⏕య࡟࠾ࡅࡿ୺せ࡞⾑ᅽㄪ⠇ᶵᵓ࡛࠶ࡾࠊ᭱㏆ࡇࡢ⣔ࡢ᪂ࡋ࠸ᵓᡂ
ᅉᏊ࡜ࡋ࡚(P)RR ࡀྠᐃࡉࢀࠊ⾑ᅽࡸ⮚ჾ㞀ᐖ࡜ࡢ㛵㐃ࡀὀ┠ࡉࢀ࡚࠸ࡿࠋࡑࡇ࡛ࠊ(P)RR 㑇ఏᏊከᆺ࡜㧗⾑ᅽᛶ⮚ჾ㞀ᐖ࡛࠶ࡿᕥᐊ⫧኱ࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖ(ࣛࢡࢼ᱾ሰཬࡧ⬻ⓑ㉁⑓ኚ)࡜ࡢ
㛵㐃ࢆ᳨ウࡋࡓࠋ⾑ᅽ ᐃཬࡧ㑇ఏᏊゎᯒ࡟ᑐࡋྠពࡀᚓࡽࢀࡓ኱㏕◊✲ཧຍ⪅ࡢෆࠊࢹ࣮ࢱࡢ
Ḟᦆࡢ࡞࠸ 779 ྡ(⏨ᛶ 250 ྡࠊዪᛶ 529 ྡ)ࢆᑐ㇟࡜ࡋࡓࠋࡑࡢ⤖ᯝࠊዪᛶ࡟࠾࠸࡚ࠊ+1513(rs6609080) A㸼G ࡣࠊᕥᐊ⫧኱ࢆ᭷ࡍࡿ๭ྜ(AA ⩌ 10.1%ࠊ
AG ⩌ 19.4%ࠊGG ⩌ 31.8%ࠊ
P=0.003)ཬࡧࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ๭ྜ(AA ⩌ 22.2%ࠊAG ⩌ 24.2%ࠊGG ⩌ 50.0%ࠊP=0.01)࡜᭷ព࡟㛵㐃ࡋࡓࠋࡲࡓࠊ༢ኚ㔞ゎᯒ࡟ࡼࡾᕥᐊ⫧኱ཬࡧࣛࢡࢼ᱾ሰ࡜᭷ព࡞㛵㐃ࢆ♧ࡋࡓᅉᏊ࡛⿵ṇࡋࡓከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒ࡟࠾࠸࡚ࠊAA ⩌࡜ẚ㍑ࡋ࡚ࠊAG ⩌࡛ࡣᕥᐊ⫧኱ࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ
2.0 (95%CI: 1.1-3.5)ࠊࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 1.0 (95%CI: 0.6-1.6)࡛࠶ࡾࠊGG ⩌࡛ࡣᕥᐊ⫧኱ࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 2.8 (95%CI: 1.0-7.8)ࠊࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ࢜ࢵࢬẚࡀ 3.2 (95%CI:
1.3-7.8)࡛࠶ࡗࡓࠋ୍᪉ࠊ⏨ᛶ࡛ࡣࡇࢀࡽࡢ᭷ព࡞㛵㐃ࡀㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ

㻝㻡

3. ⾑₢࢔ࣝࢻࢫࢸࣟࣥ/⾑₢ࣞࢽࣥẚ[ARR]㸦ㄽᩥⓎ⾲ 3ࠊᏛ఍Ⓨ⾲ 3.㸧
ARR 㧗್ࡣࠊ㧗⾑ᅽ᭷⑓࣭Ⓨ⑕࡜㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋࡋ࠿ࡋࠊNa ᦤྲྀ࣭᤼ἥ
㔞ࡀࡇࡢ㛵㐃࡟ཬࡰࡍᙳ㡪࡟ࡘ࠸࡚ࡢሗ࿌ࡣ୍㈏ࡋ࡚࠸࡞࠸ࠋࡑࡇ࡛ࠊARR ࡜㧗⾑ᅽ᭷⑓ࡢ㛵㐃࡟ࡘ࠸࡚ࠊNa ᦤྲྀ㔞ࢆຍ࠼ࡓ᳨ウࢆ⾜ࡗࡓࠋ኱㏕◊✲ཧຍ⪅ࡢෆࠊࢹ࣮ࢱࡢḞᦆࡢ࡞࠸ 514 ྡࢆᑐ㇟࡜ࡋࡓࠋNa ᦤྲྀ㔞ࡣࠊ㣗≀ᦤྲྀ㢖ᗘㄪᰝἲࢆ⏝࠸࡚⟬ฟࡋࡓࠋ⾑₢ࣞࢽࣥάᛶࠊ⾑₢࢔ࣝࢻࢫࢸࣟࣥ⃰ᗘࠊARR ࡜㧗⾑ᅽ᭷⑓ࡢ㛵㐃ࢆከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒ࡟᳨࡚ウࡋࡓࠋᑐ㇟⪅ࡢᐙᗞ⾑ᅽࡣ཰⦰ᮇ 117 mmHgࠊᣑᙇᮇ 73mmHgࠊ⾑₢ࣞࢽࣥάᛶࡢ୰ኸ್ࡣ 1.1 ng/mL/hrࠊ⾑₢࢔ࣝࢻࢫࢸࣟࣥ⃰ᗘࡢ୰ኸ್ࡣ 64 pg/mLࠊARR ࡢ୰ኸ್ࡣ 55 pg/mL per ng/mL/hr ࡛࠶ࡗࡓࠋARR ࡣᐙᗞ⾑ᅽ࡟ࡼࡿ㧗⾑ᅽ᭷⑓⋡࡜᭷ព࡟㛵㐃ࡋ࡚࠸ࡓ(logARR 1SD ୖ᪼ẖࡢ࢜ࢵࢬẚ1.4)ࠋ୍᪉ࠊ⾑₢ࣞࢽࣥάᛶཬࡧ⾑₢࢔ࣝࢻࢫࢸࣟࣥ⃰ᗘࡣ㧗⾑ᅽ᭷⑓⋡࡜㛵㐃ࡋ࡞࠿ࡗࡓࠋྠ
ᵝࡢゎᯒࢆ Na ᦤྲྀ㔞୰ኸ್(㣗ሷ┦ᙜ㔞 12.3 g/᪥)࡛ᒙูゎᯒࡋࡓ࡜ࡇࢁࠊNa ᦤྲྀ㔞㧗್⩌࡟࠾࠸࡚ࠊࡼࡾ᫂░࡞㛵㐃ࡀᚓࡽࢀࡓ(logARR 1SD ୖ᪼ẖࡢ࢜ࢵࢬẚ 2.4)ࠋ୍᪉ࠊNa ᦤྲྀ㔞ప್⩌࡛ࡣࡇࡢ㛵㐃ࡣᾘኻࡋࡓࠋ
ࡲࡓࠊ
Na ᦤྲྀ㔞㧗್࠿ࡘ㧗⾑ᅽ᭷⑓ࡢᑐ㇟ 30 ྡࡢ⾑₢ࣞࢽࣥάᛶࡣࠊ
Na ᦤྲྀ㔞㧗್࠿ࡘṇᖖ⾑ᅽࡢᑐ㇟ 227 ྡ࡟ẚ࡭᭷ព࡟㧗್࡛࠶ࡗࡓࠋ௨ୖࡼࡾࠊ㧗 Na ᦤྲྀ⩌࡟
࠾࠸࡚ࠊARR 㧗್ࡀᐙᗞ⾑ᅽ࡟ࡼࡾᐃ⩏ࡉࢀࡿ㧗⾑ᅽ᭷⑓࡜㛵㐃ࡍࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ㧗 Na ᦤྲྀ࣭ARR 㧗್ࡢᑐ㇟࡟࠾ࡅࡿ㧗⾑ᅽࡢᡂᅉ࡟ࡣࠊ㣗ሷឤཷᛶ࡛࠶ࡿపࣞࢽࣥᛶ㧗⾑ᅽ(࠶ࡿ࠸ࡣẚ㍑ⓗ࢔ࣝࢻࢫࢸࣟࣥ㧗್)ࢆకࡗࡓ㣗ሷឤཷᛶቑຍࡢ㛵୚ࡀ⪃࠼ࡽࢀࠊARR ࡀ୍⯡ᆅᇦఫẸ࡟࠾࠸࡚㣗ሷឤཷᛶࡢᣦᶆ࡟࡞ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ
4. ⭈⮚㞀ᐖ㸦ㄽᩥⓎ⾲ 4.㸧
⭈ᶵ⬟㞀ᐖཬࡧ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡣ࡜ࡶ࡟⬻ᚰ⾑⟶⑌ᝈ࣭⬻༞୰Ⓨ⑕ࡢணᅉᏊ࡛࠶ࡿࡀࠊ⭈ᶵ⬟㞀ᐖ࡜↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢ㛵㐃࡟ࡘ࠸࡚ࡢሗ࿌ࡣࡇࢀࡲ࡛࡟࡞࠸ࠋࡑࡇ࡛⭈ᶵ⬟㞀ᐖ࡜↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢ㛵㐃ࢆ኱㏕◊✲ཧຍ⪅᳨࡛ウࡋࡓࠋࢹ࣮ࢱ࡟Ḟᦆࡢ࡞࠸ 1008 ྡࢆᑐ㇟࡜ࡋࠊ
Cockcroft-Gault ᘧ࡟࡚ᚓࡽࢀࡓࢡࣞ࢔ࢳࢽࣥࢡࣜ࢔ࣛࣥࢫ(CCr)࡜↓⑕ೃᛶ⬻⾑⟶㞀ᐖ(ࣛࢡࢼ᱾ሰཬࡧ⬻ⓑ㉁⑓ኚ)ࡢ㛵㐃ࢆ༢ኚ㔞ゎᯒཬࡧྛ✀༴㝤ᅉᏊ࡛⿵ṇࡋࡓከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐ
ศᯒ࡟᳨࡚ウࡋࡓࠋࡑࡢ⤖ᯝࠊ༢ኚ㔞ゎᯒ࡟࠾࠸࡚ࠊࣛࢡࢼ᱾ሰཬࡧ⬻ⓑ㉁⑓ኚࡢ㔜⑕ᗘࡀୖ᪼
ࡍࡿ࡟ᚑ࠸ࠊCCr ࡢ್ࡀ᭷ព࡟㧗್࡜࡞ࡿࡇ࡜ࡀ᫂ࡽ࠿࡜࡞ࡗࡓࠋࡲࡓࠊከ㔜ࣟࢪࢫࢸ࢕ࢵࢡᅇ
ᖐศᯒ࡟࠾࠸࡚ࠊCCr 1SD పୗẖ࡟ࣛࢡࢼ᱾ሰࢆ᭷ࡍࡿ࢜ࢵࢬẚࡣ 1.3 ࡜࡞ࡾࠊ⬻ⓑ㉁⑓ኚࢆ᭷
ࡍࡿ࢜ࢵࢬẚࡣ 1.1 ࡜࡞ࡗࡓࠋ௨ୖࡼࡾࠊ୍⯡ᆅᇦఫẸ࡟࠾࠸࡚ CCr ప್ࡣ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢ⊂❧ࡋࡓ༴㝤ᅉᏊ࠶ࡿ࠸ࡣண ᅉᏊ࡛࠶ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ
ㄽᩥⓎ⾲㸦ࡍ࡭࡚ᰝㄞ࠶ࡾ㸧
1. Hirose T, Totsune K, Imai Y, et al. (Total 18, first) Association of adrenomedullin
2/intermedin gene insertion/deletion polymorphism with blood pressure, renal function andsilent cerebrovascular lesions in the japanese general population: the Ohasama study. Am J
Kid Dis. ᢞ✏୰.
2. Hirose T, Totsune K, Imai Y, et al. (Total 17, first) Association of (pro)renin receptor gene
polymorphisms with lacunar infarction and left ventricular hypertrophy in Japanese women:㻝㻢the Ohasama study. Hypertens Res. Revise ୰.
3. Satoh M, Hirose T, Imai Y, et al. (Total 15, 8th) Aldosterone-and-renin ratio and home bloodpressure is subjectsd with higher and lower sodium intake: the Ohasama study. Hypertens
Res. 2010; in press.
4. Otani H, Hirose T, Imai Y, et al. (Total 19, 7th) Association of Kidney Dysfunction with
Silent Lacunar Infarcts and White Matter Hyperintensity in the General Population: The
Ohasama Study. Cerebrovasc Dis. 2010;30:43-50.
Ꮫ఍Ⓨ⾲
1. Hirose T, Totsune T, Imai, et al. (Total 8th, first) (Pro)renin receptor in the brain, heart andkidney. 3rd (pro)renin receptor forum in Japan '10 2010 ᖺ 7 ᭶ 31 ᪥ ᮾி㒔ရᕝ༊(౫㢗ཱྀ₇)
2. Hirose T, Totsune T, Imai, et al. (Total 12th, first) Insersion/deletion polymorphism ofadrenomedullin 2/intermedin gene associated with chronic kidney disease and silent
cerebrovascular lesions in a Japanese general population: the Ohasama study. ISN-Nexus
Kyoto 2010 2010 ᖺ 4 ᭶ 16 ᪥ ி㒔ᗓி㒔ᕷ(࣏ࢫࢱ࣮ࠊYoung Investigator Award ཷ㈹)3. బ⸨೔ᗈ, ᘅ℩༟⏨, ௒஭₶, et al. (Total 15, 8th) ୍⯡ఫẸ࡟࠾ࡅࡿ⾑Ύ࢔ࣝࢻࢫࢸࣟࣥ/⾑₢ࣞࢽࣥάᛶẚ㸦ARR㸧࡜⬻༞୰Ⓨ⑕࠾ࡼࡧ Na ᦤྲྀ㔞࡜ࡢ㛵㐃 -኱㏕◊✲-. ➨ 33 ᅇ᪥ᮏ㧗⾑ᅽᏛ఍⥲఍. 2010 ᖺ 10 ᭶ 16 ᪥ ⚟ᒸ┴⚟ᒸᕷ(ཱྀ₇, Top 10 ₇㢟)
4. ᘅ℩༟⏨, ᡞᜏ࿴ே, ௒஭₶, et al. (Total 9, first) ࢔ࢻࣞࣀ࣓ࢹࣗࣜࣥ 2/࢖ࣥࢱ࣮࣓ࢪࣥ㑇ఏᏊከᆺ࡜⾑ᅽࠊ⭈ᶵ⬟ࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖ࡜ࡢ㛵㐃ࡢ᳨ウ㸸኱㏕◊✲. ➨ 33 ᅇ᪥ᮏ㧗⾑ᅽᏛ఍⥲఍. 2010 ᖺ 10 ᭶ 16 ᪥ ⚟ᒸ┴⚟ᒸᕷ(࣏ࢫࢱ࣮)5. ᘅ℩༟⏨, ᡞᜏ࿴ே, ௒஭₶, et al. (Total 9, first) (ࣉࣟ)ࣞࢽࣥཷᐜయ࡜㧗⾑ᅽ. RANGERS ◊✲఍. 2010 ᖺ 8 ᭶ 12 ᪥ 㧗▱┴㧗▱ᕷ(౫㢗ཱྀ₇)մཷධ◊✲⪅ࡢホ౯ᮏࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺࡣࠊཷධ◊✲⪅௒஭ࡀᢸᙜࡍࡿᒾᡭ┴࡟࠾ࡅࡿ୍⯡ᆅᇦఫẸࢆᑐ㇟࡜ࡋࡓࢥ࣮࣍ࢺ◊✲ࠊ኱㏕◊✲ࡢࢹ࣮ࢱ཰㞟࣭ศᯒ࡟ᚑ஦ࡋࡓࠋᴗົᚑ஦ᚋࠊ㑇ఏᏊ࡜⬻ᚰ⾑⟶㞀ᐖ࣭⭈⮚㞀ᐖ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ヲ⣽࡞᳨ウࢆ⾜࠸ࠊࡑࡢ⤖ᯝࠊ࢔ࢻࣞࣀ࣓ࢹࣗࣜࣥ 2/࢖ࣥࢱ࣮࣓
ࢪࣥࡢ㑇ఏᏊከᆺࡀ⾑ᅽࠊ⭈ᶵ⬟ࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖ࡟㛵㐃ࡍࡿࡇ࡜ࠊ
㸦ࣉࣟ㸧ࣞࢽࣥཷᐜయࡢ
㑇ఏᏊከᆺࡀዪᛶ࡟࠾࠸࡚ᕥᐊ⫧኱ࠊ↓⑕ೃᛶ⬻⾑⟶㞀ᐖ࡟㛵㐃ࡍࡿࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓࠋຍ࠼
࡚ࠊ㧗 Na ᦤྲྀ⩌࡛ ARR 㧗್ࡀ㧗⾑ᅽ᭷⑓࡟㛵㐃ࡍࡿࡇ࡜ࡸ⭈ᶵ⬟㞀ᐖࡀ↓⑕ೃᛶ⬻⾑⟶㞀ᐖࡢ⊂❧ࡋࡓ༴㝤ᅉᏊ࡛࠶ࡿࡇ࡜ࡶ᫂ࡽ࠿࡟ࡋࡓࠋࡇࢀࡽࡣࠊ⬻࣭ᚰ⾑⟶࣭⭈⮚⑌ᝈ࡟ᑐࡍࡿ᪥ᮏⓎࡢ᪥ᮏேࡢⅭࡢ࢚ࣅࢹࣥࢫ࡛࠶ࡾࠊ⤫ྜࢹ࣮ࢱ࣮࣋ࢫ࡟࠾࠸࡚෌⌧ᛶࢆ☜ㄆࡍࡿࡇ࡜࡟ࡼࡾࠊࢸ
࣮࣮࣓ࣛ࢖ࢻ་⒪ࡢᐇ⌧࡟ࡘ࡞ࡅࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࠋ௨ୖࠊᮏࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺࡢ◊✲ㄢ㢟㐙⾜࡟ࡼࡾࠊ⬻࣭ᚰ⾑⟶࣭⭈⮚⑌ᝈ࡟㛵ࢃࡿ᪂ࡓ࡞
༴㝤ᅉᏊࡸ┦஫㛵ಀࡀ᫂ࡽ࠿࡜࡞ࡗࡓࠋ௒ᚋࠊࡇࢀࡽࡢ⤖ᯝࡣࠊ⏕ά⩦័⑓ࡢ᪂ࡓ࡞ண㜵࣭἞⒪ࡢࢫࢺࣛࢸࢪ࣮ࢆ๰ฟࡍࡿࡓࡵࡢᇶ┙࡜࡞ࡗ࡚࠸ࡃ࡛࠶ࢁ࠺ࠋ
ཷධ◊✲⪅ ௒஭ ₶㻝㻣      ◊✲ᐇ⦼ሗ࿌᭩
㸯㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺẶྡ   㔝⸨ ᝆ
㸰㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺᮇ㛫ᖹᡂᖺ᭶᪥ 㹼 ᖹᡂᖺ᭶᪥ 㸱㸬ཷධᶵ㛵ྡ⛠㸸஑ᕞ኱Ꮫ೺ᗣ⛉Ꮫࢭࣥࢱ࣮
ᡤᅾᆅ㸸⚟ᒸ┴᫓᪥ᕷ᫓᪥බᅬ㸴㸫㸯       㸲㸬◊✲ᣦᑟ⪅ᡤᒓ㸸஑ᕞ኱Ꮫ೺ᗣ⛉Ꮫࢭࣥࢱ࣮
⫋ྡ㸸ᩍᤵẶྡ㸸⇃㇂ ⛅୕       㸳㸬◊✲ㄢ㢟኱つᶍࢥ࣮࣍ࢺࢆ⏝࠸ࡓ⏕ά⩦័⑓ࡢ୍ḟண㜵ࡢࡓࡵࡢ㐠ື㔞⟇ᐃ࡟㛵ࡍࡿ㐠ື␿Ꮫ◊✲       㸴㸬◊✲άື
ձᴫせ ᖺ  ᭶  ᪥ࡼࡾୖグ㸲ࡢ◊✲ᣦᑟ⪅ࡢୗ࡟࠾࠸࡚㸪◊✲ㄢ㢟͂኱つᶍࢥ࣮࣍ࢺࢆ⏝࠸ࡓ⏕ά⩦័⑓ࡢ୍ḟண㜵ࡢࡓࡵࡢ㐠ື㔞⟇ᐃ࡟㛵ࡍࡿ㐠ື␿Ꮫ◊✲̓࡟ࡘ࠸࡚㸪≉࡟㌟యάື࠾ࡼ
ࡧ୙άືࡀ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡢⓎ⌧࡟ཬࡰࡍᙳ㡪࡟㛵ࡍࡿ◊✲ࢆ㛤ጞࡋࡓ㸬 ղෆ ᐜ
㌟యάື࠾ࡼࡧ୙άືࡀ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡢⓎ⌧࡟ཬࡰࡍᙳ㡪㸦◊✲ձ㸧㸯㸧⫼ᬒ࡜┠ⓗ㌟యάືࡣ⫧‶ࢆࡣࡌࡵ࡜ࡍࡿ⏕ά⩦័⑓ࡢಖㆤᅉᏊ࡛࠶ࡾ㸪୍᪉㸪㌟య୙άືࡣ༴㝤ᅉᏊ࡛࠶ࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿ㸬㌟యάື࡟㛵ࡍࡿ◊✲ࡣከࡃ㸪 ᖺ࡟⟇ᐃࡉࢀࡓ᪂ࡋ࠸೺ᗣ࡙ࡃࡾࡢ
ࡓࡵࡢ㐠ືᇶ‽࣭ᣦ㔪࡛ࡣ㸪୰➼ᗘ௨ୖࡢ㌟యάືࢆ㐌࠶ࡓࡾ  ࢚ࢡࢧࢧ࢖ࢬ௨ୖ⾜࡞࠺ࡇ࡜ࡀ
᥎ዡࡉࢀ࡚࠸ࡿ㸬ࡋ࠿ࡋ㸪㌟య୙άື࡜⏕ά⩦័⑓Ⓨ⑕࡜ࡢ㛵㐃ᛶ࡟ࡘ࠸࡚ࡣ࢚ࣅࢹࣥࢫࡀ୙㊊ࡋ࡚࠾ࡾ㸪ୖグ㐠ືᇶ‽࣭ᣦ㔪࡟࠾࠸࡚ࡶ㸪㌟య୙άືࡢᙳ㡪ࡣ⪃៖ࡉࢀ࡚࠸࡞࠸㸬㌴࡛ࡢ⛣ືࡸࢹࢫࢡ࣮࣡ࢡ㸪ࢸࣞࣅࡢど⫈࡞࡝㸪⌧௦ேࡣᗙ఩୰ᚰࡢ⏕άࢆ㏦ࡗ࡚࠸ࡿ㸬୍᪉࡛㸪వᬤάື࡜ࡋ࡚㐠ືࢆ⾜ࡗ࡚࠸ࡿேࡶᑡ࡞ࡃ࡞࠸㸬ࡇࡢࡼ࠺࡞⌧௦ேࡢ⏕άᵝᘧ࡟ࡘ࠸࡚⪃࠼࡚ࡳࡿ࡜㸪㻝㻤୰➼ᗘ௨ୖࡢ㌟యάື㔞ࡢࡳ࡟ὀ┠ࡍࡿࡢ࡛ࡣ࡞ࡃ㸪㌟యάື࡜୙άືࢆࢭࢵࢺ࡟⏕ά⩦័⑓Ⓨ⑕࡬ࡢᙳ㡪ࢆ᫂ࡽ࠿࡟ࡍ࡭ࡁ࡛࠶ࡿ㸬ࡑࡇ࡛ᮏ◊✲ࡣ㸪๓ྥࡁ࡟㏣㊧ㄪᰝࢆ⾜࠸㸪࣓ࢱ࣎ࣜࢵࢡ
ࢩࣥࢻ࣮࣒ࣟࡢⓎ⌧࡟ᑐࡍࡿ㌟యάື࠾ࡼࡧ㌟య୙άືࡢᙳ㡪ࢆ᫂ࡽ࠿࡟ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡍࡿ㸬ᮏሗ࿌࡛ࡣ㸪ࡑࡢ㏵୰ࡢẁ㝵࡜ࡋ࡚㸪⏕ά⩦័⑓ࡢᇶ┙࡜࡞ࡿ⫧‶࡜㸪㌟యάື࠾ࡼࡧ୙άື࡜
ࡢ㛵㐃ᛶࢆᶓ᩿ⓗ࡟᳨ウࡋࡓᡂᯝࢆሗ࿌ࡍࡿ㸬㸰㸧᪉ἲᑐ㇟㸧ᖹᡂ  ᖺᗘஂᒣ⏫⏕ά⩦័⑓ண㜵೺デࢆཷデࡋ㸪ㄪᰝ࡟ྠពࡋࡓ  ṓ௨ୖ  ṓᮍ‶ࡢ⏨ዪ  ྡ   ◊✲ࢹࢨ࢖ࣥ㸧ᶓ᩿◊✲  ᐃ㡯┠㸧㌟యάື㔞㸸೺デ᫬࡟  ㍈ຍ㏿ᗘࢭࣥࢧ࣮άື㔞ィ㸦$FWLYH6W\OH3UR㸪࣒࢜ࣟࣥ࣊ࣝࢫࢣ࢔♫〇㸧ࢆ㓄ᕸࡋࡓ㸬ᑐ㇟⪅࡟ࡣ㸪ධᾎ࠾ࡼࡧධỈ᫬௨እࡢ㉳ᗋ࠿ࡽᑵᐷࡲ࡛ຍ㏿ᗘィࢆ⿦╔ࡍࡿࡼ࠺ㄝ᫂ࡋࡓ㸬⿦╔ᮇ㛫ࡣ  㐌㛫࡜ࡋࡓ㸬⿦╔㒊఩ࡣ㌟యࡢ๓㠃࣭⭜఩⨨࡜ࡋ㸪࣋ࣝࢺࡲࡓࡣࢬ࣎ࣥࡢ〈࡟ࢡࣜࢵࣉ࡛ᣳࡳ⿦╔ࡋࡓ㸬࡞࠾㸪㛫୰㸪ཧຍ⪅ࡀィᐃᮇ್ࢆ㜀ぴࡋ࡞࠸ࡼ࠺࡟⏬㠃⾲♧ࡣ᪥᫬ࡢࡳ࡜ࡋࡓ㸬     ⫧‶ᗘ㸸೺デ᫬ࡢ㌟㛗㸪య㔜࠿ࡽ %RG\0DVV,QGH[ %0, ࢆ⟬ฟࡋࡓ㸬ᐃ⩏㸧㌟యάື㸸 ࣓ࢵࢶ௨ୖࡢάື   ㌟య୙άື㸸 ࣓ࢵࢶᮍ‶ࡢάື   ⫧‶㸸%0,ӋNJPศ㢮㸧⏨ዪู࡟㌟యάື㔞࠾ࡼࡧ୙άື᫬㛫ࢆࡑࢀࡒࢀ  ศ఩ࡋ㸪పάື㧗୙άື㸪పάືప୙άື㸪㧗άື㧗୙άື㸪㧗άືప୙άືࡢ  ⩌࡟ᑐ㇟⪅ࢆศ㢮ࡋࡓ㸬⤫ィゎᯒ㸧ྛ⩌࡟࠾ࡅࡿᑐ㇟⪅ࡢ≉ᛶࡢẚ㍑࡟ࡣȮ஧஌᳨ᐃ࠾ࡼࡧ୍ඖ㓄⨨ศᩓศᯒࢆ⏝࠸ࡓ㸬ࡲࡓ㸪ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒࢆ⾜࠸㸪పάື㧗୙άື⩌ࢆᇶ‽࡜ࡋࡓ࡜ࡁࡢྛ⩌࡟࠾ࡅࡿ⫧‶ࡢ࢜ࢵࢬẚࢆồࡵࡓ㸬ㄪᩚᅉᏊ࡟ࡣᛶ㸪ᖺ㱋㸪⿦╔᫬㛫ࢆ⏝࠸ࡓ㸬ճᡂ ᯝ⏨ᛶࡢ 㸣㸪ዪᛶࡢ 㸣࡟⫧‶ࡀㄆࡵࡽࢀࡓ㸬⾲㸯࡟ᑐ㇟⪅ࡢ≉ᛶࢆ㸪ᅗ㸯࡟పάື㧗୙άືࢆᇶ‽࡜ࡋࡓ࡜ࡁࡢ㸪ྛ⩌࡟࠾ࡅࡿᛶ࣭ᖺ㱋࣭άື㔞ィ⿦╔᫬㛫ㄪᩚᚋࡢ⫧‶ࡢ࢜ࢵࢬẚࢆ♧ࡍ㸬పάື㧗୙άືࢆᇶ‽࡜ࡋࡓ࡜ࡁࡢ⫧‶ࡢ࢜ࢵࢬẚࡣ㸪㧗άືప୙άື⩌࡛ 㸦&,㸧㸪పάືప୙άື⩌࡛ 㸦&,
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㻝㻥ࡼࡗ࡚㐠ືࢆ㛤ጞࡋ㌟యάື㔞ࡀከࡃ࡞ࡗࡓࡀ㸪ࡇࢀࡲ࡛࡝࠾ࡾ㐠ື௨እࡢ᫬㛫ࡣᗙ఩୰ᚰࡢ⏕άࢆ㏦ࡗ࡚࠸ࡿࠖ࡜࠸࠺ࡼ࠺࡞ேࡓࡕࡀ㧗άື㧗୙άື⩌࡟ከࡃྵࡲࢀ࡚࠸ࡿྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿ㸬ࡋࡓࡀࡗ࡚㸪ᅉᯝࡢ㏫㌿ࡢྍ⬟ᛶࡀ࠶ࡾ㸪⫧‶ࡢࣜࢫࢡ㍍ῶ࡟㌟యάື㔞ࡀ㧗࠸ࡇ࡜ࡢࡳ࡛
ࡣ୙㡰ศ࠿ྰ࠿ࡣ᳨ウࡢవᆅࡀ࠶ࡿ㸬௒ᚋ㏣㊧ㄪᰝࢆ⾜࠸㸪㌟య୙άືࡀ㌟యάື࡜ࡣ⊂❧ࡋ࡚⫧‶ࡢ༴㝤ᅉᏊ࡛࠶ࡿ࠿ྰ࠿ࢆ᳨ウࡍࡿᚲせࡀ࠶ࡿ㸬ࡲࡓ㸪௒ᅇࡣ⫧‶࡜㌟యάື㸪୙άື࡜ࡢ
㛫ࡢ஺⤡ᅉᏊࡢᙳ㡪ࢆ⪃៖ࡋ࡚࠸࡞࠸ࡓࡵ㸪௒ᚋ㸪஺⤡ᅉᏊࡢᙳ㡪ࢆ㝖እࡋ㸪᭦࡞ࡿ᳨ウࢆ⾜ࡗ࡚࠸ࡃணᐃ࡛࠶ࡿ㸬⾲㸯㸬ྛ⩌࡟࠾ࡅࡿᑐ㇟⪅ࡢ≉ᛶపάື-㧗୙άື పάື-ప୙άື⏨ᛶ 䍻㻠㻡㻣ศ㻌㻒㻌㻨㻟㻚㻡䝯䝑䝒䞉᫬

<457ศ & <3.5࣓ࢵࢶ࣭᫬

䍻㻠㻡㻣ศ㻌㻒㻌䍻㻟㻚㻡䝯䝑䝒䞉᫬

<457ศ & Ӎ3.5࣓ࢵࢶ࣭᫬ዪᛶ 䍻㻡㻥㻞ศ㻌㻒㻌㻨㻟㻚㻢䝯䝑䝒䞉᫬

<592ศ & <3.6࣓ࢵࢶ࣭᫬

䍻㻡㻥㻞ศ㻌㻒㻌㻟㻚㻢䍻䝯䝑䝒䞉᫬

<592ศ & Ӎ3.6࣓ࢵࢶ࣭᫬

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࡚࠸ࡿ㸬ࡋ࠿ࡋ㸪ࡇࢀࡽࡢ◊✲࡛ࡣవᬤ᫬ࡢ㐠ື⩦័ࢆホ౯ࡋ࡚࠸ࡿࡓࡵ㸪ປാ᫬ࡢ㌟యάືࡀ⪃៖ࡉࢀ࡚࠾ࡽࡎ㸪ࡲࡓ㉁ၥ⣬ࢆ⏝࠸࡚㌟యάືࡢホ౯ࢆ⾜ࡗ࡚࠸ࡿࡓࡵᐈほᛶࡶஈࡋ࠸࡜࠸࠺
ㄢ㢟ࡀṧࡉࢀ࡚࠸ࡓ㸬ᡃࠎࡢ◊✲ࢳ࣮࣒ࡢ᭱⤊┠ᶆ࡛࠶ࡿ㸪ࠕ⏕ά⩦័⑓ࡢ୍ḟண㜵ࡢࡓࡵࡢ㐠ື㔞⟇ᐃࠖࡢࡓࡵ࡟ࡣ㸪⏕ά⩦័⑓࡜㛵㐃ࡢ࠶ࡿ࠺ࡘ⑕≧࡜㌟యάື㔞࡜ࡢ㛵㐃ᛶࢆ᳨ウࡋ࡚࠾ࡃᚲせࡀ࠶ࡿ㸬ࡑࡇ࡛㸪ᮏ◊✲࡛ࡣ㌟యάື㔞ࢆᐇ ࡋ㸪࠺ࡘ⑕≧࡜ࡢ㛵㐃ᛶࢆ᳨ウࡋࡓ㸬㸰㸧᪉ἲᖹᡂ  ᖺᗘ࡟ᐃᮇ೺デࢆཷデࡋࡓ ᰴ ࢩ࣮࣭࢔࣮࣭ࣝࢩ࣮࠾ࡼࡧ୧ഛࢩࢫࢸ࣒ࢬࡢᚑᴗဨ ྡࡢ࠺ࡕ㸪ྠពࡀᚓࡽࢀ㸪ࢹ࣮ࢱ࡟୙ഛࡢ࡞࠸  ྡ㸦⏨ᛶ  ྡ㸪ዪᛶ  ྡ㸧ࢆゎᯒᑐ㇟࡜ࡋࡓ㸬೺デ๓  㐌㛫࡟  ㍈ຍ㏿ᗘࢭࣥࢧ࣮άື㔞ィࢆ⏝࠸࡚㌟యάື㔞ࡢ ᐃࢆ⾜ࡗࡓ㸬0(7V௨ୖࡢάືࢆ㌟యάື࡜ᐃ⩏ࡋ㸪 ᪥࠶ࡓࡾࡢ࢚ࢡࢧࢧ࢖ࢬ㸦(;0(7V K㸧ࢆ⟬ฟࡋࡓ㸬ࡇࢀࢆ ศ఩࡟ศࡅ࡚ࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒࢆ⾜࠸㸪᭱ࡶ㌟యάື㔞ࡀᑡ࡞࠸⩌ࢆᇶ‽࡜ࡋࡓ࡜ࡁࡢྛ
⩌࡟࠾ࡅࡿ࠺ࡘ⑕≧ಖ᭷ࡢ࢜ࢵࢬẚࢆồࡵࡓ㸬ㄪᩚᅉᏊ࡟ࡣᛶ㸪ᖺ㱋㸪ᩍ⫱ᖺᩘ㸪㓄അ⪅ࡢ᭷↓㸪⫧‶㸪㧗⾑ᅽ㸪⬡㉁௦ㅰ␗ᖖ㸪✵⭡᫬㧗⾑⢾㸪㌟య୙άື㸪ႚ↮㸪㣧㓇ࢆ⏝࠸ࡓ㸬࠺ࡘ⑕≧ࡣ WKH&HQWHUIRU(SLGHPLRORJLFDO6WXGLHV'HSUHVVLRQ6FDOH㸦&(6'㸧ࢆ⏝࠸࡚ホ౯ࡋ㸪 Ⅼ௨ୖࢆ࠺ࡘ⑕≧࠶ࡾ࡜ᐃ⩏ࡋࡓ㸬㸱㸧⤖ᯝ࠺ࡘ⑕≧ࡣ  ྡ㸦㸬㸧࡟ㄆࡵࡽࢀࡓ㸬ప㔞⩌ࢆᇶ‽࡜ࡋࡓᛶ࣭ᖺ㱋ㄪᩚᚋࡢ୰㔞⩌㸪㧗㔞⩌࡟࠾ࡅࡿ࠺ࡘ⑕≧ಖ᭷࢜ࢵࢬẚࡣ㸪ࡑࢀࡒࢀ 㸦㸧㸪㸦㸧࡛࠶ࡗࡓ㸦SIRUWUHQG 㸧㸬ࡲࡓ㸪(; ቑຍẖ࡟࠺ࡘ⑕≧ಖ᭷ࡢ࢜ࢵࢬẚࡣ   ῶᑡࡋࡓ㸬ࡇࢀࡽࡢ᭷ព࡞㛵ಀᛶࡣ㸪௚ࡢ஺⤡ᅉᏊ࡛ㄪᩚᚋࡶ⥔ᣢࡉࢀࡓ㸦୰㔞⩌ 25 㸪&,
㸪㧗㔞⩌ 25  &,SIRUWUHQG 㸪(; ቑຍ 25 㸪&,
㸧㸬௒ᅇࡢ◊✲ᡂ⦼ࡣ㸪㌟యάື㔞࡜࠺ࡘ⑕≧࡜࡟ࡣ┤⥺ⓗ࡞㛵㐃ᛶࡀ࠶ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓ㸬௒ᚋ㸪㌟యάື㔞ࡢᇶ‽್ࡢసᡂ࡟࠶ࡓࡗ࡚㸪࠺ࡘ⑕≧ࡶ⪃៖࡟ධࢀࡓ᳨ウࢆ⾜࠺ᚲせ࡜⪃࠼ࡽ
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⾲㸰㸬ᑐ㇟⪅ࡢ≉ᛶ⏨ᛶዪᛶ㻝᪥䛒䛯䜚䛾㌟యάື㔞ேᩘᖺ㱋䠄ṓ䠅㻯㻱㻿㻙㻰ᚓⅬ䠄Ⅼ䠅䛖䛴⑕≧䠄䠂䠅ᩍ⫱䠄䠂䠅㓄അ⪅䠄䠂䠅
㻞㻮㼛㼐㼥㻌㻹㼍㼟㼟㻌㻵㼚㼐㼑㼤㻌㻔㼗㼓㻛㼙 㻕⫧‶㻌䠄㻑䠅㻌
㧗⾑ᅽ㻌䠄㻑䠅⬡㉁␗ᖖ⑕㻌䠄㻑䠅⢾ᒀ⑓㻌䠄㻑䠅
Ṍ⾜ᩘ㻌㻔Ṍ㻛᪥㻕
㌟య୙άື㻌㻔ศ㻛᪥㻕ႚ↮⩦័㻌㻔㻑㻕
㣧㓇⩦័㻌㻔㻑㻕

ప㔞⩌㻜䍸㻱㼄㻨㻝㻚㻤
㻜䍸㻱㼄㻨㻞㻚㻞
㻞㻠㻢㻠㻟 㻔 㻥 㻕㻝㻜 㻔 㻤 㻕
㻞㻝㻚㻝
㻞㻞㻚㻠
㻢㻣㻚㻥
㻞㻞㻚㻤 㻔 㻟㻚㻢 㻕
㻞㻣㻚㻞
㻞㻥㻚㻟
㻞㻢㻚㻤
㻥㻚㻤
㻠㻜㻢㻜 㻔 㻝㻠㻞㻝 㻕㻡㻠㻟 㻔 㻥㻟 㻕
㻟㻟㻚㻟
㻢㻟㻚㻤

୰㔞⩌
㻝㻚㻤䍸㻱㼄㻨㻟
㻞㻚㻞䍸㻱㼄㻨㻟㻚㻠㻞㻢㻟㻠㻞 㻔 㻤 㻕㻝㻜 㻔 㻣 㻕
㻝㻣㻚㻥
㻞㻣㻚㻜
㻣㻟㻚㻜
㻞㻞㻚㻥 㻔 㻟㻚㻠 㻕
㻞㻟㻚㻢
㻟㻝㻚㻢
㻞㻤㻚㻝
㻝㻞㻚㻥
㻡㻣㻣㻢 㻔 㻝㻢㻢㻠 㻕㻡㻟㻞 㻔 㻤㻣 㻕
㻟㻝㻚㻥
㻢㻥㻚㻝

㧗㔞⩌
㻟䍸㻱㼄
㻟㻚㻠䍸㻱㼄
㻞㻢㻟㻠㻞 㻔 㻝㻜 㻕㻥 㻔 㻣 㻕
㻝㻠㻚㻤
㻞㻞㻚㻤
㻢㻢㻚㻡
㻞㻞㻚㻣 㻔 㻟㻚㻟 㻕
㻝㻥㻚㻜
㻞㻠㻚㻜
㻞㻝㻚㻟
㻝㻞㻚㻞
㻤㻟㻢㻡 㻔 㻞㻠㻞㻠 㻕㻡㻝㻜 㻔 㻥㻣 㻕
㻞㻝㻚㻟
㻢㻞㻚㻜

㻼㻌㼒㼛㼞
㼠㼞㼑㼚㼐
㻜㻚㻠㻜
㻜㻚㻞㻟
㻜㻚㻜㻢
㻜㻚㻥㻟
㻜㻚㻥㻟
㻜㻚㻤㻟
㻜㻚㻞㻝
㻜㻚㻝㻠
㻜㻚㻝㻠
㻜㻚㻠㻝
㻨㻜㻚㻜㻝
㻨㻜㻚㻜㻝
㻨㻜㻚㻜㻝
㻜㻚㻢㻠

ᖹᆒ್䠄ᶆ‽೫ᕪ䠅䜎䛯䛿๭ྜ(P for trend: 0.03)

㻝㻚㻞



㻝㻚㻜



吁 㻜㻚㻤
吚
向 㻜㻚㻢
ẚ
㻜㻚㻠







1.0

*; P<0.05 vs ప



0.8

*

0.6

㻜㻚㻞
㻜㻚㻜

ప

୰

㧗

䠄246ྡ䠅

㌟యάື㔞
䠄2䠒䠏ྡ䠅

䠄2䠒䠏ྡ䠅

ㄪᩚᅉᏊ䠖 ᛶ㻘㻌ᖺ㱋㻘㻌ᩍ⫱㻘㻌㓄അ⪅䛾᭷↓㻘㻌⫧‶㻘㻌㧗⾑ᅽ㻘㻌⬡㉁␗ᖖ⑕
✵⭡᫬㧗⾑⢾㻘㻌㌟య୙άື㻘㻌ႚ↮㻘㻌㣧㓇⩦័     ᅗ㸰㸬㌟యάື㔞ู࡟ࡳࡓ࠺ࡘ⑕≧ಖ᭷ࡢ࢜ࢵࢬẚմ◊✲௦⾲⪅㸦ཪࡣཷධ◊✲⪅㸧ࡢホ౯ ࣜࢧ࣮ࢳࣞࢪࢹࣥࢺࡢᮇ㛫ࡣ 6 ࣨ᭶㛫࡜▷ᮇ㛫࡛࠶ࡗࡓࡀࠊᮏ◊✲ㄢ㢟࡟ᐦ᥋࡟㛵㐃ࡋࡓ 2 ࡘࡢ◊✲ࢸ࣮࣐࡟㛵ࡋ࡚ࠊ◊✲ㄢ㢟ࡢタᐃࠊ◊✲௻⏬ࠊ⤫ィゎᯒࠊ⤖ᯝࡢせ⣙ࠊᏛ఍Ⓨ⾲ࡲ࡛ࢆᢸᙜࡉࢀࠊ࠸ࡎࢀࡢ◊✲ᡂᯝࡶ㧗࠸ホ౯ࡀᚓࡽࢀࡓࠋ◊✲ࢸ࣮࣐ձ࡟㛵ࡋ࡚ࡣࠊᅜ㝿⫧‶Ꮫ఍㸦ࢫࢺࢵࢡ࣒࣍ࣝࠊࢫ࢙࣮࢘ࢹࣥ㸧࡛ࢪูࣕࣥࣝࡢ࣏ࢫࢱ࣮Ⓨ⾲࡛ඃ⚽㈹࡜ࡋ࡚᥇ᢥࡉࢀࠊᏛ఍ᮇ㛫
୰ࢆ㏻ࡋ࡚࣏ࢫࢱ࣮ࡢᥖ♧ࡀㄆࡵࡽࢀࡓࠋࡇࡢ◊✲࡛ࡣࠊᐈほⓗ࡟ホ౯ࡉࢀࡓ㌟యάື㔞࡜㌟య
୙άື㔞࡜⫧‶ࡢⓎ⑕࡜ࡢ㛵㐃ᛶ࡟㛵ࡋ࡚ᶓ᩿ⓗ࡛࠶ࡿࡀゎᯒࢆຍ࠼ࠊ⫧‶Ⓨ⌧࡬ࡢ㌟య୙άື㔞ࡢ㛵୚ࢆ᫂ࡽ࠿࡟ࡋࡓࠋ◊✲ࢸ࣮࣐ղ࡛ࡣࠊ㌟యάື㔞ࡀ࠺ࡘ⑕≧࡜࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮ࣟ
࡜ࡢ㛵㐃ᛶ࡟ཬࡰࡍᙳ㡪ࢆᶓ᩿ⓗ࡟ゎᯒࡋࡓࠋࡑࡢ⤖ᯝࠊ㌟యάື㔞ࡣ࠺ࡘ⑕≧ࡢಖ᭷࡟㛵㐃ࡍࡿࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓࠋᮏ◊✲ࡣࠊ᪥ᮏ␿Ꮫ఍࡛◊✲ᡂᯝࡢⓎ⾲ࢆ⾜ࡗࡓࠋ ௨ୖࡼࡾࠊ㔝⸨ ᝆࡉࢇ࡟ࡼࡗ࡚ᐇ᪋ࡉࢀࡓ஧ࡘࡢ◊✲ࢸ࣮࣐ࡣࠊ㐠ື␿Ꮫ◊✲ୖࠊᴟࡵ࡚㔜せ࡞ㄢ㢟࡛࠶ࡾࠊࡑࡢᡂ⦼ࡶ㔜せ࡞◊✲▱ぢ࡜ホ౯ࡉࢀࡼ࠺ࠋࡲࡓࠊᙜヱ◊✲ᐊࡀᐇ᪋ࡋ࡚࠸ࡿ
ᵝࠎ࡞㐠ື␿Ꮫ◊✲ࡢ᥎㐍࡟ࡶ኱ኚ㔜せ࡞ᙺ๭ࢆᯝࡓࡉࢀࡓࠋ
◊✲௦⾲⪅ ⇃㇂ ⛅୕  㻞㻞ᖹᡂ㸰㸱ᖺᗘศϨ ⱝᡭ◊✲⪅⫱ᡂά⏝஦ᴗ㸦ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺ㸧㻞㻟   ◊✲ᐇ⦼ሗ࿌᭩

㸯㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺẶྡ໭ᮧ ဴஂ
㸰㸬ࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺᮇ㛫ᖹᡂ 23 ᖺ 4 ᭶ 1 ᪥ 㹼 ᖹᡂ 24 ᖺ 3 ᭶ 31 ᪥㸱㸬ཷධᶵ㛵
ྡ⛠㸸ி㒔኱Ꮫᡤ ᅾ ᆅ㸸ி㒔ᗓி㒔ᕷྜྷ⏣ᮏ⏫
㸲㸬◊✲ᣦᑟ⪅ᡤᒓ㸸ி㒔኱Ꮫ⎔ቃᏳ඲ಖ೺ᶵᵓ೺ᗣ⛉Ꮫࢭࣥࢱ࣮

⫋

ྡ㸸ຓᩍ

Ặ

ྡ㸸▼ぢ ᣅ㸳㸬◊✲ㄢ㢟
ᚠ⎔ჾ⑌ᝈ➼ࡢᩆ࿨⋡ྥୖ࡟㈨ࡍࡿຠᯝⓗ࡞ᩆᛴ⸽⏕ἲࡢᬑཬၨⓎ࡟㛵ࡍࡿ◊✲㸴㸬◊✲άື
ձᴫ せᖹᡂ 23 ᖺ 4 ᭶ 1 ᪥ࡼࡾୖグ㸲ࡢ◊✲ᣦᑟ⪅ࡢୗ࡟࠾࠸࡚ࠊ◊✲ㄢ㢟͂ᚠ⎔ჾ⑌ᝈ➼ࡢᩆ࿨⋡ྥ
ୖ࡟㈨ࡍࡿຠᯝⓗ࡞ᩆᛴ⸽⏕ἲࡢᬑཬၨⓎ࡟㛵ࡍࡿ◊✲̓࡟ࡘ࠸࡚ࠊ≉࡟⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆ⏝࠸ࡓ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࡢᆅᇦᒎ㛤࡜ࡑࡢຠᯝ᳨ド࡟㛵ࡍࡿ◊✲ࢆ㛤ጞࡋࡓࠋղෆ ᐜせ᪨㸸45 ศ㛫࡛⬚㦵ᅽ㏕ࡢࡳ࡟༢⣧࣭▷᫬㛫໬ࡋࡓᚰ⫵⸽⏕ἲࢆከேᩘ࡟ᣦᑟࡍࡿ࣐ࢫࢺ࣮ࣞ
ࢽࣥࢢࣉࣟࢢ࣒ࣛࢆࠊẖᖺ࠶ࡓࡾேཱྀࡢ 5%࡟࠶ࡓࡿ 19,000 ேࢆ┠ᶆ࡟ࠊ኱㜰ᗓ㇏୰ᕷ㸦ேཱྀ 38୓ே㸧࡟ᑟධࡋࡓࠋ2010 ᖺ 4 ᭶㹼2011 ᖺ 10 ᭶ࡲ࡛ࡢᮇ㛫࡛ࠊ⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆ⏝࠸ࡓ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࢆ 264 ᅇࠊཷㅮ⪅ேᩘ 16,265 ྡࠊᚑ᮶ᆺࡢᚰ⫵⸽⏕ㅮ⩦
఍ࢆ 404 ᅇࠊཷㅮ⪅ேᩘ 10,384 ྡࠊᘏ࡭ཷㅮ⪅ேᩘ 26,649 ྡ㸦㇏୰ᕷேཱྀࡢ 6.9㸣㸧࡟ᑐࡋ࡚ᐇ᪋ࡋࡓࠋᆅᇦఫẸࡢࣛࣥࢲ࣒ࢧࣥࣉࣝࢆᑐ㇟࡜ࡋࡓ㉁ၥ⣬ㄪᰝ࡛ࡣࠊࠕ⬚㦵ᅽ㏕ࡢࡳࡢᚰ㓄⸽⏕ἲ࡛ࡶࠊேᕤ࿧྾ࢆࡍࡿᚰ⫵⸽⏕࡜ྠࡌࡄࡽ࠸ຠᯝࡀ࠶ࡿ࡜࠸࠺ࡇ࡜ࢆ௒ࡲ࡛⪺࠸ࡓࡇ࡜ࡀ࠶
ࡾࡲࡍ࠿㸽ࠖ࡜࠸࠺㉁ၥ࡟ᑐࡋ࡚ࠊ2010 ᖺ 5 ᭶ࡢㄪᰝ࡛ࡣ 46.0㸣ࠊ2011 ᖺ 11 ᭶࡛ࡣ 53.5㸣ࠊ㻞㻠2012 ᖺ 1 ᭶࡛ࡣ 54.0㸣ࡀࠕࡑ࠺ᛮ࠺ࠖ࡜ᅇ⟅ࡋࠊᖺࠎቑຍࡋ࡚࠸ࡓࠋ2012 ᖺᗘࡶᘬࡁ⥆ࡁྠつᶍࡢ࣐ࢫࢺ࣮ࣞࢽࣥࢢࢆᒎ㛤ࡋࠊᆅᇦఫẸࡢᩆ࿨ព㆑ࡢኚ໬ࠊᚰ⫵⸽⏕ᐇ᪋๭ྜࡢኚ໬➼ࢆホ౯ࡋࠊ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࡢᆅᇦᒎ㛤ࡢຠᯝࢆ᳨ドࡋ࡚࠸ࡃணᐃ࡛࠶ࡿࠋ

◊✲┠ⓗ㝔እᚰ೵Ṇ౛ࡢ኱つᶍࢥ࣮࣍ࢺ࡛࠶ࡿ࢘ࢶࢱ࢖ࣥ኱㜰ࣉࣟࢪ࢙ࢡࢺࡢࢹ࣮ࢱ཰㞟ࢩࢫࢸ࣒ࢆ⏝࠸ࠊᆅᇦ࡛⬚㦵ᅽ㏕ࡢࡳࡢ⸽⏕ἲࢆ▷᫬㛫࡛ከேᩘ࡟ᣦᑟࡍࡿ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࢆᬑ
ཬࡉࡏࠊࡑࢀ࡟ࡼࡗ࡚ᩆ࿨ព㆑ࠊBystander CPR ࡢᐇ᪋๭ྜࠊ࡞ࡽࡧ࡟ᩆ࿨⋡ࡀྥୖࡍࡿ࠿ྰ࠿ࢆ
᳨ドࡍࡿࠋ
◊✲᪉ἲ㸸
◊✲ࢹࢨ࢖ࣥ㸸ࢥ࣮࣍ࢺ◊✲ࢆ࣮࣋ࢫ࡟ࡋࡓ๓ᚋẚ㍑ヨ㦂࠾ࡼࡧᆅᇦ㛫ࡢ⏕ែᏛⓗ◊✲ᑐ㇟㸸1) ᑐ㇟⪅㸸㇏୰ᕷẸ 38 ୓ே2) 㑅ᢥᇶ‽㸸㇏୰ᕷ࡟ᅾఫࠊᅾ໅ࡢ 11 ṓ௨ୖࡢᕷẸࠋ3) 㝖እᇶ‽㸸ᚰ㌟ᶵ⬟࡟㞀ᐖࡀ࠶ࡾࠊᚰ⫵⸽⏕ㅮ⩦࡟㐺ࡉ࡞࠸࡜ุ᩿ࡉࢀࡓࡶࡢࠋ4) ㅮ⩦఍ᐇ᪋ᑐ㇟⪅࡜ເ㞟ࡢ᪉ἲձᑠ୰㧗ᰯ⏕㸸Ꮫᰯࠊᩍ⫱ጤဨ఍ࡢ༠ຊࢆᚓ࡚ເ㞟ࢆ⾜࠺ࠋղ௻ᴗࠊ኱Ꮫࠊࡑࡢ௚ࡢᆅᇦఫẸ㸸௻ᴗࠊ኱Ꮫࠊ▷ᮇ኱Ꮫࠊᑓ㛛Ꮫᰯࠊ⪁ேࢡࣛࣈ㐃ྜ఍ࠊ୺㜵⅏⤌ྜࠊᕷ⫋ဨࠊᑠ࣭୰࣭㧗ᰯ⏕ࡢ∗඗➼࡟ᙜヱᕷࡢᗈሗࡸ Webࠊ᪂⪺ࠊಶูゼၥࢆ⾜࠺ࠋ5) ㅮ⩦఍ᣦᑟ┠ᶆேᩘ㸸ẖᖺேཱྀ 38 ୓ேࡢ 5%࡟࠶ࡓࡿ 19,000 ே࡟ᚰ⫵⸽⏕ㅮ⩦఍ࢆᐇ᪋ࡍࡿࠋᚑ᮶⾜ࡗ࡚࠸ࡓᶆ‽ᆺࡢᚰ⫵⸽⏕ἲㅮ⩦఍㸦ேᕤ࿧྾ࢆྵࡴࠊ3 ᫬㛫㸧⣙ 8000 ே࡟ຍ࠼࡚ࠊ⬚㦵ᅽ㏕ࡢࡳࡢ⸽⏕ἲ࡜ AED
ࡢ౑⏝ἲࢆ▷᫬㛫࡛ᣦᑟࡍࡿ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࢆ 11000 ே㹼12000 ே࡟ᐇ᪋ࡍࡿࠋ
◊✲ᐇ᪋ᮇ㛫㸸
2009 ᖺ࠿ࡽ 4 ᖺ㛫௓ධ᪉ἲ㸸1) ௓ධ㸦ㅮ⩦఍㸧ࡢෆᐜ㸸ᚑ᮶⾜ࡗ࡚࠸ࡓᶆ‽ᆺࡢᚰ⫵⸽⏕ἲㅮ⩦఍࡟ຍ࠼࡚ࠊ1 ே 1 యࡢࢺ࣮ࣞࢽࣥࢢேᙧࢆ㓄ഛࡋࠊࠗ⬚㦵ᅽ㏕ࡢࡳࡢᚰ⫵⸽⏕ἲ࡜ AED ࡢ౑⏝ἲ࠘ࢆࠊ45 ศ㛫࡛ከேᩘ㸦20 ྡ㹼200 ྡ⛬ᗘ㸧࡟ᣦᑟࡍࡿ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛ㸦௨ୗࠊPUSH ㅮ⩦఍㸧ࢆᒎ㛤ࡍࡿࠋ2) ㅮ⩦఍ࡢ㐠Ⴀ㸸ձ࢖ࣥࢫࢺࣛࢡࢱ࣮㸸ᾘ㜵ࡢ⫋ဨ࡟ຍ࠼ࠊᮏࣉࣟࢪ࢙ࢡࢺࡢࡓࡵ࡟஦๓࡟ࢺ࣮ࣞࢽࣥࢢࢆ✚ࢇࡔ་ᖌ࣭┳ㆤᖌ࣭ᩆ࿨ኈࠋ
ղㅮ⩦఍ෆᐜ㸸㻞㻡ղ-1㸸ㅮ⩦఍ᣦᑟෆᐜ㸸ᣦᑟෆᐜࢆ⤫୍ࡍࡿࡓࡵࠊ㐍⾜⏝ࡢࣅࢹ࢜ᩍᮦࢆ⏝࠸ࠊ45 ศ㛫㸦Ꮫᰯࡢᤵᴗࡢ 1 ࢥ࣐ศ࡟┦ᙜ㸧࡛⬚㦵ᅽ㏕ࡢ᪉ἲ࠾ࡼࡧ AED ᧯స᪉ἲ࡟ࡘ࠸࡚ࠊᣦᑟࢆ⾜࠺ࠋཷㅮ⏕ 1 ே࡟ࡘࡁ 1 యࡢࢺ࣮ࣞࢽࣥࢢேᙧࢆ⏝࠸ࡿࠋ
ղ-2㸸ㅮ⩦఍᫬㛫๭㸦⾲ 1㸧

ղ-3㸸ཷㅮ⏕ᩘ㸸1 ᅇ࠶ࡓࡾ 20㹼200 ྡ࡜ࡋࠊ20 ྡ࡟ 1 ேࡢ๭ྜ࡛⿵ຓᙺࡢ࢖ࣥࢫࢺࣛࢡࢱ࣮
ࢆ㓄⨨ࡍࡿࠋ
ղ-4㸸౑⏝ჾල㸸኱㜰ࣛ࢖ࣇࢧ࣏࣮ࢺ༠఍ࡢ CPR training Box ࢆ౑⏝ࡍࡿࠋせᅉ࡜㌿ᖐ ᐃ㸸1)ᐃ㡯┠ձ⡆᫆ㅮ⩦఍ཷㅮ⏕ࡢࢹ࣮ࢱ㸸ᖺ㱋ࠊᛶูղᚰ೵Ṇᝈ⪅ࡢࢹ࣮ࢱ㸦㌿ᖐࢹ࣮ࢱ㸧㸸㇏୰ᕷ࡛Ⓨ⏕ࡋࡓᩆᛴ㝲ࡢ㛵ࢃࡿࡍ࡭࡚ࡢ㝔እᚰ೵Ṇᝈ⪅ࡢᛶูࠊᖺ㱋ࠊᬑẁࡢ⏕ά≧ែࠊᚰ⫵೵Ṇ┠ᧁ≧ἣࠊ┠ᧁ⪅࡜ᚰ೵Ṇᝈ⪅ࡢ㛵ಀ㸦ᐙ᪘ࠊ཭ேࠊྠ൉ࠊ㏻⾜ேࠊᾘ㜵㝲ဨࠊᩆᛴ㝲ဨࠊᩆᛴᩆ࿨ኈ㝲㸧ࠊᚰ⫵೵Ṇሙᡤࠊᚰ೵Ṇ᫬ࡢ≧ἣࠊཱྀ
㢌ᣦᑟࠊBystander CPRࠊBystander CPR ࡢ㉁ࠊᕷẸ࡟ࡼࡿ㝖⣽ືࠊ᫬㛫⤒㐣(ぬ▱᫬้ࠊฟሙ᫬
้ࠊ⌧ሙ฿╔᫬้ࠊᝈ⪅᥋ゐ᫬้ࠊ㝲ဨ࡟ࡼࡿ CPR 㛤ጞ᫬้ࠊึᅇ㝖⣽ືᐇ᪋᫬้)ࠊᩆᛴ㝲฿╔᫬ࡢ་ᖌ࡟ࡼࡿ 2 ḟᩆ࿨ฎ⨨ࠊึᮇᚰ㟁ᅗἼᙧࠊ஧ḟᩆ࿨ฎ⨨ࠊᚰ೵Ṇ࡟⮳ࡗࡓཎᅉࠊⓎ⑕ 1 ࣨ᭶ᚋ⏕ᏑࠊⓎ⑕ 1 ࣨ᭶ᚋࡲࡓࡣ㏥㝔᫬ࡢ⬻ᶵ⬟ࠊᩆຓ⪅ࡢᖺ㱋ࠊᛶูࠊᚰ⫵⸽⏕ㅮ⩦఍㸦AED ࢆྵࡴ㸧ཷㅮṔࠊճᩆ࿨ព㆑ࡢㄪᰝ
ճ㸫㸯㸸ㅮ⩦఍๓ᚋࡢᩆ࿨ព㆑ࡢኚ໬㸦ᖺ㱋࣭ᛶู࣭⫋ᴗ࣭⸽⏕ᩍ⫱ㅮ⩦ࡢཷㅮࡢ᭷↓࣭ᚰ⫵⸽⏕ᐇ᪋ࡢ✚ᴟᛶ࣭ᚰ⫵⸽⏕ᐇ᪋ࢆ㌋㌉ࡍࡿ⌮⏤࣭AED ౑⏝ࡢ✚ᴟᛶ࣭AED ࢆࡓࡵࡽ࠺⌮⏤㸧ճ㸫㸰㸸↓సⅭ໬ᢳฟ࡟ࡼࡿᆅᇦఫẸࡢᩆ࿨ព㆑ࡢኚ໬㸦ᖺ㱋࣭ᛶู࣭⫋ᴗ࣭⸽⏕ᩍ⫱ㅮ⩦ࡢཷㅮࡢ᭷↓࣭ᚰ⫵⸽⏕ᐇ᪋ࡢ✚ᴟᛶ࣭ᚰ⫵⸽⏕ᐇ᪋ࢆ㌋㌉ࡍࡿ⌮⏤࣭AED ౑⏝ࡢ✚ᴟᛶ࣭AED
౑⏝ࢆࡓࡵࡽ࠺⌮⏤㸧2)ᐃ᪉ἲձཷㅮ⏕ࡢࢹ࣮ࢱ㸸ㅮ⩦఍ཷㅮ⪅ࡢᖺ㱋ࠊᛶูࡢࢹ࣮ࢱࡣㅮ⩦఍⤊஢ᚋ࡟ࠊWeb ࢹ࣮ࢱ࣮࣋ࢫ
࡬Ⓩ㘓ࡉࢀࡿࠋ
ղᚰ೵Ṇᝈ⪅ࡢࢹ࣮ࢱ㸦㌿ᖐࢹ࣮ࢱ㸧㸸㌿ᖐࢹ࣮ࢱ࡟ࡘ࠸࡚ࡣࠊᩆᛴ㝲ࡀ᪥ᖖⓗ࡟཰㞟ࡋ࡚࠸ࡿ㝔እᚰ೵Ṇࢹ࣮ࢱࢆ⏝࠸ࡿࠋ
ճ㉁ၥ⣬ㄪᰝ࡟ࡼࡿᩆ࿨ព㆑ࡢኚ໬

㻞㻢ճ㸫㸯㸸ㅮ⩦఍ཷㅮ⪅࡟ᑐࡋࠊㅮ⩦఍㛤ጞ๓⤊஢┤ᚋࡢ2ᅇࠊᩆ࿨ព㆑࡟㛵ࡍࡿ㉁ၥ⣬ㄪᰝࢆ⾜
࠺ࠋ2ᅇศࡢㄪᰝ⚊ࢆ㐃⤖ࡉࡏࡿࡓࡵ࡟㸪ྛᑐ㇟⪅ࡢ㆑ู␒ྕࢆ௜グࡋࡓࡶࡢࢆ౑⏝ࡍࡿ.
ճ㸫㸰㸸ᆅᇦ࡛ㅮ⩦఍ᑟධ๓ࠊ࠾ࡼࡧᑟධࡢ 1㸪2㸪3 ᖺᚋ㸦ᆅᇦఫẸࡢ 5㸪10㸪15%࡟ᑐࡍࡿᐇ
᪋ࡀ┠ᶆ㸧᫬Ⅼ࡛ࠊᆅᇦఫẸ 100㹼200 ྡࢆ↓సⅭᢳฟࡋࠊᩆ࿨ព㆑࡟㛵ࡍࡿ㉁ၥ⣬ㄪࢆ⾜࠺ࠋࡲࡓࠊ௓ධᆅᇦ௨እࡢ୍⯡ఫẸ 1200 ྡࢆ↓సⅭᢳฟࡋࠊᩆ࿨ព㆑࡟㛵ࡍࡿ㉁ၥ⣬ㄪࢆ⾜࠸ࠊ௓ධᆅᇦ࡜ẚ㍑ࡍࡿࠋ3) ホ౯㡯┠ࡢᐃ⩏ձ୺せ㌿ᖐ㸸Bystander CPR ࡢ᭷↓ղ๪ḟ㌿ᖐ㸸Bystander CPR ࡢ✀ูࠊึᮇᚰ㟁ᅗἼᙧࠊᕷẸ࡟ࡼࡿ AED ౑⏝ࡢ᭷↓ࠊCPR ㅮ⩦఍ཷㅮࡢ᭷↓ࠊBystander CPR ࡢ㉁ࠊ᫬㛫⤒㐣㸦ぬ▱᫬้ࠊฟሙ᫬้ࠊ⌧ሙ฿╔᫬้ࠊBystander
CPR 㛤ጞࡲ࡛ࡢ᫬㛫ࠊᝈ⪅᥋ゐ᫬้ࠊ㝲ဨ࡟ࡼࡿ CPR 㛤ጞ᫬้ࠊึᅇ㝖⣽ືᐇ᪋᫬้㸧ࠊⓎ⑕
1 ࣨ᭶ᚋ⏕ᏑࠊⓎ⑕ 1 ࣨ᭶ᚋࡢ⬻ᶵ⬟ࠊᩆ࿨ព㆑࢔ࣥࢣ࣮ࢺ㸦ᖺ㱋࣭ᛶู࣭⫋ᴗ࣭⸽⏕ᩍ⫱ㅮ⩦ࡢཷㅮࡢ᭷↓࣭ᚰ⫵⸽⏕ᐇ᪋ࡢ✚ᴟᛶ࣭ᚰ⫵⸽⏕ᐇ᪋ࢆ㌋㌉ࡍࡿ⌮⏤࣭AED ౑⏝ࡢ✚ᴟᛶ࣭
AED ౑⏝ࢆࡓࡵࡽ࠺⌮⏤㸧㸧೔⌮㠃࡬ࡢ㓄៖ᮏ◊✲ࡣ࣊ࣝࢩࣥ࢟ᐉゝ࠾ࡼࡧ␿Ꮫ◊✲࡟㛵ࡍࡿ೔⌮ᣦ㔪ࢆ㑂Ᏺࡋ࡚ᐇ᪋ࡋࡓࠋ㞟ィ࣭ゎᯒ࡟࠶ࡓࡗ࡚ࡣࠊᑐ㇟⪅ྠᐃ᝟ሗࡣ๐㝖ࡋ༏ྡ໬ࢆ⾜ࡗࡓࠋ࡞࠾ࠊᮏ◊✲ࡣி㒔኱Ꮫ኱Ꮫ㝔་Ꮫ◊✲⛉࣭་Ꮫ㒊་ࡢ೔⌮ጤဨ఍࡟࡚ᢎㄆࢆᚓ࡚࠸ࡿࠋ
⤖ᯝ㸸኱㜰ᗓ㇏୰ᕷ㸦ேཱྀ 38 ୓ே㸧࡟࠾࠸࡚ࠊ2010 ᖺ 4 ᭶㹼2011 ᖺ 9 ᭶ࡲ࡛ࡢᮇ㛫࡛ࠊ⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆ⏝࠸ࡓ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛࢆ 264 ᅇࠊཷㅮ⪅ேᩘ 16,265 ྡࠊᚑ᮶ᆺࡢᚰ⫵⸽⏕ㅮ⩦఍ࢆ 404 ᅇࠊཷㅮ⪅ேᩘ 10,384 ྡࠊᘏ࡭ཷㅮ⪅ேᩘ 26,649 ྡ㸦㇏୰ᕷேཱྀࡢ
6.9㸣㸧࡟ᑐࡋ࡚ᐇ᪋ࡋࡓ(ᅗ 1)ࠋ

10.0⬚㦵ᅽ㏕䛾䜏䛾CPRㅮ⩦
8.0

6.9

ᚑ᮶ᆺ䛾CPRㅮ⩦

5.5

6.0

4.8
4.2

4.0

3.0
2.1

2.0

1.3
0.5

4-6

3.0
2.6

1.7
1.5

1.1

0.8

0.0

3.5

1.0

7-9

1.5

1.8

10-12

1-3

2010

2.2

2.5

2.7

4-6

7-9

10-12

2011

ᅗ 1 ⣼✚ CPR ㅮ⩦ཷㅮ⪅๭ྜࡢ⤒㐣

㻞㻣

(᭶)

ཷㅮ⪅ࡢෆヂࡣࠊ୍⯡ᕷẸࡀ 28%ࠊ⥆࠸࡚୰Ꮫ⏕ࡀ 13㸣ࠊᑠᏛ⏕ࡀ 9㸣ࠊ㧗ᰯ⏕ 8㸣ࠊᩍဨ 7㸣ࠊ఍♫ဨ 7㸣࡛࠶ࡗࡓ(ᅗ 2)ࠋ

䝪䝷䞁䝔䜱䜰
㻠㻑

㻼㼀㻭
㻡㻑
௓ㆤ㛵ಀ
㻢㻑

䛭䛾௚
㻢㻑
୍⯡ᕷẸ
㻞㻤㻑

බົဨ
㻣㻑
఍♫ဨ
㻣㻑
ᩍဨ
㻣㻑

୰Ꮫ⏕
㻝㻟㻑

㧗ᰯ⏕㻌ᑠᏛ⏕㻤㻑㻥㻑ᅗ 2 CPR ㅮ⩦ཷㅮ⪅ࡢෆヂ㇏୰ᕷࡀᥖࡆ࡚࠸ࡿ
ࠗ㇏୰ ᩆ࿨ຊୡ⏺୍ᐉゝ࠘ࢆ▱ࡗ࡚࠸ࡿ⪅ࡣࠊ
2010 ᖺ 5 ᭶ࡢㄪᰝ࡛ࡣ 24.0㸣ࠊ2011 ᖺ 5 ᭶࡛ࡣ 29.0㸣ࠊ2012 ᖺ 1 ᭶࡛ࡣ 22.0㸣࡛࠶ࡗࡓ(ᅗ 3-1)ࠋ

㇏୰ᕷ(2010ᖺ5᭶200ྡ䚸2011ᖺ5᭶200ྡ)௚ᆅᇦ䝷䞁䝎䝮䝃䞁䝥䝸䞁䜾(2011ᖺ7᭶1200ྡ)䖃㇏୰ᕷ䛜ᥖ䛢䛶䛔䜛䛄㇏୰ ᩆ࿨ຊୡ⏺୍ᐉゝ䛅䜢
29▱䛳䛶䛔䜎䛩䛛䚹
30
24
22<▱䛳䛶䛔䜛>20
2010.5 ㇏୰24.0% (48/200) (%)
10
2011.5 ㇏୰29.0% (58/200)02012.1 ㇏୰22.0% (44/200)
1
2
3

2010ᖺ 2011ᖺ 2012ᖺ
1᭶
5᭶
5᭶

ᅗ 3-1 ᩆ࿨ព㆑࢔ࣥࢣ࣮ࢺ(ᆅᇦ)
㇏୰ᕷࡢᆅᇦఫẸࢆᑐ㇟࡜ࡋࡓ㉁ၥ⣬ㄪᰝ࡛ࡣࠊࠕࡶࡋぢ▱ࡽࡠேࡀ࠶࡞ࡓࡢ┠ࡢ๓࡛ಽࢀ࡚࠸
࡚ព㆑ࡀ࡞࠸ࡼ࠺࡞ࡽࠊ࠶࡞ࡓ⮬ࡽᚰ⫵⸽⏕ἲࢆヨࡳࡼ࠺࡜ᛮ࠸ࡲࡍ࠿㸽ࠖ࡜࠸࠺㉁ၥ࡟ᑐࡋ࡚ࠊ

㻞㻤

2010 ᖺ 5 ᭶ࡢㄪᰝ࡛ࡣ 40.5㸣ࠊ2011 ᖺ 5 ᭶࡛ࡣ 34.0㸣ࠊ2012 ᖺ 1 ᭶࡛ࡣ 40.5㸣ࡀࠕࡑ࠺ᛮ࠺ࠖ
࡜ᅇ⟅ࡋࠊ2011 ᖺ 7 ᭶࡟᪋⾜ࡋࡓ௚ᆅᇦ࡟࠾ࡅࡿྠ㉁ၥ࡛ࡣ 32.6%࡛࠶ࡗࡓ(ᅗ 3-2)ࠋ

䖃䜒䛧ぢ▱䜙䛼ே䛜䛒䛺䛯䛾┠䛾๓䛷ಽ䜜䛶䛔䛶ព㆑䛜䛺䛔䜘䛖䛺䜙䚸䛒䛺䛯⮬䜙ᚰ⫵⸽⏕ἲ(ேᕤ࿧྾䜔ᚰ⮚䝬䝑䝃䞊䝆)䜢ヨ䜏䜘䛖䛸ᛮ䛔䜎䛩䛛䚹60<䛭䛖ᛮ䛖>
2010.5 ㇏୰40.5% (81/200)
41
41
40
34
2011.5 ㇏୰34.0% (68/200)
33 30
(%)
2012.1 ㇏୰40.5% (81/200)
௚20
2011.7 ௚ᆅᇦ32.6% (391/1200)
ᆅ㇏ᇦ
2012.7 ௚ᆅᇦ30.1% (361/1200)
୰
0

㻝

10.5

㻞

㻟

㻠

㻡

12.1

11.7

12.1

11.5

䖃䜒䛧ᚰ⮚䝬䝑䝃䞊䝆䛰䛡䛷Ⰻ䛔䛺䜙䜀䜔䛳䛶䜏䜘䛖䛸ᛮ䛔䜎䛩䛛䚹ୖグ㉁ၥ䛷䚸䡞䛭䛖ᛮ䛖䡟䛸⟅䛘䛺䛛䛳䛯ே䛾䜏䜈䛾㉁ၥ䚹 60<䛭䛖ᛮ䛖>
40 35
2010.5 ㇏୰35.3% (42/119)
33 33
(%)
2011.5 ㇏୰33.3% (44/132)
20 20
20
2012.1 ㇏୰33.6% (40/119)௚㇏ᆅ
2011.7 ௚ᆅᇦ20.3% (159/782)୰ᇦ
02012.1 ௚ᆅᇦ20.5% (171/835)
12.1
㻝

10.5

㻞

㻟

㻠

㻡

11.7

12.1

11.5

ᅗ 3-2 ᩆ࿨ព㆑࢔ࣥࢣ࣮ࢺ(ᆅᇦ)ࠕ⬚㦵ᅽ㏕ࡢࡳࡢᚰ㓄⸽⏕ἲ࡛ࡶࠊேᕤ࿧྾ࢆࡍࡿᚰ⫵⸽⏕࡜ྠࡌࡄࡽ࠸ຠᯝࡀ࠶ࡿ࡜࠸࠺ࡇ࡜
ࢆ௒ࡲ࡛⪺࠸ࡓࡇ࡜ࡀ࠶ࡾࡲࡍ࠿㸽ࠖ࡜࠸࠺㉁ၥ࡟ᑐࡋ࡚ࠊ2010 ᖺ 5 ᭶ࡢㄪᰝ࡛ࡣ 46.0㸣ࠊ2011
ᖺ 11 ᭶࡛ࡣ 53.5㸣ࠊ2012 ᖺ 1 ᭶࡛ࡣ 54.0㸣ࡀࠕࡑ࠺ᛮ࠺ࠖ࡜ᖺࠎቑຍࡋ࡚࠾ࡾࠊ2011 ᖺ 7 ᭶࡟᪋⾜ࡋࡓ௚ᆅᇦ࡟࠾ࡅࡿྠ㉁ၥ࡛ࡣ 46.9%࡛࠶ࡗࡓࠊ(ᅗ 3-3)ࠋ

䖃⬚㦵ᅽ㏕䠄ᚰ⮚䝬䝑䝃䞊䝆䠅䛾䜏䛾ᚰ⫵⸽⏕ἲ䛷䜒䚸ேᕤ࿧྾䜢䛩䜛ᚰ⫵⸽⏕ἲ䛸ྠ䛨䛠䜙䛔ຠᯝ䛜䛒䜛䛸䛔䛖䛣䛸䜢௒䜎䛷⪺䛔䛯䛣䛸䛜䛒䜚䜎䛩䛛䚹
60
<䛿䛔>
54 54
46
46 47
2010.5 ㇏୰46.0% (92/200)
40
2011.5 ㇏୰53.5% (107/200)(%)
2012.1 ㇏୰54.0% (108/200)
௚㇏ 20
2011.7 ௚ᆅᇦ45.7% (548/1200)
ᆅ୰ᇦ
2012.1 ௚ᆅᇦ46.9% (563/1200)
0
㻝

10.5

㻞

11.5

㻟

12.1

㻠

11.7

㻡

12.1

䖃ᐇ㝿䛻┠䛾๓䛷ே䛜ಽ䜜䛯䜙AED䛜䛒䜜䜀౑⏝䛧䛶䜏䜘䛖䛸ᛮ䛔䜎䛩䛛䚹60<䛭䛖ᛮ䛖>48 46 49
2010.5 ㇏୰47.5% (94/200)
37 39
40
2011.5 ㇏୰46.0% (92/200)(%)
2012.1 ㇏୰48.5% (97/200)
20
௚
2011.7 ௚ᆅᇦ36.9% (443/1200)
㇏ᆅ୰
2012.1 ௚ᆅᇦ39.4% (473/1200)
ᇦ
0

㻝

10.5

㻞

11.5

ᅗ 3-2 ᩆ࿨ព㆑࢔ࣥࢣ࣮ࢺ(ᆅᇦ)

㻞㻥

㻟

12.1

㻠

11.7

㻡

12.1

ࡲࡓᑠᏛ⏕ 5࣭6 ᖺ⏕ࢆᑐ㇟࡟ࡋࡓ 45 ศ⡆᫆ㅮ⩦఍ࡢ๓ᚋ࡛ࡢᩆ࿨ព㆑ㄪᰝ࡛ࡣࠊ
ࠕࡶࡋ▱ࡽ࡞࠸
ேࡀ┠ࡢ๓࡛ಽࢀࡓࡽࠊኌࢆ࠿ࡅ࡚ࠊ119 ␒㏻ሗ࡞࡝ࠊఱ࠿ฟ᮶ࡿࡇ࡜ࢆࡋࡼ࠺࡜ᛮ࠸ࡲࡍ࠿㸽ࠖ
࡜࠸࠺㉁ၥ࡟ᑐࡋ࡚ࠊࠕࡑ࠺ᛮ࠺ࠖ࡜ࡢᅇ⟅ࡣࠊㅮ⩦๓ࡢ 50.2㸣࠿ࡽㅮ⩦ᚋ࡟ࡣ 75.2㸣࡜ୖ᪼ࡋ
ࡓ(ᅗ 4)ࠋ

45ศ⡆᫆ㅮ⩦2010ᖺ5᭶䡚2011ᖺ4᭶
Q䠖䜒䛧▱䜙䛺䛔ே䛜┠䛾๓䛷ಽ䜜䛯䜙䚸ኌ䜢䛛䛡䛶䚸
119␒㏻ሗ䛺䛹䚸ఱ䛛䛷䛝䜛䛣䛸䜢䛧䜘䛖䛸ᛮ䛔䜎䛩䛛?
ㅮ⩦๓ᑠᏛ⏕5䡡6ᖺ⏕1899ே

2.2 1.2
16.1

50.2

ㅮ⩦ᚋ
0.5 0.5
5.1

䛭䛖ᛮ䛖

18.3

75.6

ᑡ䛧䛭䛖ᛮ䛖

䛹䛱䜙䛸䜒䛔䛘䛺䛔䛒䜎䜚䛭䛖ᛮ䜟䛺䛔30.3

䛭䛖ᛮ䜟䛺䛔

ᅗ 4 ᩆ࿨ព㆑࢔ࣥࢣ࣮ࢺ(ᑠᏛᰯ)ճᡂ ᯝ⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆά⏝ࡍࡿࡇ࡜࡛ࠊᚑ᮶ࡢ᪉ἲ࡜ẚ㍑ࡋ࡚ࠊ኱ᖜ࡟ከࡃࡢఫ
Ẹ࡟ᑐࡋࠊᚰ⫵⸽⏕ㅮ⩦఍࡟ཧຍࡍࡿࡇ࡜ࡀྍ⬟࡜࡞ࡗࡓࠋࡇࢀࡣࠊࡇࢀࡲ࡛࡟ከࡃࡢᆅᇦ࡛⾜ࢃࢀ࡚ࡁࡓᚰ⫵⸽⏕ㅮ⩦఍ᐇ᪋つᶍࡢᩘಸ࡟࠾ࡼࡧࠊᚑ᮶ࡢ 3 ᫬㛫ࢆせࡍࡿᶆ‽ⓗ࡞ᚰ⫵⸽⏕ἲㅮ⩦఍ࡢࡳ࡛ࡣ㐩ᡂࡍࡿࡇ࡜ࡢ࡛ࡁ࡞࠸つᶍ࡛࠶ࡾࠊ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆά⏝ࡍࡿࡇ࡜࡛ࠊᆅᇦ
࡬ࡢᚰ⫵⸽⏕ἲᬑཬࢆ㐍ࡵࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࡇ࡜ࢆᐇドࡋࡓ㈗㔜࡞ᆅᇦ௓ධࣔࢹ࡛ࣝ࠶ࡿࠋ
2011 ᖺ 10 ᭶࡟ࡣ⣙ 3000 ேࡶࡢཷㅮ⪅࡟ᑐࡋ࡚኱つᶍ࡞ㅮ⩦఍ࢆᐇ᪋ࡋࡓࠋࡇࢀࡣ୍ᗘ࡟⾜ࡗࡓᚰ⫵⸽⏕ㅮ⩦఍࡛ࡣ᪥ᮏ᭱ከࡢࡶࡢ࡛࠶ࡿࠋẖᖺேཱྀࡢ 5㸣࡟ᑐࡋ࡚ᚰ⫵⸽⏕ㅮ⩦ࢆᥦ౪ࡍࡿ
࡜ࡢணᐃ࡛࠶ࡗࡓࡀࠊ2011 ᖺᮎ᫬Ⅼ࡛⣙ 7%࡛࠶ࡾࠊࡑࡢ┠ᶆࡣ㐩ᡂ࡛ࡁ࡚࠸࡞࠸ࡀࠊ௓ධᆅᇦ
࡟࠾࠸࡚⡆᫆ᆺㅮ⩦఍ࡣᚑ᮶ᆺㅮ⩦఍ࡢ⣙ 2 ಸ࡟㐩ࡋ࡚࠸ࡿࠋࡇࢀࡣ⡆᫆ᆺㅮ⩦఍ࡀᆅᇦ࡟ᾐ㏱
ࡋࡘࡘ࠶ࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿ࡜ᛮࢃࢀࡿࠋᆅᇦ࡛ࡢᩆ࿨ព㆑ㄪᰝ࡛ࡣࠊ⬚㦵ᅽ㏕ࡢࡳࡢᚰ⫵⸽⏕࡜ேᕤ࿧྾ࡘࡁࡢᚑ᮶ᆺࡢᚰ⫵⸽⏕ࡀ࡯ࡰྠࡌຠᯝࢆᣢࡘࡇ࡜ࢆ⌮ゎࡋ࡚࠸ࡿ㖠ぢ௵ࡢ๭ྜࡀ
ᚎࠎ࡟ቑຍࡋ࡚࠾ࡾࠊ௚ᆅᇦࡼࡾࡶࡑࡢ๭ྜࡀከࡃࠊఫẸࡢ⬚㦵ᅽ㏕࡟㛵ࡍࡿㄆ㆑ࡶኚࢃࡾࡘࡘ
࠶ࡿ࡜ᛮࢃࢀࡿࠋࢩ࣏ࣥࢪ࣒࢘ࡢ㛤ദ࡞࡝)ࠊᆅᇦ࡟࠾ࡅࡿᚰ⫵⸽⏕ᬑཬࡢࡓࡵࡢၨⓎάື࡟ࡶຊ
ࢆධࢀ࡚࠾ࡾࠊ௒ᚋࠊ◊✲ᮇ㛫୰࡟┠ᶆ࡜ࡍࡿ㇏୰ᕷேཱྀࡢ 16%࡟ㅮ⩦఍ࢆᐇ᪋࡛ࡁࡿࡼ࠺࡟ࠊ
ᚰ⫵⸽⏕ἲㅮ⩦఍ࡢᬑཬࢆ⥅⥆ࡋࠊᆅᇦఫẸࡢᩆ࿨ព㆑ࡢྥୖࠊᚰ⫵⸽⏕ᐇ᪋๭ྜࡢྥୖ࡞࡝ࡢຠᯝ᳨ドࢆ㐍ࡵ࡚࠸ࡃணᐃ࡛࠶ࡿࠋ
ࡲࡓࠊ45 ศ⡆᫆ㅮ⩦఍ࡣᑠᏛ⏕ࡢᩆ࿨ព㆑ࢆ㧗ࡵࡿࡇ࡜ࡀᮏ◊✲࠿ࡽ᫂ࡽ࠿࡟࡞ࡗࡓࠋᑠᏛ⏕࡟ᑐࡋ࡚࡝ࡢࡼ࠺࡞ᚰ⫵⸽⏕ㅮ⩦఍ࢆ⾜࠺࡭ࡁ࠿㆟ㄽࡣከࡃ࠶ࡿࡀࠊࡇࡢ⡆᫆ࡢㅮ⩦఍࡛⬚㦵ᅽ㻟㻜㏕ࡢయ㦂ࡋࠊ࿨ࡢ኱ษࡉࢆᏛࡪࡇ࡜ࡣࠊᏛᰯᩍ⫱ࡢ୍ࡘࡢࣔࢹࣝ࡜࡞ࡿ࡜ᛮࢃࢀࡿࠋ

⤖ㄽ㸸࣐ࢫࢺ࣮ࣞࢽࣥࢢࡢᬑཬຠᯝ࡟ࡘ࠸࡚ࡣࠊ⌧ᅾࡶ㐍⾜୰ࡢࡓࡵᮍ☜ᐃ࡛࠶ࡿࡀࠊ45 ศ⡆᫆ㅮ⩦఍ࡣᑠᏛ⏕ࡢᩆ࿨ព㆑ࢆᨵၿࡍࡿࡢ࡟ᙺ❧ࡘ࡜⪃࠼ࡽࢀࡿࠋᏛ఍Ⓨ⾲㸸

Iwami T, Kitamura T, Nishiyama C, Ohta K, Kaneko H, Kanna T, Takahashi H, Nachi S,
Matsumi H, Yonezawa T, Tanaka H. Systematic CPR training in elementary schools andstudents’ attitudes toward CPR and AED use. 236. Presented at the 2011 American Heart
Association Scientific Session, Resuscitation Science Symposium. Orland, Fla, Nov 13, 2011.
մ◊✲௦⾲⪅㸦ཪࡣཷධ◊✲⪅㸧ࡢホ౯ᮏࣜࢧ࣮ࢳ࣭ࣞࢪࢹࣥࢺࡣࠊ
ࠕ⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ᆺᚰ⫵⸽⏕ἲࢆ⏝࠸ࡓ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟ
ࢢ࣒ࣛࡢᆅᇦᒎ㛤࡜ࡑࡢຠᯝ᳨ド࡟㛵ࡍࡿ◊✲ࠖ࡟࠾࠸࡚ࠊ◊✲ᶵ㛵ࠊ⾜ᨻ࡞ࡽࡧ࡟ᆅᇦ♫఍࡜ࡢᐦ᥋࡞㐃⤡ࢆ⾜࠸ࠊࡑࢀࡽࢆࡲ࡜ࡵࡿㄪᩚᙺ࡜ࡋ࡚ࠊࡲࡓ࣐ࢫࢺ࣮ࣞࢽࣥࢢࣉࣟࢢ࣒ࣛ࡟࠾ࡅ
ࡿᚰ⫵⸽⏕ㅮ⩦఍ࡢ㐠Ⴀ࣭ᐇ᪋࡟✚ᴟⓗ࡟ᚑ஦ࡋࡓࠋᮏ◊✲࡟࠾ࡅࡿࠊ⬚㦵ᅽ㏕ࡢࡳࡢ⡆᫆ㅮ⩦఍ࡢᬑཬࡣࠊᆅᇦ࡛ࡢࣂ࢖ࢫࢱࣥࢲ࣮CPR ࡢᐇ᪋๭ྜࢆୖࡆࡿࡓࡵࡢ㘽࡜࡞ࡿࡶࡢ࡛࠶ࡾࠊ㇏୰
ᕷࡣࡑࡢࣔࢹࣝࢣ࣮ࢫ࡜ࡋ࡚㔜せ࡛࠶ࡿࠋㅮ⩦఍ࡢᬑཬຠᯝࢆホ౯ࡍࡿࡓࡵ࡟ࡣࡉࡽ࡞ࡿほᐹᮇ㛫ࡀᚲせ࡛࠶ࡿࡀࠊᆅᇦఫẸࡸᑠᏛ⏕࡟ᑐࡍࡿᩆ࿨ព㆑ᨵၿ࡟㈉⊩ࡍࡿྍ⬟ᛶࢆ♧၀ࡋ࡚࠾ࡾࠊ
ࡇࢀࡽࡢ⤖ᯝࡣⱥㄒㄽᩥ࡜ࡋ࡚ᢞ✏ࡍࡿணᐃ࡛࠶ࡿࠋࡋࡓࡀࡗ࡚ࠊᮏ◊✲ࡣࠊ⸽⏕⛉Ꮫࡢ㐍Ṍ࡟኱ࡁ࡞㈉⊩ࡀ࠶ࡿ࡜☜ಙࡍࡿࠋཷධ◊✲⪅ ▼ぢ ᣅ㻟㻝