ෘ↢ഭ௛⑼ቇ⎇ⓥ⾌⵬ഥ㊄㧔ሶߤ߽ኅᐸ✚ว⎇ⓥ੐ᬺ㧕ಽᜂ⎇ⓥႎ๔ᦠಽᜂ⺖㗴㧦⠌ᘠᵹ↥ߦኻߔࠆᄦ࡝ࡦࡄ⃿఺∉≮ᴺ   㧙ࠊ߇࿖ߦ߅ߌࠆታᘒ⺞ᩏߣ੹ᓟߩዷᦸߦ㑐ߔࠆ⎇ⓥ⎇ⓥಽᜂ⠪ ┻ਅବⴕ ᣣᧄක⑼ᄢቇ↥ᇚੱ⑼ᢎ᝼
⎇ⓥදജ⠪ ፃ స਽ ᣣᧄක⑼ᄢቇ↥ᇚੱ⑼ഥᢎ   ⎇ⓥⷐᣦ⠌ᘠᵹ↥ߦኻߔࠆᴦ≮ߦᄦ࡝ࡦࡄ⃿఺∉≮ᴺ߇޽ࠆ߇‫☨ޔ‬࿖ FDA ࠃࠅᣉⴕࠍប߃ࠆࠃ߁ㅢ㆐߇ߢߚߎߣ߽޽޿߹ߞߡ‫ޔ‬એ㒠఺∉≮ᴺߦ㑐ߔࠆႎ๔ߪᭂ┵ߦᷫዋߒߡ޿ࠆ‫ࠊޕ‬ࠇࠊࠇߪ 2001 ᐕߦᣣᧄߦ߅ߌࠆᄦ࡝ࡦࡄ⃿఺∉≮ᴺߩᣉⴕ⁁ᴫࠍ⺞ᩏߒ‫ޔ‬71㧑ߣᄙߊߩᣉ⸳ߢᣉⴕߐࠇߡ޿ࠆߎߣࠍႎ๔ߒߚ߇‫ޔ‬㧤ᐕߩᱦ᦬ࠍ⚻ߚ⃻࿷ߩ⁁ᴫߦߟ޿ߡౣᐲో
࿖⺞ᩏࠍⴕ޿‫ޔ‬ᄦ࡝ࡦࡄ⃿఺∉≮ᴺߩ⃻⁁ߣ੹ᓟߩዷᦸߦߟ޿ߡ⠨ኤࠍട߃ߚ‫੹ޕ‬࿁ߪ
615 ᣉ⸳ߦኻߒࠕࡦࠤ࡯࠻ࠍㅍઃߒ 331 ᣉ⸳ࠃࠅ࿁╵ࠍᓧߚ㧔࿁෼₸ 53.8%㧕‫ޕ‬331 ᣉ⸳ਛ‫≮∉఺ޔ‬ᴺࠍᣉⴕߒߚߎߣ߇޽ࠆᣉ⸳ߪ 166 ᣉ⸳ߢ⚂ඨᢙߦ෸ࠎߛ߇‫⃻ޔ‬࿷ߢ߽ታᣉ
ߒߡ޿ࠆᣉ⸳ߪ 57 ᣉ⸳(17㧑)ߢ޽ߞߚ‫ޕ‬1998 ᐕࠃࠅᣉⴕࠍਛᱛߔࠆᣉ⸳ߪჇടߒ‫ޔ‬ਛᱛℂ↱ߣߒߡᦨ߽ᄙ߆ߞߚߩ߇‫≮∉఺ޔ‬ᴺߩ᦭ലᕈ߇⸽᣿ߐࠇߡ޿ߥߎߣߢ޽ߞߚ‫ޕ‬2001ᐕ⺞ᩏߢ໧㗴ߣߥߞߚ࡝ࡦࡄ⃿߳ߩ᡼኿✢ᾖ኿ߪ‫ޔ‬66%ߩᣉ⸳ߢⴕࠊࠇߡ޿ࠆߦㆊ߉ߕ‫ޔ‬೨࿁ߩ⺞ᩏᤨߩ 55㧑ࠃࠅߪჇടߒߚ߽ߩߩଐὼߣߒߡᧂᣉⴕߩᣉ⸳߇ዋߥߊߥ޿ߎߣ߇
᣿ࠄ߆ߣߥߞߚ‫ޕ‬ᄦߩ࡝ࡦࡄ⃿ߪห⒳⇣♽⚦⢩ߢ޽ࠅ‫ޔ‬2004 ᐕߩᣣ↥ᇚ↢ᱺౝಽᴲᆔຬ
ળ߇ឭ␜ߒߡ޿ࠆࠃ߁ߦ GVHD ࿁ㆱߩߚ߼ߩ᡼኿✢ᾖ኿ߪᔅ㗇ߢ޽ࠆ੐ࠍ๟⍮ᔀᐩߔࠆᔅⷐ߇޽ࠈ߁‫ޕ‬㧭㧚⎇ⓥ⋡⊛ߥߞߚߩߪ‫☨ޔ‬࿖ FDA ߇⊒ߒߚ൘๔ߢ޽ߞߚ‫ߔޕ‬⠌ᘠᵹ↥ߦኻߔࠆ࡝ࡦࡄ⃿ャᵈ≮ᴺ㧔ᄦ࡝ࡦࡄߥࠊߜ‫≮∉఺ޔ‬ᴺߪ᦭ലᕈߣ቟ోᕈ߇⏕⹺಴᧪ࠆ⃿఺∉≮ᴺ㧕ߪ‫ޔ‬1981 ᐕ Taylor, Beer ࠄߦࠃࠅ⋧߹ߢߪߒ߫ࠄߊⴕࠊߥ޿ߣ޿߁߽ߩߢ޽ߞߚ‫ߘޕ‬ᰴ޿ߢᚑഞ଀߇ႎ๔ߐࠇߚߎߣߦᆎ߹ߞߚ‫ེ⤳ޕ‬ߩ⚿ᨐ‫≮∉఺ޔ‬ᴺߪㆊ෰ߩㆮ‛ߩࠃ߁ߥሽ࿷ߦߥ

⒖ ᬀ ߢ ⴕ ࠊ ࠇ ߚ ャ ⴊ ≮ ᴺ 㧔 Donor specificߞߡߒ߹ߞߚ‫ޕ‬transfusion㧕ߦࡅࡦ࠻ࠍᓧߚ߽ߩߢ޽ࠆ߇‫ޔ‬ᒰᤨࠊ߇࿖ߩ⃻⁁ߪߤ߁ߢ޽ࠈ߁߆‫ޕ‬2001 ᐕߦ┻ਅਇ⢒∝ߦኻߔࠆ᦭ലߥᴦ≮ᴺ߇ዋߥ߆ߞߚᤨᦼߦ‫ޔ‬ߪ‫ోޔ‬࿖ߩᄢቇ∛㒮ࠍਛᔃߦ‫≮∉఺ޔ‬ᴺߦ㑐ߔࠆ↹ᦼ⊛ߥᴦ≮ᴺߣߒߡᄢ޿ߦᦼᓙࠍ㓸߼ߚ߽ߩߢ

ࠕࡦࠤ࡯࠻⺞ᩏࠍⴕߞߚ‫⚿ߩߘޕ‬ᨐ‫⚂ޔ‬㧣㧜㧑ߩ޽ߞߚ‫ޕ‬ᒰೋ߆ࠄࡔࠞ࠾࠭ࡓߪਇ᣿ߢ޽ࠅ‫ޔ‬㧠ඨᣉ⸳߇૗ࠄ߆ߩᒻߢᄦ࡝ࡦࡄ⃿఺∉≮ᴺࠍⴕߞߡ਎♿ࠍ⚻ߚ⃻࿷ߦ⥋ߞߡ߽૞↪ᯏᐨߦ㑐ߔࠆ⎇ⓥ޿ߚ‫ߩߘޕ‬ᓟ‫ޔ‬ᣣ↥ᇚ↢ᱺౝಽᴲᆔຬળߩਇ⢒∝ߪᱴߤㅴዷࠍ⷗ߡ޿ߥ޿‫ߩߘޕ‬ᓟ‫ޔ‬1985 ᐕߩߦ㑐ߔࠆዊᆔຬળߢߩ⺞ᩏߢ߽‫߷߶ޔ‬ห᭽ߩ⚿ᨐ

Mowbray ࠄߩ RCT ࠍ⊹ಾࠅߦ‫ޔ‬ᄙߊߩ RCT ߇ࠍᓧߚ‫ޔᤨߩߎޕ‬หᤨߦ‫ޔ‬ャᵈߔࠆ࡝ࡦࡄ⃿ߦ᡼ⴕࠊࠇߚ‫ޕ‬㧞㧜㧜㧝ᐕ‫ޔ‬Scott ߇ⴕߞߚ㧝㧤ߩ RCT኿✢ᾖ኿ࠍⴕߞߡ޿ߥ޿ᣉ⸳߇ዋߥ߆ࠄߕ⹺߼ࠄࠍ߹ߣ߼ߚࡔ࠲ࠕ࠽࡝ࠪࠬߦࠃࠆߣ‫ޔ‬ᄦ࡝ࡦࡄ⃿ࠇࠆߎߣ߇್᣿ߒߚ‫⼊ߩߘޔߢߎߘޕ‬㏹߽฽߼ߡ఺∉≮ᴺߩ᦭ലᕈߪ⏕⹺಴᧪ߥ߆ߞߚ‫ޕ‬᳿ቯ⊛ߣᣣ↥ᇚ⹹㧔Vol.56(6)㧕ߦᄦ࡝ࡦࡄ⃿఺∉≮ᴺታᣉ

109ߦ޽ߚߞߡߩࠟࠗ࠼࡜ࠗࡦ⊛ߥႎ๔ᦠࠍ⊒⴫ߒߡࠅ‫ޔ‬ធ⒳ᤨᦼߪᅧᆼ೨෸߮ᅧᆼਛߦᛩਈߔࠆᣉ⸳

޿ࠆ‫ޕ‬߇ 44 ᣉ⸳(76%)ߣᦨ߽ᄙߊ‫ޔ‬ᰴ޿ߢᅧᆼ೨ߩߺߣ

޽ࠇ߆ࠄᢙᐕߩᤨ㑆⊛⚻ㆊࠍ⚻ߡ‫ޔ‬ਇ⢒∝ቇ߽ߔࠆᣉ⸳߇ 12 ᣉ⸳(20%)ߢ޽ߞߚ‫ޕ‬ធ⒳೨ߦ࡝ࡦ

ㅴᱠߒ‫ޔ‬ㆊ෰ߦⴕࠊࠇߚ఺∉≮ᴺ߇ᔅߕߒ߽ㆡಾ

ࡄ⃿ߦ᡼኿✢ᾖ኿ࠍⴕ߁ᣉ⸳ߪ 38 ᣉ⸳(66%)ߢ޽

ߥᒻߢⴕࠊࠇߡ޿ߥ߆ߞߚߎߣ߽᣿ࠄ߆ߦߥߞߡ

ࠅ‫ޔ‬೨࿁ߩ⺞ᩏᤨߩ 55㧑ࠃࠅߪჇടߒߚ߽ߩߩଐ

߈ߚ‫ޕ‬ὼߣߒߡ 20 ᣉ⸳(34%)ߪᧂᣉⴕߩ߹߹ᛩਈߒߡ޿

ᧄಽᜂ⎇ⓥߢߪ‫ޔ‬ᄦ࡝ࡦࡄ⃿఺∉≮ᴺߩታᘒ⺞ߚ‫ޕ‬ᴦ≮ലᨐߩᜬ⛯ᦼ㑆ߦߟ޿ߡߪ 6 ࠞ᦬ߣ⠨߃ᩏࠍⴕ޿‫੹ޔ‬ᓟࠊ߇࿖ߩ఺∉≮ᴺࠍߤߩࠃ߁ߦ⠨ࠆᣉ⸳߇ 20 ᣉ⸳(33%)ߢᦨ߽ᄙߊ‫ޔ‬ᅧᆼߒߥ޿႐

߃ߡⴕߊߴ߈߆ࠍ⠨߃ࠆ਄ߢၮ⋚ߣߥࠆ⸃ᨆࠍⴕ

วߪ 34 ᣉ⸳(58%)߇ㅊട఺∉ࠍⴕߞߡ޿ߚ‫ޕ‬೽૞߁ߎߣࠍ⋡⊛ߣߒߚ‫ޕ‬↪ࠍ⹺߼ߚᣉ⸳ߪ 7 ᣉ⸳(12%)ߢ޽ࠅ‫ޔ∐⊹ޔ‬ហ∣ߥߤシᓸߥ೽૞↪ߢ⒖ᬀ㧮㧚⎇ⓥᣇᴺߩ↢๮ࠍ⢿߆ߔ㊀◊ߥ߽ߩߪ⹺߼ߥ߆ߞߚ‫ޕ‬ࠕࡦࠤ࡯࠻⺞ᩏ⴫㧝ߩࠃ߁ߥࠕࡦࠤ࡯࠻ࠍ૞ᚑߒ‫ోޔ‬࿖ߢਇᅧ㧰㧚⠨ኤ∝࡮ਇ⢒∝⸻≮ߦജࠍ౉ࠇߡ޿ࠆ∛㒮‫≮⸻ޔ‬ᚲߦ ࠊ߇࿖ߦ߅ߌࠆᄦ࡝ࡦࡄ⃿఺∉≮ᴺߪ‫ޔ‬㧞㧜㧜ㅍઃߒߚ‫ߩ࠻࡯ࠤࡦࠕޕ‬ㅍઃኻ⽎ᣉ⸳ߪᣣ↥ᇚቇ㧞ᐕߩ┻ਅߦࠃࠆ⺞ᩏߢ‫ޔ‬ᄢቇ∛㒮ࠍਛᔃߣߒߚ

ળߦ⊓㍳ߒߡ޿ࠆ↢ᱺ⵬ഥක≮ታᣉ⊓㍳ᣉ⸳616

Ყセ⊛ᄢ߈ߥ∛㒮ߢ㧣㧜㧑߇ᄦ࡝ࡦࡄ⃿఺∉≮ᴺᣉ⸳ߣߒߚ‫ޕ‬࿁╵ߪේೣߣߒߡ⸥㌏࿁╵ߣߒߚ‫ޕ‬ࠍታᣉߒߡ޿ߚ‫ޔߚ߹ޕ‬ᣣᧄ↥⑼ᇚੱ⑼ቇળ↢ᱺኻኋਥ∛(GVHD)ߥߤ

ౝಽᴲᆔຬળ㧔ᐔᚑ㧝㧟ᐕᐲ㨪㧝㧠ᐕᐲ㧕‫ᧄޟ‬㇌ߦ110

㧯㧚⎇ⓥ⚿ᨐ߅ߌࠆ⠌ᘠᵹ↥㧔ਇ⢒∝㧕▤ℂߩ⃻⁁⺞ᩏߦ㑐ߔ㧝㧕ࠕࡦࠤ࡯࠻⺞ᩏࠆዊᆔຬળ㧔ዊᆔຬ㐳 ’㊁ᕡਭ ᧲ᶏᄢቇᢎ

ࠕࡦࠤ࡯࠻ࠍㅍઃߒߚ616ᣉ⸳ਛ331ᣉ⸳߆ࠄ࿁

᝼㧕‫ోߩޠ‬࿖㧞㧞㧥ᣉ⸳ࠕࡦࠤ࡯࠻⺞ᩏߢߪ⚂㧤╵ࠍᓧߚ‫ޕ‬࿁෼₸ߪ53.8㧑ߢ޽ߞߚ‫ޕ‬㧜㧑ߩᣉ⸳߇ታᣉߒߡ޿ߚ‫ޕ‬ᄢቇ∛㒮ߪ 74 ᣉ⸳㧔18㧑㧕‫ޔ‬ਇᅧኾ㐷ࠢ࡝࠾࠶ࠢ ੹࿁ߩ⺞ᩏߢߪ‫≮ᧄޔ‬ᴺࠍㆊ෰ߦታᣉߒߚߎߣ

ߪ 62 ᣉ⸳㧔19㧑㧕ߢ޽ߞߚ‫ޕ‬331 ᣉ⸳ਛ‫≮∉఺ޔ‬߇޽ࠆᣉ⸳ࠍ฽߼ࠆߣో૕ߩ 50%ߦ෸ࠎߛ߇‫⃻ޔ‬ᴺࠍᣉⴕߒߚߎߣ߇޽ࠆᣉ⸳ߪ 166 ᣉ⸳ߢ⚂ඨᢙ࿷ߢ߽ⴕߞߡ޿ࠆᣉ⸳ߪ㧡㧤ᣉ⸳㧔17.5%㧕ߢ޽ߦ෸ࠎߛ߇‫⃻ޔ‬࿷ߢ߽ታᣉߒߡ޿ࠆᣉ⸳ߪ 58 ᣉ⸳ߞߚ‫ߩߎޕ‬㧣ᐕ㑆ߢ㧠ಽߩ㧝ߦᷫዋߒߚߎߣߦߥ

(17.5㧑)ߢ޽ߞߚ‫ޕ‬1998 ᐕࠃࠅᣉⴕࠍਛᱛߔࠆᣉ⸳ࠆ‫ޔߜ߁ߩߎޕ‬ᄢቇ∛㒮ߪ 17 ᣉ⸳ߢ‫ޔ‬ታᣉᣉ⸳ߩߪჇടߒ‫ޔ‬ਛᱛℂ↱ߣߒߡᦨ߽ᄙ߆ߞߚߩ߇‫఺ޔ‬29.3㧑‫ޔ‬࿁╵ߒߚᄢቇ∛㒮ߩ 27.9㧑ߦ⋧ᒰߒߚ‫ޕ‬∉≮ᴺߩ᦭ലᕈ߇⸽᣿ߐࠇߡ޿ߥߎߣߢ޽ߞߚ‫ޕ‬

2002 ᐕߩ FDA ൘๔એ᧪‫≮∉఺ޔ‬ᴺ߇ⴕࠊࠇߥߊ

ታᣉ⁁ᴫߦ㑐ߒߡߪ‫ޔ‬ᐕ㑆 1㨪20 ∝଀ߣ࿁╵ߔࠆߥߞߚ☨࿖ߩ⁁ᴫࠍ⠨߃ࠆߣ‫߇ࠊޔ‬࿖ߩᄢቇ∛㒮

ᣉ⸳߇ 49 ᣉ⸳㧔86㧑㧕ߢ޽ࠅ‫ޔ‬ᣉⴕ∝଀ߩᷫዋ߇ߢߩታᣉ₸ߪ㜞޿ශ⽎߇޽ࠆ‫ޕ‬⹺߼ࠄࠇߚ‫ޕ‬ㆡᔕߣߔࠆᵹ↥࿁ᢙࠍ 3 ࿁એ਄ߣߔ ㆡᔕ߿ࡊࡠ࠻ࠦ࡯࡞ߦ㑐ߒߡߪ‫ޔ‬ታᣉᣉ⸳㑆ߢࠆᣉ⸳ߪ 41 ᣉ⸳㧔71㧑㧕ߢ޽ࠅ‫⊒⛯ޔ‬ᕈᵹ↥∝଀߫ࠄߟ߈߇޽ࠅ‫≮ᧄޔ‬ᴺߩℂ⺰⊛⢛᥊߇ଐὼᷙᴋ

߽ㆡᔕߣߔࠆᣉ⸳ߪ 39 ᣉ⸳㧔66㧑㧕ߦ߅ࠃࠎߢ޿ߣߒߡ޿ࠆߎߣࠍ෻ᤋߒߡ޿ࠆࠃ߁ߢ޽ߞߚ‫ޕ‬ߚ‫ޕ‬᛫ᩭ᛫૕‫ޔ‬᛫࡝ࡦ⢽⾰᛫૕ߥߤߩ⥄Ꮖ᛫૕㓁 㐳ᐕ໧㗴ߦߥߞߡ޿ࠆ᦭ലᕈߩᬌ⸽ߪ‫੹ޔ‬࿁ߩᕈ∝଀ߦኻߒߡߪ‫ޔ‬47 ᣉ⸳(78㧑)߇఺∉≮ᴺࠍㆡࠃ߁ߥࠕࡦࠤ࡯࠻⺞ᩏߢߪ㒢⇇߇޽ࠆ‫ޕ‬ᄢⷙᮨߥᔕᄖߣߒߡ޿ߚ‫ޕ‬ធ⒳ᣇᴺߪోᣉ⸳⊹ౝᛩਈߢ޽

RCT ߇ⴕࠊࠇࠆߴ߈ߢ޽ࠆ߇‫߇ࠊߩ੹ޔ‬࿖ߩ⁁ᴫߢߪᧄ≮ᴺߦ㑐ߔࠆ RCT ߪਇน⢻ߢ޽ࠈ߁‫ޕ‬ࠊࠇߚߎߣ߇޽ࠅ‫ޔ‬ℂ⺰⊛ߦߪᦨ߽ෂ㒾ߥⴕὑߛ੹࿁ߩ⺞ᩏߢᦨ߽㊀ⷐߥߩߪ቟ోᕈߩᬌ⸽ߢ޽ߞߚߎߣߦߥࠆ‫ޕ‬ᐘ޿‫ޔ‬㧟㧜ᐕㄭ޿ᱧผࠍᜬߟᧄߞߚ‫ޕ‬೽૞↪ࠍ⚻㛎ߒߚߣ࿁╵ߒߚᣉ⸳ߪ㧝㧞㧑≮ᴺߢ GVHD ⊒∝ߩႎ๔ߪ‫▸ߚߴ⺞ޔ‬࿐ౝߢߪሽ޽ߞߚ߇‫߽ࠇߕ޿ޔ‬シ∝ߢ‫⥄ޔ‬Ꮖ᛫૕㓁ォ‫ޔ∐⊹ޔ‬࿷ߖߕ‫ޔ‬೨ㅀߩࠃ߁ߦ੹࿁ߩ⺞ᩏߢ߽ߘߩࠃ߁ߥ⢄ᯏ⢻㓚ኂߥߤߢ‫ޔ‬EBV ߩવ᠞߇⇼ࠊࠇߚ∝଀߇ႎ๔ߪߥ߆ߞߚ߇‫≮ᧄޔ‬ᴺࠍታᣉߔࠆ႐วߪ᡼኿৻଀ႎ๔ߐࠇߚ‫ ޕ‬ᔨߐࠇߚ GVHD ߪႎ๔߇ߥ߆✢ᾖ኿߇ᔅ㗇ߢ޽ࠆߎߣࠍ๟⍮ᔀᐩߔࠆᔅⷐ߇޽ߞߚ‫ޕ‬ࠆ‫⎇ᧄޕ‬ⓥ⃰ߣߒߡߪ‫ޔ‬ᣣᧄ↥⑼ᇚੱ⑼ቇળળຬ

੹࿁᣿ࠄ߆ߦߥߞߚߎߣߢᦨ߽㊀ⷐߥ໧㗴ὐߪ‫ޔ‬ߦኻߒߡᵈᗧࠍ༐⿠ߔࠆߎߣࠍ‫ޔ‬ᣣᧄ↥⑼ᇚੱ⑼ታᣉᣉ⸳ߢ࡝ࡦࡄ⃿ߦ᡼኿✢ᾖ኿ࠍߒߡ޿ߥ޿ᣉ

ቇળศ᧛ᵏౖℂ੐㐳ተߦⷐ⺧ߒߚ㧔⴫㧞㧕‫ޕ‬⸳߇ 34㧑޽ߞߚߎߣߢ޽ࠆ‫ޕ‬ᣣ↥ᇚ↢ᱺౝಽᴲᆔ ᄦ࡝ࡦࡄ⃿఺∉≮ᴺߪℂ⺰⊛⢛᥊߇᣿ࠄ߆ߦߥຬળਇ⢒∝ዊᆔຬળߪߘߩᓟ‫ޔ‬㥲⮮ṑዊᆔຬ㐳ߩࠄߥ޿߹߹‫੹ޔ‬ᣣ߹ߢታᣉߐࠇߡ޿ࠆ‫੹ޕ‬࿁ߩ⺞߽ߣ⎇ⓥ߇⛮⛯ߐࠇ‫ޔ‬᭽‫⺞ߥޘ‬ᩏ⚿ᨐࠍၮߦᄦ࡝ᩏߢߪ㊀◊ߥ᦭ኂ੐⽎ߪႎ๔ߐࠇߡ޿ߥ޿߇‫᦭ޔ‬ࡦࡄ⃿఺∉≮ᴺߦ㑐ߔࠆࠟࠗ࠼࡜ࠗࡦ⊛ߥႎ๔ᦠലᕈߩࠛࡆ࠺ࡦࠬ߇ਲߒ޿ᴦ≮ࠍẂὼߣ⛯ߌߡ⦟ࠍ⊒⴫ߒߚ㧔ᣣ↥ᇚ⹹㧦56(4)㧕‫ߩߎޕ‬ਛߢ‫ޔ‬ᄦ࡝޿ߩ߆ߣ޿߁໧㗴ߪᱷࠆ‫ࡏ࠮࡜ࡊޕ‬ലᨐߦㆊ߉ߥࡦࡄ⃿఺∉≮ᴺߪャⴊߢ޽ࠅ‫ߩߘޔ‬ㆡᔕၮḰࠍㆩ޿ߣ޿߁ᜰ៰ߪએ೨߆ࠄ޽ࠆ߇‫৻ޔ‬ᣇߢ♖ᩏߩᓟ቞ߔࠆߎߣ‫ ߦ߮ࠄߥޔ‬GVHD ࿁ㆱߩߚ߼ߦ࡝ࡦࡄ߽ේ࿃߇ਇ᣿ߢ޽ࠆࠞ࠶ࡊ࡞ߦߪᦨᓟߩ⎏ߣߥࠆ⃿ߦ᡼኿✢ࠍᾖ኿ߔࠆߎߣ߇ᒝ⺞ߐࠇߚ‫੹ޕ‬࿁ߩᴦ≮ߢ߽޽ࠆ‫ޕ‬ේ࿃ਇ᣿⠌ᘠᵹ↥ߦ tender loving⺞ᩏߢߪ‫ߩ࠻࡯ࠤࡦࠕޔ‬౨㗡ߦߎߩႎ๔ᦠߩሽ࿷

care (TLC)ߩ᦭ലᕈ߇Ყセ⊛㜞޿ࠛࡆ࠺ࡦࠬ࡟ࡌ

ࠍ⍮ߞߡ޿ࠆ߆‫ࠍ߆ࠆ޽߇ߣߎߛࠎ⺒ߚ߹ޔ‬໧߁࡞ߢႎ๔ߐࠇߡ޿ࠆߎߣࠍ⠨߃ࠆߣ‫࠮࡜ࡊ߃଀ޔ‬ߚ‫ߩߎޕ‬ႎ๔ࠍ⺒ࠎߛߣ࿁╵ߒߚᣉ⸳ߪ 148 ᣉ⸳‫ޔ‬ࡏലᨐߢ޽ߞߡ߽᦭ኂ੐⽎ߩႎ๔߇ዋߥ޿⃻࿷‫ޔ‬

44.7%ߢ޽ߞߚ‫ޕ‬ᄦ࡝ࡦࡄ⃿఺∉≮ᴺࠍታᣉߒߡਇ⢒∝ࠞ࠶ࡊ࡞߆ࠄߎߩㆬᛯᨑࠍቢోߦᅓߞߡߒ޿ࠆᣉ⸳ߢ⺒ࠎߛߣ࿁╵ߒߚߩߪ㧡㧥㧑‫ߢࠎ⺒ޔ‬߹߁ߎߣ߽ߢ߈ߥ޿‫ޔߒߛߚޕ‬life threatening ߥ޿ߡ᡼኿✢ᾖ኿ࠍታᣉߒߡ޿ߥ޿ᣉ⸳ߪ㧝㧥㧑ሽ⁁ᘒߢߪߥ޿ਇ⢒∝ᖚ⠪ߦᧄ≮ᴺࠍⴕ߁ߎߣߦࠃ࿷ߒߚ‫ޕ‬ߞߡ GVHD ࠍ⿠ߎߔࠃ߁ߥ੐ᘒߪ‫⛘ޔ‬ኻߦㆱߌߥ ャⴊᓟ㧳㨂㧴㧰ߪⴊᶧ⵾೷ߦ฽߹ࠇࠆ࡝ࡦࡄ⃿ߌࠇ߫ߥࠄߕ‫ߩ߳⃿ࡄࡦ࡝ޔ‬᡼኿✢ᾖ኿ߪᔅߕⴕߦࠃߞߡᗖ⿠ߐࠇ‫৻ޔ‬ᐲ⊒∝ߔࠆߣ߶߷ 95㧑એ਄߁ߴ߈ߢ޽ࠆߎߣࠍ➅ࠅ㄰ߒᒝ⺞ߒߚ޿‫ޕ‬ᱫ੢ߔࠆ㊀◊ߥ∔ᖚߢ޽ࠆ‫ޕ‬1996 ᐕߦᣣᧄャⴊቇળ߆ࠄ‫ޟ‬ャⴊߦࠃࠆ㧳㨂㧴㧰੍㒐ߩߚ߼ߩⴊᶧߦ㧱㧚⚿⺰ኻߔࠆ᡼኿✢ᾖ኿ࠟࠗ࠼࡜ࠗࡦ‫߇ޠ‬಴ߐࠇ‫ޔ‬એ᧪ᄦ࡝ࡦࡄ⃿఺∉≮ᴺࠍᣉⴕߔࠆᣉ⸳ߪᷫዋ௑ะ㧳㨂㧴㧰ߩႎ๔ߪỗᷫߒ‫ޔ‬2000 ᐕએ㒠㧝଀߽ႎ๔ߦ޽ࠆ߽ߩߩ‫ޔ‬ଐὼߣߒߡᚒ߇࿖ߢߪⴕࠊࠇ⛯ߌߐࠇߡ޿ߥ޿‫ޔߦࠄߐޕ‬2009 ᐕ㧞᦬‫ޔ‬ෘ↢ഭ௛⋭ߡ޿ࠆᴦ≮ᴺߢ޽ߞߚ‫ޕ‬ᣉ⸳ߦࠃࠅㆡᔕ߿ࡊࡠ࠻ߪ‫ޔ‬‫ޟ‬ャⴊ≮ᴺߩታᣉߦ㑐ߔࠆᜰ㊎‫ޠ‬෸߮‫ⴊޟ‬ᶧ⵾ࠦ࡯࡞ߦࡃ࡜ߟ߈߇⹺߼ࠄࠇ‫⃻ޔ‬࿷ߢ߽᡼኿✢ᾖ೷ߩ૶↪ᜰ㊎‫৻ߩޠ‬ㇱᡷᱜࠍⴕ޿‫ޔ‬㧳㨂㧴D ߇᡼኿ࠍⴕࠊߕߦ࡝ࡦࡄ⃿ធ⒳ࠍⴕ߁ᣉ⸳߇੍ᗐᄖߦ

኿✢ᾖ኿ⴊᶧࠍ૶↪ߔࠆߎߣߦࠃߞߡ੍㒐ߢ߈ࠆ⹺߼ࠄࠇߚ‫ޕ‬ᐘ޿‫੹ޔ‬࿁ߩ⺞ᩏߢ߽ GVHD ߩႎ๔ߎߣࠍ᣿⸥ߒߚ‫ࠍ⃿ࡄࡦ࡝ޕ‬Ớ❗ߒߡធ⒳ߔࠆᧄ

ߪߥ߆ߞߚ߇‫ߩ߳⃿ࡄࡦ࡝ޔ‬᡼኿✢ᾖ኿ߪᔅ㗇ߢ

≮ᴺߢߪ‫ޔ‬ᾖ኿ߥߒߦᛩਈߐࠇߚ႐ว GVHD ⊒∝޽ࠆ੐ࠍ๟⍮ᔀᐩߔࠆᔅⷐ߇޽ࠈ߁‫ޕ‬ߩน⢻ᕈߪ߈ࠊ߼ߡ㜞޿ߣ⠨߃ࠄࠇࠆ‫ᧄߡߟ߆ޕ‬≮ᴺߪᄦᇚ㑆ߢ HLA ౒᦭₸߇㜞޿ࠞ࠶ࡊ࡞ߦⴕ

111‫ޣ‬ㅊ⸥‫ޤ‬

Successful long-term management of੹࿁ߩࠕࡦࠤ࡯࠻ߩᦨᓟߦ‫ᦨޔ‬ㄭ᛫࡝ࡦ⢽⾰᛫૕

adenomyosis associated with deep∝୥⟲ว૬ᅧᆼߦኻߒߡⴕࠊࠇࠆࠃ߁ߦߥߞߚࠕ

thrombosis by low-dose gonadotropin -ࠬࡇ࡝ࡦ࡮ࡋࡄ࡝ࡦ≮ᴺߦߟ޿ߡ⸳໧ࠍ⸳ߌߚ‫ޕ‬releasing hormone agonist therapy. Clinߘߩ⚿ᨐ‫ޔ‬࿁╵ߩ޽ߞߚ 331 ᣉ⸳ਛ 109 ᣉ⸳ߢࡋExp Obstet Gynecol. 2009;36(2):123-5.

ࡄ࡝ࡦ≮ᴺ߇ⴕࠊࠇߡ޿ߚ‫⃻ޕ‬࿷ᅧᇚߦ↪޿ࠄࠇ4)

Luo SS, Ishibashi O, Ishikawa G, Ishikawaࠆࡋࡄ࡝ࡦ⵾೷ߪᧂಽ↹ࡋࡄ࡝ࡦ㧔ࡋࡄ࡝ࡦࠞ࡞

T, Katayama A, Mishima T, Takizawa T,ࠪ࠙ࡓ‫ࡓ࠙࡝࠻࠽ࡦ࡝ࡄࡋޔ‬㧕ߩߺߢ޽ࠅ‫ߩߘޔ‬

Shigihara T, Goto T, Izumi A, Ohkuchi A,೑ଢᕈ߆ࠄ⊹ਅᵈ↪ࡋࡄ࡝ࡦࠞ࡞ࠪ࠙ࡓ㧔ࠞࡊࡠMatsubara S, Takeshita T, Takizawa T.

ࠪࡦ®㧕߇ࠃߊ↪޿ࠄࠇࠆ‫ߪࡦࠪࡠࡊࠞޕ‬㧝ᣣ㧞

Human villous trophoblasts express and࿁ߩᛩਈ߇ᔅⷐߥߚ߼‫ޔ‬ᄙߊߪᖚ⠪߇⥄Ꮖᵈ኿ࠍsecrete placenta-specific microRNAs intoⴕߞߡ޿ࠆ‫⃻ޕ‬࿷ߩߣߎࠈ‫ᧄޔ‬ᴦ≮ߦ㑐ࠊࠆ᦭ኂ

maternal circulation via exosomes. Biol੐⽎ߪ⺞ߴߚ▸࿐ߢႎ๔ߐࠇߡ޿ߥ޿߇‫⥄ޔ‬ᏆᵈReprod. 2009 Oct;81(4):717-29. Epub 2009኿ߦߪ଻㒾ㆡᔕ߇ߥߊ‫⮎ޔ‬೷ᷝઃᢥᦠߦ߽⸥タ߇Jun 3.

ߥ޿ߚ߼໧㗴߇ߥ޿ߣߪ⸒߃ߥ޿‫≮ࡦ࡝ࡄࡋޕ‬ᴺ5)

Asakura H, Fukami T, Kurashina R,ታᣉᣉ⸳ߩ㧠ಽߩ㧝ߪಽᇂࠍขࠅᛒࠊߥ޿⸻≮ᚲ‫ޔ‬

Tateyama N, Doi D, Takeshita T.

ࠢ࡝࠾࠶ࠢߢ޽ࠅ‫ޔ‬ᄛ㑆✕ᕆᤨߩኻᔕߥߤߦ໧㗴

Significance of cervical gland area in߇ߥ޿߆╬‫ޔ‬ᬌ⸽ߩᔅⷐ߇޽ࠆߣ⠨߃ࠄࠇࠆ‫ޕ‬㧞predicting preterm birth for patients with㧞ᐕᐲએ㒠ߩ⺖㗴ߣߒߚ޿‫ޕ‬

threatened preterm delivery: comparison
with cervical length and fetal fibronectin.

㧲㧚ஜᐽෂ㒾ᖱႎ

Gynecol Obstet Invest. 2009;68(1):1-8.

ߥߒEpub 2009 Mar 25.
6)㧳㧚⎇ⓥ⊒⴫Takeshita T. Combined chemotherapy with1㧚⺰ᢥ⊒⴫paclitaxel and carboplatin for mucinous

1)

Igarashi K, Akira S, Imaki J, Takeshita T.

cystadenocarcinoma of the ovary during

Systemic endotoxin induces gene

pregnancy. Arch Gynecol Obstet. 2009

expression of inducible nitric oxide

Oct;280(4):633-6. Epub 2009 Feb 11.

synthase in fetal rat brain. J Nippon Med2)

3)

7)

Akira S, Mine K, Kuwabara Y, Takeshita T.

Sch. 2009 Oct;76(5):232-9.

Efficacy of long-term, low-dose

Kuwabara Y, Mine K, Katayama A,

gonadotropin-releasing hormone agonist

Inagawa T, Akira S, Takeshita T. Proteomictherapy (draw-back therapy) foranalyses of recombinant humanadenomyosis. Med Sci Monit. 2009

follicle-stimulating hormone andJan;15(1):CR1-4.

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Doi D, Boh Y, Konishi H, Asakura H,8)‫↢ޣ‬ᱺߣ఺∉ࠍ߼ߋߞߡ‫ޤ‬㉿⷗ᠲ✜, ┻ਅବⴕ㧦

J Reprod Med. 2009 Aug;54(8):459-66.

ᄦ࡝ࡦࡄ⃿఺∉≮ᴺᓟߩ⛯⊒ᕈਇᅧ∝㧦⥃ᐥ

Akira S, Iwasaki N, Ichikawa M, Mine K,఺∉࡮ࠕ࡟࡞ࠡ࡯⑼(1881-1930)52 Ꮞ 2 ภKuwabara Y, Takeshita T, Tajima H.

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hexanoyl-lysineỚᐲߣART⥃ᐥ⢛᥊ߩᬌ⸛㧦ᣣᧄฃ♖⌕ᐥቇળ㔀⹹(0914-6776)26 Ꮞ 1ภ Page114-11710) ┻ਅବⴕ(ᣣᧄක⑼ᄢቇ ↥ᇚੱ⑼)㧦
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11) ┻ਅବⴕ㧦ਇ⢒∝ߩ⸻ᢿߣᴦ≮ ሶችᄸᒻߩ.
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12) ┻ਅବⴕ(ᣣᧄක⑼ᄢቇ ↥ᇚੱ⑼ቇ)㧦ਇ⢒∝ߣᲣᕈ ᵹ↥ᱫ↥ᓟߩᔃℂࠤࠕ㧦␹ᄹᎹᲣᕈⴡ↢ቇળ⹹(1343-831X)12 Ꮞ 1 ภ Page73-74
13) ┻ਅବⴕ(ᣣᧄක⑼ᄢቇ ↥ᇚੱ⑼ቇᢎቶ)‫ߎޣ‬ߎ߇⡞߈ߚ޿ ਇᅧ࡮ਇ⢒∝⸻≮ࡌࠬ࠻ࡊ࡜ࠢ࠹ࠖࠬ‫ ޤ‬ਇ⢒∝ߩᬌᩏ࡮⸻ᢿ ౝಽᴲ࡮ઍ⻢࿃ሶ ‫ޣ‬ౝಽᴲ࡮ઍ⻢⇣Ᏹ‫ ޤ‬ਇ⢒∝ߦ߅ߌࠆ↲⁁⣼ᯏ⢻⇣Ᏹߩ∛ᘒߦߟ޿ߡᢎ߃ߡߊ
ߛߐ޿.ᧄᒰߦᵹ↥ߣߩ㑐ଥߪ޽ࠆߩߢߒࠂ߁߆㧦⥃ᐥᇚੱ⑼↥⑼(0386-9865)63 Ꮞ 4 ภPage639-64114) ┻ਅବⴕ(ᣣᧄක⑼ᄢቇ ↥ᇚੱ⑼ቇᢎቶ)‫ߎޣ‬ߎ߇⡞߈ߚ޿ ਇᅧ࡮ਇ⢒∝⸻≮ࡌࠬ࠻ࡊ࡜ࠢ࠹ࠖࠬ‫ ޤ‬ਇ⢒∝ߩᬌᩏ࡮⸻ᢿ ౝಽᴲ࡮ઍ⻢࿃ሶ ‫ޣ‬ౝಽᴲ࡮ઍ⻢⇣Ᏹ‫↢ ޤ‬ᱺౝಽᴲ⇣Ᏹ,↲⁁⣼ᯏ⢻⇣Ᏹ,♧ዩ∛ߩᬌᩏߩታ㓙ߦߟ޿ߡᢎ߃ߡߊߛߐ޿㧦⥃ᐥᇚੱ⑼↥⑼(0386-9865)63 Ꮞ 4 ภ Page636-6372㧚ቇળ⊒⴫ߥߒ㧴㧚⍮⊛⽷↥ᮭߩ಴㗿࡮⊓㍳⁁ᴫ㧔੍ቯࠍ฽߻‫ޕ‬㧕
1. ․⸵ขᓧߥߒ
2. ታ↪ᣂ᩺⊓㍳ߥߒ

113⴫㧝㧚ᄦ࡝ࡦࡄ⃿఺∉≮ᴺߦ㑐ߔࠆࠕࡦࠤ࡯࠻
ᣉ⸳ฬᜂᒰ⠪٧⹥ᒰߔࠆ㗄⋡ߩ‫ߡߒࠍࠢ࠶ࠚ࠴ߦغ‬ਅߐ޿‫ޕ‬ٟ৻⥸                   ⸳໧㧝㧚⾆㒮ߩ⒳೎ߪ㧫A ↥ᇚੱ⑼ක㒮࡮⸻≮ᚲ㧔ಽᇂࠍขࠅᛒ߁㧕B ↥ᇚੱ⑼ක㒮࡮⸻≮ᚲ㧔ಽᇂࠍขࠅᛒࠊߥ޿㧕C ᄢቇ∛㒮D ᄢቇએᄖߩ✚ว∛㒮E ਇᅧኾ㐷ࠢ࡝࠾࠶ࠢ࡮∛㒮F ߘߩઁ⸳໧㧞㧚ᣣ↥ᇚ↢ᱺౝಽᴲᆔຬળႎ๔㧔એਅਇ⢒∝ዊᆔຬળႎ๔㧦㥲⮮ṑዊᆔຬ㐳㧕ᣣ↥ᇚ⹹㧔Vol.56(6)‫ޔ‬2004㧕ߦߟ޿ߡ㧔ⶄᢙ࿁╵น㧕A ឝタߐࠇߚߎߣࠍ⍮ࠄߥ޿B ឝタߐࠇߚߎߣߪ⍮ߞߡ޿ࠆ߇‫޿ߥ޿ߢࠎ⺒ޔ‬C ⺒ࠎߛD ផᅑߦၮߠ޿ߡᬌᩏࠍⴕߞߡ޿ࠆE ផᅑߦၮߠ޿ߡᴦ≮ࠍⴕߞߡ޿ࠆF ߘߩઁٟᵹ↥࡮ਇ⢒∝ߦኻߔࠆ⠨߃ᣇߦߟ޿ߡ߅዆ߨߒ߹ߔ‫ޕ‬⸳໧㧟㧚ൻቇᅧᆼ㧔ᵹ↥㧕ߪᵹ↥࿁ᢙߦࠞ࠙ࡦ࠻ߒ߹ߔ߆㧫A ࠞ࠙ࡦ࠻ߔࠆB ࠞ࠙ࡦ࠻ߒߥ޿⸳໧㧠㧚ሶችᄖᅧᆼߪᵹ↥࿁ᢙߦࠞ࠙ࡦ࠻ߒ߹ߔ߆㧫A ࠞ࠙ࡦ࠻ߔࠆB ࠞ࠙ࡦ࠻ߒߥ޿114   ⸳໧㧡㧚෻ᓳᵹ↥㧔㧞࿁ߩ⥄ὼᵹ↥ᱧ㧕∝଀ߦේ࿃ᬌ⚝ߩࠬࠢ࡝࡯࠾ࡦࠣࠍⴕ޿߹ߔ߆㧫A ߔࠆB ߒߥ޿ٟታᣉ⁁ᴫߦߟ޿ߡ           ⸳໧㧢㧚఺∉≮ᴺࠍታᣉߒߡ޿߹ߔ߆㧫A ታᣉߒߡ޿ࠆB ᤄߪታᣉߒߡ޿ߚ߇੹ߪߒߡ޿ߥ޿‫ޕ‬C ታᣉߒߚߎߣ߇ߥ޿‫ޕ‬㧖㧝ߢ B ߣ߅╵߃ߦߥߞߚᣇ߳ߩ⾰໧ߢߔ‫ޕ‬⸳໧㧣㧚޿ߟ߹ߢ㧔⷏ᥲ૗ᐕ߹ߢ㧕ታᣉߒߡ޿߹ߒߚ߆㧫㧔    㧕ᐕ߹ߢ㧖㧝ߢ㧮㧚੹ߪታᣉߒߡ޿ߥ޿‫ޔ‬㧯㧚ታᣉߒߚߎߣ߇ߥ޿ ߣ߅╵߃ߦߥߞߚᣉ⸳߳ߩ⾰໧ߢߔ‫ޕ‬⸳໧㧤㧚ታᣉߒߥ޿ℂ↱ߪ㧫(ⶄᢙ࿁╵น㧕A ఺∉≮ᴺߩലᨐߦ⇼໧߇޽ࠆ߆ࠄ‫ޕ‬B ೽૞↪߇ᔃ㈩ߛ߆ࠄ‫ޕ‬C ᣉ⸳߿ੱຬߦ೙⚂߇޽ࠆ߆ࠄ‫ޕ‬D ୶ℂᆔຬળߩᛚ⹺߇ᓧࠄࠇߥ޿߆ࠄ‫ޕ‬E ଻㒾ㆡᔕ߇ߥ޿߆ࠄ‫ޕ‬F ☨࿖㧲㧰㧭߇ේೣ⑌ᱛߣߒߚ߆ࠄG ߘߩઁ㧖એਅ‫ޔ‬ታᣉߒߡ޿ࠆߣ߅╵߃ߦߥߞߚᣉ⸳߳ߩ⾰໧ߢߔ‫ޕ‬⸳໧㧥㧚ᐕ㑆ᴦ≮✚ᢙ(∝଀ᢙ)ߪ㧫A 㧝㧞㧜B 㧞㧝㧙㧡㧜C 㧡㧝㧙㧝㧜㧜D 㧝㧜㧝એ਄ٟㆡᔕߦߟ޿ߡ               

⸳໧ 10㧚ㆡᔕߣߔࠆᣢᓔᵹ↥࿁ᢙߪ㧫A 㧟࿁એ਄

115

B 㧞࿁એ਄㧖એਅߩ᧦ઙࠍḩߚߔߣ߈ߪ㧞࿁ߢ߽ታᣉߔࠆ‫ޕ‬㧔ⶄᢙ࿁╵น㧕
a.ㆊ෰ߩᵹ↥ߦᨴ⦡૕⇣Ᏹߦࠃࠆ߽ߩ߇ߥ޿
b. ㆤᢿ᛫૕㒶ᕈc.Th1/Th2 㜞୯ߥࠄ㨐.ߘߩઁ
⸳໧ 11㧚⛯⊒ᕈ⠌ᘠᵹ↥ࠍㆡᔕߣߒ߹ߔ߆㧫A ㆡᔕߣߔࠆB ㆡᔕߣߒߥ޿⸳໧ 12㧚఺∉⇣Ᏹࠍᬌ಴ߔࠆߚ߼ߦⴕ߁ᬌᩏߪ㧫㧔ⶄᢙ࿁╵น㧕A ࡝ࡦࡄ⃿ᷙวၭ㙃㧔MLC㧕B ࡝ࡦࡄ⃿ࠢࡠࠬࡑ࠶࠴㧔⵬૕ଐሽᕈ⚦⢩㓚ኂ⹜㛎㧕C ࡝ࡦࡄ⃿ࠢࡠࠬࡑ࠶࠴㧔ࡈࡠ࡯ࠨࠗ࠻ࡔ࠻࡝࡯ߦࠃࠆ㧕D HLA ࠲ࠗࡇࡦࠣ
E ᧃ᪳ⴊ NK ⚦⢩ᵴᕈF Th1/Th2G ߘߩઁ㧔        㧕

⸳໧ 13㧚 ਇ⢒∝ዊᆔຬળႎ๔ߢߪ᛫࡝ࡦ⢽⾰᛫૕‫ޔ‬᛫ᩭ᛫૕ߥߤߩ⥄Ꮖ᛫૕㓁ᕈ଀ߪㆡᔕ߆ࠄ㒰ᄖߔࠆߣߒߡ޿߹ߔ‫⾆ޕ‬ᣉ⸳ߢߪߤ߁ߒߡ޿߹ߔ߆㧫"A ㆡᔕ߆ࠄ㒰ᄖߔࠆ‫ޕ‬B ㆡᔕߣߒߡ޿ࠆ‫ޕ‬C ∝଀ߦࠃࠆ‫ޕ‬D ߘߩઁ㧔           㧕㧖ᣇᴺߦߟ޿ߡ⸳໧ 14㧚࡝ࡦࡄ⃿㧔නᩭ⃿‫⃿ⴊ⊕ޔ‬㧕ߦ᡼኿✢ᾖ኿ࠍⴕ޿߹ߔ߆㧫A ⴕ߁‫ޕ‬B ⴕࠊߥ޿‫ޕ‬
⸳໧ 15㧚ធ⒳ᴺA ⊹ౝᵈ኿B 㕒⣂ౝᛩਈ

116

⸳໧ 16㧚ធ⒳ᤨᦼ
A ᅧᆼ೨ߩߺB ᅧᆼਛߩߺ
C ᅧᆼ೨෸߮ᅧᆼਛ
D ߘߩઁ㧖ലᨐ್ቯ࡮೽૞↪
⸳໧ 17㧚ᴦ≮ലᨐߩ್ቯᴺߪ㧫㧔ⶄᢙ࿁╵น㧕A ࡝ࡦࡄ⃿ᷙวၭ㙃㧔MLC㧕ᛥ೙₸B ࡝ࡦࡄ⃿ࠢࡠࠬࡑ࠶࠴㧔⵬૕ଐሽᕈ⚦⢩㓚ኂ⹜㛎㧕C ࡝ࡦࡄ⃿ࠢࡠࠬࡑ࠶࠴㧔ࡈࡠ࡯ࠨࠗ࠻ࡔ࠻࡝࡯ߦࠃࠆ㧕D ⊹ౝ෻ᔕᄌൻ₸E NK ⚦⢩ᵴᕈᄌൻ₸F Th1/Th2 ᄌൻ₸G ․ߦߥߒH ߘߩઁ
⸳໧ 18㧚ലᨐᜬ⛯ᦼ㑆ߪߤߩߊࠄ޿ߣ߅⠨߃ߢߔ߆㧫A 㧟ࡩ᦬B 㨪㧢ࡩ᦬C 㨪㧝ᐕD 㨪㧞ᐕE ߘߩઁ  㧖ߘࠇࠍㆊ߉ߡᅧᆼߒߥ޿႐วߪㅊട఺∉ࠍⴕ޿߹ߔ߆㧫A ⴕ߁B ⴕࠊߥ޿⸳໧ 19㧚೽૞↪ߩ⚻㛎ߪ޽ࠅ߹ߔ߆㧫A ૞↪ߩ⚻㛎ߥߒB ޽ࠅ㧖޽ࠅߩ႐ว㧔                             㧕ٟᄦ࡝ࡦࡄ⃿఺∉≮ᴺએᄖߦ㑐ߔࠆ⾰໧ߢߔ‫ޕ‬
⸳໧ 20㧚᛫࡝ࡦ⢽⾰᛫૕㓁ᕈ଀ߥߤߩਇ⢒∝∝଀ߦૐ↪㊂ࠕࠬࡇ࡝ࡦ≮ᴺ and/or ࡋࡄ࡝117

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B ૐ↪㊂ࠕࠬࡇ࡝ࡦ࡮ࡋࡄ࡝ࡦ૬↪≮ᴺࠍⴕߞߡ޿ࠆ
C ࡋࡄ࡝ࡦ≮ᴺߩߺⴕߞߡ޿ࠆ
D ⴕߞߡ޿ߥ޿ߏදജ޽ࠅ߇ߣ߁ߏߑ޿߹ߒߚ‫ޕ‬118⴫㧞㧚 ᐕ  ᦬  ᣣ␠࿅ᴺੱ ᣣᧄ↥⑼ᇚੱ⑼ቇળ
ℂ੐㐳 ศ᧛ᵏౖ Ლේ࿃ਇ᣿⠌ᘠᵹ↥଀ߦኻߒߡⴕߥ߁ᄦ࡝ࡦࡄ⃿఺∉≮ᴺߦ߅ߌࠆ࡝ࡦࡄ⃿߳ߩ᡼኿✢ᾖ኿ߦߟ޿ߡේ࿃ਇ᣿⠌ᘠᵹ↥ߦኻߒߡᄦ࡝ࡦࡄ⃿఺∉≮ᴺ߇ⴕࠊࠇߡ߈߹ߒߚ߇‫ᦨޔ‬ㄭߩࡔ࠲ࠕ࠽࡝ࠪࠬߢߪߘߩ᦭ലᕈࠍ␜ߔ࠺࡯࠲߇ᓧࠄࠇߡ޿߹ߖࠎ‫ޕ‬ട߃ߡ  ᐕߦ☨࿖ (&# ߇ᧄ≮ᴺߪ⥃ᐥ⎇ⓥߦ㒢ቯߒߡⴕࠊࠇࠆߴ߈ߣߩ൘๔ࠍ಴ߒߡએ᧪‫ߩߘޔ‬ታᣉᢙߪ਎⇇⊛ߦᷫዋߒߡ޿ࠆߣ⠨߃ࠄࠇ߹ߔ‫ޔߢߎߘޕ‬ෘ↢ഭ௛⑼⎇ਇ⢒∝⎇ⓥ⃰ߢߪ‫⃻ޔ‬࿷ߩࠊ߇࿖ߦ߅ߌࠆᄦ࡝ࡦࡄ⃿఺∉≮ᴺߩታᘒ⺞ᩏࠍⴕ޿߹ߒߚ‫ޕ‬ߘߩ⚿ᨐ‫⃻ޔ‬࿷ߢ߽ห≮ᴺࠍታᣉߒߡ޿ࠆᣉ⸳ߪ 2002 ᐕᒰᤨߩ㧠ಽߩ㧝ߦᷫዋߒߡ޿ࠆߎߣ߇್᣿ߒ߹ߒߚ‫ޕ‬㊀ᄢߥߎߣߦ‫ޔ‬ታᣉߒߡ޿ࠆᣉ⸳ߩਛߦ‫ޔ‬ធ⒳ߔࠆ࡝ࡦࡄ⃿ߦ᡼኿✢ᾖ኿ࠍⴕߞߡ޿ߥ޿ᣉ⸳߇ዋߥ߆ࠄߕ㧔34㧑㧕ሽ࿷ߔࠆߎߣ߇᣿ࠄ߆ߦߥࠅ߹ߒߚ‫ޕ‬⒖ᬀ ኻኋਥ∛㧔GVHD㧕ߪャⴊߩ೽૞↪ߩਛߢ߽ᦨ߽㊀◊ߥ߽ߩߩ߭ߣߟߢ‫ޔ‬ャⴊⴊᶧਛߩ࡝ࡦࡄ⃿ߦࠃߞߡᒁ߈⿠ߎߐࠇ߹ߔ‫ޕ‬ᐔᚑ 21 ᐕ㧞᦬‫ޔ‬ෘ↢ഭ௛⋭ߪ‫ޟޔ‬ャⴊ≮ᴺߩታᣉߦ㑐ߔࠆᜰ㊎‫ޠ‬෸߮‫ⴊޟ‬ᶧ⵾೷ߩ૶↪ᜰ㊎‫৻ߩޠ‬ㇱᡷᱜࠍⴕ޿‫ޔ‬GVHD ߇᡼኿✢ᾖ኿ⴊᶧࠍ૶↪ߔࠆߎߣߦࠃߞߡ੍㒐ߢ߈ࠆߎߣࠍ᣿⸥ߒ߹ߒߚ‫ࠍ⃿ࡄࡦ࡝ޕ‬Ớ❗ߒߡធ⒳ߔ
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6CMGUJKVC6㉿⷗ᠲ✜┻ਅବⴕፃస਽ንጊ௥ሶ᪀ේᘮలឃෆ⺃⊒ᤨߩෆ⢩ᶧਛ ᣣᧄฃ♖⌕ᐥJGZCPQ[NN[UKPGỚᐲ ቇળ㔀⹹
ߣ#46⥃ᐥ⢛᥊ߩᬌ⸛ⒷᎹᥓሶ㒙ㇱፏ⷏ᒎ↢᣿ᭉ㊀ᄦᚑ⋧ቁ৻૒⮮ཅ౓┻ਅବⴕਇ⢒∝ߩ⸻ᢿߣᴦ≮ ᣣᧄ↥⑼ᇚੱ
ሶችᄸᒻߩᬌᩏߣᴦ ⑼ቇળ㑐᧲ㅪ≮ว࿾ᣇㇱળ⹹127

┻ਅବⴕ ᣣᧄක ਇ⢒∝ߣᲣᕈ ᵹ↥ᱫ ␹ᄹᎹᲣᕈⴡ⑼ᄢቇ↥ᇚੱ⑼ ↥ᓟߩᔃℂࠤࠕ
↢ቇળ⹹
ቇ 



128

  

  

  

:┻ਅବⴕ ᣣᧄක ‫߇ߎߎޣ‬⡞߈ߚ޿ ਇ ⥃ᐥᇚੱ⑼↥⑼ᄢቇ↥ᇚੱ⑼ ᅧ࡮ਇ⢒∝⸻≮ࡌࠬ࠻ ⑼ࡊ࡜ࠢ࠹ࠖࠬ‫ ޤ‬ਇ⢒ቇᢎቶ ∝ߩᬌᩏ࡮⸻ᢿ ౝಽ ᴲ࡮ઍ⻢࿃ሶ‫ޣ‬ౝಽᴲ࡮ઍ⻢⇣Ᏹ‫ ޤ‬ਇ⢒∝ߦ߅ߌࠆ↲⁁⣼ᯏ⢻⇣Ᏹߩ∛ᘒߦߟ޿ߡᢎ߃ߡߊߛߐ޿ᧄᒰߦᵹ↥ߣߩ㑐ଥߪ޽ࠆߩߢߒࠂ߁߆┻ਅବⴕ ᣣᧄක ‫߇ߎߎޣ‬⡞߈ߚ޿ ਇ ⥃ᐥᇚੱ⑼↥⑼ᄢቇ↥ᇚੱ⑼ ᅧ࡮ਇ⢒∝⸻≮ࡌࠬ࠻ ⑼ࡊ࡜ࠢ࠹ࠖࠬ‫ ޤ‬ਇ⢒ቇᢎቶ ∝ߩᬌᩏ࡮⸻ᢿ ౝಽ ᴲ࡮ઍ⻢࿃ሶ‫ޣ‬ౝಽᴲ࡮ઍ⻢⇣Ᏹ‫↢ ޤ‬ᱺౝಽᴲ⇣Ᏹ↲⁁⣼ᯏ⢻⇣Ᏹ♧ዩ∛ߩᬌᩏߩታ㓙ߦߟ޿ߡᢎ߃ߡߊߛߐ޿