∝଀ႎ๔ஜᐽ⸻ᢿߢਔ஥⢖㐷࡝ࡦࡄ▵⣲⣘ࠍᜰ៰ߐࠇߚࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩ 1 ଀⮮Ỉ㓶ᐔ 㧕㈬੗⃨⟤ 㧕☨↰ᄥ㇢ 㧕ේਂ੺ 㧕ᩮ਄᣽ሶ 㧕₵㓁ᐔ 㧕㚍ᷰཅᦶ 㧕㧕ᕺኼ✚ว∛㒮ౝ⑼㧕หஜᐽ▤ℂ࠮ࡦ࠲࡯㧕หᓴⅣེౝ⑼㧕ห⌒⑼‫ⷐޣ‬ᣦ‫ޤ‬∝଀ߪ 55 ᱦᅚᕈ‫ޕ‬ஜᐽ⸻ᢿߦߡਔ஥⢖㐷࡝ࡦࡄ▵⣲ᒛ㧔BHL㧕ࠍᜰ៰ߐࠇ㧘2 ᰴஜᐽ⸻ᢿ⋡⊛ߦߡᒰ㒮ౝ⑼ࠍฃ⸻ߒߚ‫ޕ‬り૕⸻ኤߢ࡝ࡦࡄ▵⣲⣘╬ߩ⇣Ᏹᚲ⷗ߪ⹺߼ߥ߆ߞߚ‫ޕ‬⢷ㇱ CT ߢ߽ BHL એᄖߦ⇣Ᏹᚲ⷗ࠍ⹺߼ߥ߆ߞߚ‫⚻ޕ‬᳇▤ᡰ⢖↢ᬌߦߡ㧘ᄙᩭᏂ⚦⢩ߣ㕖ੇ㈼ᕈ⡺⧘⣲ࠍ⹺߼㧘ࠨ࡞ࠦࠗ࠼࡯ࠪࠬߣ⸻ᢿߒߚ‫ޕ‬⃻࿷⚻ㆊⷰኤ⋡⊛ߦߡήᴦ≮ߢᄖ᧪ㅢ㒮ਛߢ޽ࠅ㧘8 ࡨ᦬⋡ߩ⢷ㇱන⚐ X ✢ߢᏀ⢖㐷࡝ࡦࡄ▵ߪ 58%❗ዊߒߚ‫ޕ‬Key Words㧦ࠨ࡞ࠦࠗ࠼࡯ࠪࠬ㧘ਔ஥⢖㐷࡝ࡦࡄ▵⣲ᒛ㧘ᄙᩭᏂ⚦⢩ࠍ઻߁㕖ੇ㈼ᕈ⡺⧘⣲‫ޤߦ߼ߓߪޣ‬3.7 %㧘Bas 0.7 %㧘Mon 8.6 %㧘Lym 24.0 %㧕RBCࠨ࡞ࠦࠗ࠼࡯ࠪࠬߪේ࿃ਇ᣿ߩోりᕈᘟᕈ⡺⧘⣲

512×104 /l㧘Hb 13.9 g/dl㧘Ht 41.3 %㧘MCV 80.7 fl㧘ᕈἻ∝∔ᖚߢ޽ࠅ㧘㕖ੇ㈼㘃਄⊹ᕈ⡺⧘⣲ࠍోりᄙ

Plt 18.7×104 /l㧘T-P 7.4 g/dl㧘Alb 4.1 g/dl㧘LDH⤳ེߦ↢ߓࠆ‫∝⊒ޕ‬ᐕ㦂ߪ↵㧘ᅚߣ߽ߦ 20 ᱦઍ߇

232 IU/l㧘CRP 0.1 mg/dl㧘BUN 14.0 mg/dl㧘Cre 0.6

67.7%㧘42.2%ߣᦨ߽ᄙߊ㧘ஜᐽ⸻ᢿߢ⢷ㇱන⚐ Xmg/dl㧘Na 140 mEq/l㧘K 4.8 mEq/l㧘Ca 9.6 mEq/l㧘✢౮⌀ࠍᄾᯏߦ஧ὼ⊒⷗ߐࠇࠆߎߣ߇ 59.7%ߣᦨ߽

P 4.3 mg/dl㧘ⴊᷡ࡝࠱࠴࡯ࡓ 16.4 g/ml㧘ᄙ޿ 1)‫ޕ‬ஜᐽ⸻ᢿߦߡ BHL ࠍ⹺߼㧘⚻᳇▤ᡰ㏜⢖

ACE 37.4 U/I㧘CEA 2.5 ng/ml㧘AFP ቯ㊂ 6.2 ng/ml㧘↢ᬌߢ⏕ቯ⸻ᢿߦ⥋ߞߚౖဳ⊛ߥࠨ࡞ࠦࠗ࠼࡯ࠪࠬCYFRA 1.7 ng/ml㧘࠷ࡌ࡞ࠢ࡝ࡦ෻ᔕ 㒶ᕈߩ∝଀ࠍ⚻㛎ߒߚߩߢႎ๔ߔࠆ‫ޕ‬⢷ㇱන⚐ X ✢㧔࿑ 1㧕㧦2 ᐕ೨ߩ⢷ㇱන⚐ X ✢౮⌀ߣᲧセߒߡ᣿ࠄ߆ߥ BHL ࠍ⹺߼ߚ‫ޕ‬‫ޤ଀∝ޣ‬⢷ㇱන⚐ CT㧔࿑ 2㧕㧦❑㓒㧘⢖㐷ߦᄙᢙߩ࡝ࡦࡄ▵ᖚ⠪㧦55 ᱦ ᅚᕈ⣲ᒛࠍਔ஥ᕈߦ⹺߼ߚ‫ޕ‬⢖㊁∛ᄌߪ⹺߼ߥ߆ߞߚ‫ޕ‬ਥ⸷㧦Ḩᕈຕ༿ᔃ㔚࿑㧦ᔃᜉᢙ 61/ಽ㧘ᢛ㧘ᱜゲ㧘PR 㑆㓒 0.16 ⑽㧘

ᣢᓔᱧ㧦37 ᱦᤨߦᏀෆᎽ⣲≌ಾ㒰ⴚ㧘43 ᱦᤨߦᏀQRS 㑆㓒 0.8 ⑽㧘QTc 㑆㓒 0.42 ⑽㧘ST-T ᄌൻ⹺߼あ⣲≌ಾ㒰ⴚ

ߕ‫ޕ‬ኅᣖᱧ㧦․⸥੐㗄ߥߒᔃࠛࠦ࡯㧦⇣Ᏹߥߒ‫ޕ‬↢ᵴᱧ㧦․⸥੐㗄ߥߒ⚦㓗㗼ᓸ㏜ᬌᩏ㧘⌒ᐩᬌᩏߢ⌒ࠨ࡞ࠦࠗ࠼࡯ࠪࠬࠍ

ࠕ࡟࡞ࠡ࡯ᱧ㧦․⸥੐㗄ߥߒ␜ໂߔࠆ߱ߤ߁⤑Ἳ╬ߩᚲ⷗ߪ⹺߼ߥ߆ߞߚ‫ޕ‬⃻∛ᱧ㧦ᢙࡩ᦬೨߆ࠄᦺᣇߦຕ߿∷߇߶߷Ფᣣ಴⃻๭ๆᯏ⢻ᬌᩏߢߪ㧘FVC 131.1%㧘1 ⑽₸ 73.2%ߢߔࠆࠃ߁ߦߥߞߚ‫ޕ‬ஜᐽ⸻ᢿߦߡ⢷ㇱන⚐ X ✢ߢ⇣Ᏹࠍ⹺߼ߥ߆ߞߚ㧔⴫ 1㧕‫ޕ‬

BHL ࠍᜰ៰ߐࠇ㧘ੑᰴᬌᩏ⋡⊛ߦౝ⑼ᄖ᧪ࠍฃ⸻ߒ

⴫ 2 ߦ᳇▤ᡰ⢖⢩ᵞᵺᶧ(BAL)ߩᚲ⷗ࠍ␜ߔ‫ޕ‬ߚ‫ޕ‬Fraction1.2 ߢߪ࡝ࡦࡄ⃿߇ 20㨪15%ߣჇടߒߡ߅

౉㒮ᤨ⃻∝㧦૕᷷ 36.4͠㧘ⴊ࿶ 116/57mmHg㧘⣂ࠅ㧘CD4/CD8 Ყ߇ 6.0 ߣ㜞୯ߢ޽ߞߚ‫ޕ‬

ᜉ 80 ࿁/ಽ㧘SpO2㧔ቶౝ᳇㧕97%‫ోޕ‬り⁁ᘒ⦟ᅢ‫ޕ‬᳇▤ᡰ㏜ᬌᩏߢߪ᳇▤ᡰ☼⤑ో૕ߦ✂⋡⁁Ძ⚦ⴊ▤␹⚻ࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩ․ᓽߢ޽ࠆ⣖␹⚻㤗∽㧘㗻ᔶ⣘ࠍ⹺߼ߚ‫ޕ‬㕙␹⚻ߥߤߩ␹⚻㤗∽ߪ⹺߼ߥ߆ߞߚ‫ޕ‬๭ๆ㖸㧘ᔃ⥃ᐥ⚻ㆊ㧦BHL ߣ⚻᳇▤ᡰ⢖↢ᬌߢߩᄙᩭᏂ⚦⢩ߣ㖸ߦ㔀㖸╬ߩ⇣Ᏹᚲ⷗⹺߼ߕ‫ޕ‬㗖ㇱ㧘⣠┃㧘㥙ᓘߦ㕖ੇ㈼ᕈ㘃਄⊹⚦⢩⡺⧘⣲㧔࿑ 3㧕ࠍ⹺߼㧘ᗵᨴᕈ࡝ࡦࡄ▵⣲ᒛߥߒ‫ޕ‬⡺⧘⣲ᕈ∔ᖚߩ㒰ᄖߒࠨ∝ߣ⸻ᢿߒߚ‫ޕ‬ᔃࠨ࡞ࠦࠗ

౉㒮ᤨᬌᩏᚲ⷗㧦WBC 5900 /l㧘㧔Neu 63.0 %㧘 Eos࠼࡯ࠪࠬ㧘␹⚻ࠨ࡞ࠦࠗ࠼࡯ࠪࠬ㧘⌒ว૬∝ߩ߱ߤ－ 71 －߁⤑Ἳ╬ࠍ⹺߼ߕ㧘∛ᄌ߇⢖ߦ㒢ዪߒߡ޿ࠆߣ⠨߃ࠄࠇ㧘⢖ࠨ࡞ࠦࠗ࠼࡯ࠪࠬΣᦼߣ⸻ᢿߒߚ‫ޕ‬ήᴦ≮ߢᄖ᧪⚻ㆊⷰኤਛߢ޽ࠆ‫ޕ‬ೋ⸻߆ࠄ 8 ࡨ᦬ߩ⊒∝BHL ߪ❗ዊ௑ะߢ޽ߞߚ(Ꮐ⢖㐷࡝ࡦࡄ▵ߩ❗ዊ₸58%㧘 ೋ⸻ᤨ:3.6x2.3cm㧘 8 ࡨ᦬ᓟ 2.3×1.5cm㧕‫ޕ‬࿑ 1 ⢷ㇱන⚐ X ✢౮⌀᣿ࠄ߆ߥ BHL ࠍ⹺߼ߚ‫ޕ‬ήᴦ≮⚻ㆊⷰኤᓟ 8 ࡨ᦬⋡ߦߪ BHL ߪ❗ዊ௑ะߢ޽ߞߚ‫ޕ‬⊒∝ᤨ                ήᴦ≮⚻ㆊⷰኤᓟ 8 ࡨ᦬⋡࿑ 2 ⢷ㇱන⚐ CT❑㓒㧘⢖㐷ߦਔ஥ኻ⒓ᕈߦᄙᢙߩ࡝ࡦࡄ▵⣲ᄢࠍ๒ߒߚ‫ޕ‬⢖㊁∛ᄌߪ⹺߼ߥ߆ߞߚ‫ޕ‬

－ 72 －

⴫ 1 ๭ๆᯏ⢻ᬌᩏ
FVC (L) (% pred.)  3.37 (131.1%)

FEV1 (L) (% pred.)  2.47 (111.8%)

FEV1/FVC (%)

  73.2

FRC (L) (% pred.)  2.23 (128.9%)

RV (L) (% pred.)  1.31 (78.4%)

TLC (L) (% pred.)  4.70 (117.2%)

RV/TLC (%)

  27.8

Dlco (ml/min/mmHg) (% pred.)  16.32 (80.1%)

DLco/VA (ml/min/mmHg/L) (% pred.)   4.57 (94.2%)
 ⴫ 2 BAL ᚲ⷗
raction

12

3

Cell count

1.0

1.0

1.0

105cells/ml

Neutrophil

0.0

1.0

8.0%

Eosinophil

0.0

0.0

1.0%

Lymphocyte

20.0

15.0

1.0%

Macrophage

80.0

84.0

90.0%

CD4/CD86.0
࿑ 3 ⚻᳇▤ᡰ⢖↢ᬌᄙᩭᏂ⚦⢩ࠍ฽߻㕖ੇ㈼㘃਄⊹⚦⢩⡺⧘⣲ࠍ๒ߒߚ‫ޕ‬－ 73 －‫ޣ‬⠨ኤ‫ޤ‬‫ޣ‬ᢥ₂‫ޤ‬ᧄ∝଀ߪ㧘⸻ᢿၮḰߩ⚵❱⸻ᢿ⟲ߩ㗄⋡ࠍḩߚߒ1) ᴰቁ⧷㧦ࠨ࡞ࠦࠗ࠼࡯ࠪࠬ 554 ଀㧔1963㨪1986㧕ߚߚ߼ࠨ࡞ࠦࠗ࠼࡯ࠪࠬߣ⸻ᢿߦ⥋ߞߚ‫ࠗࠦ࡞ࠨޕ‬ߩ ⥃ ᐥ ௝ ߣ ੍ ᓟ . ᣣ ᧄ ⢷ ㇱ ∔ ᖚ ቇ ⇇ 㔀 ⹹ 25 㧦࠼࡯ࠪࠬߪᄙ⤳ེࠍଚߔේ࿃ਇ᣿ߩోりᕈ⡺⧘⣲ᕈ

998-1004㧘1987∔ᖚߢ㧘․ߦᔃ∛ᄌࠍ᦭ߔࠆᔃࠨ࡞ࠦࠗ࠼࡯ࠪࠬߪ㧘2) ᬀ᧛ᤩਭ㧘᫪ᧄ⚩৻㇢㧦⢖ᄖࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩ⓭ὼᱫ߿ᔃਇోᱫࠍᒁ߈⿠ߎߔߚ߼੍ᓟ߇ਇ⦟ߢ޽

⥃ᐥᔃࠨ࡞ࠦࠗ࠼࡯ࠪࠬ.ᣣᧄ⥃ᐥ 60㧦1794-1800㧘

ࠆ‫ᧄޕ‬㇌ߢߪ᰷☨ߦᲧߴᔃ∛ᄌࠍว૬ߔࠆߎߣ߇ᄙ

2002ߊ㧘⥃ᐥ∝⁁ࠍ᦭ߔࠆࠨ࡞ࠦࠗ࠼࡯ࠪࠬߪోࠨ࡞ࠦ3) ᢪ⮮৻ਯ㧘㜞↰✍㧘᧛੗㆐຦㧘ઁ㧦ࠨ࡞ࠦࠗ࠼࡯

ࠗ࠼࡯ࠪࠬߩ 5%೨ᓟߣ޿ࠊࠇߡ޿ࠆ‫࠼ࠗࠦ࡞ࠨޕ‬ࠪࠬߩᴦ≮ߣ੍ᓟ ⓭ὼᱫ଀ߦߺࠄࠇࠆᔃࠨ࡞ࠦࠗ

࡯ࠪࠬ∝଀ߩ 47-87%߇ᔃ∛ᄌߢᱫ੢ߒߡ޿ࠆ‫ޕ‬ᓴ࠼࡯ࠪࠬಽሶ๭ๆེ∛ 7㧦43-50㧘 2003

Ⅳེ⑼ߦࠃࠆᔃࠛࠦ࡯㧘ᔃ㔚࿑ߩࡈࠜࡠ࡯ߪ㊀ⷐⷞ4) ੗ᚻብ㧘㋈ᧁቁ⧷㧘⑺⪲␭ੑ㧘ઁ㧦BHL ߆ࠄ⢖

ߐࠇߡ޿ࠆ

2㧘3)

‫ޕ‬

㊁ဳ߳ᕆㅦߦᄌൻߒߚࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩ 1 ଀.ᣩ

1963 ᐕ߆ࠄ 1981 ᐕߩ 24 ᐕ㑆ߦࠨ࡞ࠦࠗ࠼࡯ࠪ

ෘක⹹ 12㧦28-33㧘2002ࠬߣ⸻ᢿߐࠇ 5 ᐕ㑆એ਄ߩ⚻ㆊⷰኤߔࠆߎߣ߇಴᧪5) ඨ↰⍮ብ㧘㐳੗⧞ሶ㧦ࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩၮ␆ߣ

ߚ 275 ଀ߩᬌ⸛ߢ㧘⊒∝ 5 ᐕ⋡ߦೋ⸻ᤨࠃࠅ⢷ㇱන⥃ᐥ Up-to-Date.๭ๆེ⑼ 12㧦403-408㧘2007⚐ X ✢ᚲ⷗਄ߩㅴዷ㧘ᖡൻࠍ߈ߚߒߚ∝଀ߪ 8%ߣ

6) 㐳੗⧞ሶ㧘ඨ↰⍮ብ㧘ⷺ㍿ߒ߅ࠅ㧘ઁ㧦ࠨ࡞ࠦࠗႎ๔ߐࠇߡ޿ࠆ߇ 1)㧘BHL ߆ࠄ⢖㊁ဳ߳ᕆㅦߦㅴⴕ࠼࡯ࠪࠬߩᴦ≮ߩ⃻⁁ߣዷᦸ.㔍∛ߣ࿷ቛࠤࠕ 11㧦ߒ๭ๆਇోߦ⥋ࠆᕆᕈჇᖡߩႎ๔ߪᬌ⚝ߒߚ㒢ࠅߢ

59-62㧘2005

ߪ 5 ଀ߩߺߣዋߥ߆ߞߚ 4)‫ޕ‬Σᦼ∝଀㧘Τᦼ∝଀ߩቢోኡ⸃ߪߘࠇߙࠇ 77.6%㧘83.7%ߢ޽ࠅᄢㇱಽߪ੍ᓟ⦟ᅢߢ޽ࠆ 1)‫ޕ‬⢖∛ᄌߩᴦ≮ߦߟ޿ߡ㧘ᧄ∝଀ߩ᭽ߥή∝⁁ߩ
BHL ∝଀ߢߪᴦ≮ߪਇⷐߢ޽ࠆ‫ޕ‬᣿⏕ߥࠛࡆ࠺ࡦࠬ
ߦၮߠߊࠨ࡞ࠦࠗ࠼࡯ࠪࠬߩᴦ≮ㆡᔕߦߟ޿ߡߩၮ
Ḱߪߥ޿߇㧘৻⥸⊛ߦ∝⁁߇޽ࠅ㧘ᯏ⢻㓚ኂࠍ᦭ߔࠆ㧘ㅴⴕᕈߩ∛ᄌ߇ᴦ≮ㆡᔕߣߥࠆ 5)‫ޕ‬ᮡḰ⊛ߥᴦ≮⮎ߪࠬ࠹ࡠࠗ࠼⮎ߢ޽ࠅ㧘4㨪6 ㅳ㑆ߩᴦ≮ലᨐࠍߺߡ߆ࠄẋᷫߒߡ޿ߊ‫ޕ‬ᷫ㊂ਛߩౣ⊒₸ߪ 30%ߣႎ
๔ߐࠇߡ޿ࠆߚ߼චಽߦᵈᗧ߇ᔅⷐߢ޽ࠆ 6)‫ޕ‬એ਄㧘ஜᐽ⸻ᢿߢ BHL ࠍᜰ៰ߐࠇ㧘⚻᳇▤ᡰ↢ᬌߦߡࠨ࡞ࠦࠗ࠼࡯ࠪࠬߣ⸻ᢿߐࠇߚ∝଀ࠍႎ๔ߒߚ‫ޕ‬ᕆᕈჇᖡࠍ␜ߔ⢖ࠨ࡞ࠦࠗ࠼࡯ࠪࠬߪ⒘ߢ޽ࠆ߇㧘ᵈᗧᷓߊ⚻ㆊⷰኤߔࠆᔅⷐ߇޽ࠆߣ⠨߃ߚ‫ޕ‬－ 74 －