ᖹᡂ  ᖺᗘ᪥ᮏࣇࣝࣁࢵࣉ◊✲ຓᡂሗ࿌᭩୰ᑠ௻ᴗ⤒Ⴀ⪅࣭ᚑᴗဨࡢ㌟య࣭ᚰ⌮ⓗ೺ᗣࡢ⥔ᣢ࣭ቑ㐍ࡢࡓࡵࡢຠᯝⓗ࡞ࢫࢺࣞࢫࢳ࢙ࢵࢡ᪉ἲ࡟㛵ࡍࡿ◊✲ᮌᒣ ᫀᙪ኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮ඹྠ◊✲⪅㸸ஂಖ⏣ ᗣᙪ㸦኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮㸧      ᡭሯ ୍⚽ 㸦኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮㸧㸫㸫ࡣࡌࡵ࡟
㏆ᖺࡢ᪥ᮏࡢປാ⎔ቃࡣࡇࢀࡲ࡛࡟࡞࠸᪂ࡓ࡞ᒁ㠃ࢆ㏄࠼࡚࠸ࡿࠋ㐣ཤᩘ༑ᖺ࡟ࢃࡓࡾࠊ
᪥ᮏࡣㅖእᅜ࡜ẚ࡭ປാ᫬㛫ࡀ㛗ࡃࠊࠗ㛗᫬㛫ປാ኱ᅜ࠘࡜ࡲ࡛ゝࢃࢀ࡚ࡁࡓࠋ㐣㓞࡞ᑵປ≧ἣ࡛࠶ࡿࡇ࡜ࡣᙜ᫬ࡶኚࢃࡽ࡞࠸ࡶࡢࡢࠊ୍᪉࡛᪥ᮏ௻ᴗ࡟࠾ࡅࡿ⤊㌟㞠⏝ไ࡞࡝ࡢே஦ฎ㐝ࡣᑵປ࡟క࠺ࢫࢺࣞࢫࡢ୍㒊ࢆ࿴ࡽࡆ࡚࠸ࡓ࡜ࡶ⪃࠼ࡽࢀࡿࠋࡋ࠿ࡋ࡞ࡀࡽࠊ᫖௒ࡢ♫఍᝟ໃࡢኚ໬࡟ᛂࡌࠊከࡃࡢ௻ᴗ࡛㠀ṇつ㞠⏝ᯟࡀቑຍࡋ୙Ᏻᐃ࡞㞠⏝≧ἣ࡛ᑗ᮶タィࢆ❧࡚࡟ࡃ࠸⪅ࡀ⥆ฟࡋ࡚࠸ࡿࠋࡲࡓᖺຌᗎิไ࡟ኚࢃࡾᡂᯝ୺⩏ࡀྲྀࡾධࢀࡽࢀࠊ᭦࡞ࡿᡂᯝࢆせồࡉࢀࡿࡇ࡜ࡀከࡃ࡞ࡗ࡚࠸ࡿࠋࡇࡢࡼ࠺࡞ࡇ࡜࡟ࡼࡗ࡚ࠊᑵປ࡟ࡼࡿࢫࢺࣞࢫࡣ࠿ࡘ
࡚࡜ࡣ␗࡞ࡿᙧ࡛⌧௦♫఍࡟ᾐ㏱ࡋ࡚࠸ࡿ࡜࠸࠼ࡿࠋ
ࡇࡢࡼ࠺࡞≧ἣࡣ௻ᴗ࡟࡜ࡗ࡚ࠊᚑᴗဨࡢ௙஦ࡢ⬟⋡పୗࡸ⑌⑓ఇᴗ࡞࡝⤒Ⴀ࡟኱ࡁ࡞㈇ᢸࢆ୚࠼࠿ࡡ࡞࠸ࠋ2000 ᖺ௦࡟ධࡾࠊ໅ົ⪅ࡢ೺ᗣࡀ௻ᴗࡢ⤒Ⴀ㠃࡟ࡶ኱ࡁ࡞ᙳ㡪ࢆ୚࠼ࡿ࡜࠸࠺ࠕ೺ᗣ⤒Ⴀࠖࡢ⪃࠼᪉ࡀᗈࡀࡗ࡚࠾ࡾࠊ௻ᴗ࡟࠾ࡅࡿ໅ົ⪅ࡢ೺ᗣ⥔ᣢ࣭ቑ㐍ࡣࡲࡍࡲࡍ㔜せどࡉࢀ࡚࠸ࡿࠋࡲࡓ໅ົ⪅࡟࡜ࡗ࡚ࡣࠊ⢭⚄ⓗཬࡧ㌟యⓗ࡞୙ㄪࢆᣍࡃࡇ࡜࡛ࠊ
ᑗ᮶ࡢ⑌⑓࣭せ௓ㆤࡸ೺ᗣᑑ࿨࡟ᝏᙳ㡪ࢆཬࡰࡋ࠿ࡡ࡞࠸ࠋᖹᡂ 28 ᖺ࡟ࡣᗈ࿌௦⌮ᗑࡢ᪂ධ♫ဨࡢ㣕ࡧ㝆ࡾ⮬ẅࡀ㐣ປṚ࡜ㄆᐃࡉࢀࡓࡇ࡜ࡀሗ㐨ࡉࢀࡿ࡞࡝ࠊ♫఍ⓗ࡟ࡶᑵປࢫࢺࣞ
ࢫࡢᚰ㌟࡬ࡢᙳ㡪࡟ࡘ࠸࡚㛵ᚰࡀ㧗ࡲࡗ࡚࠸ࡿࠋࡇࡢ೺ᗣㄢ㢟࡟ᑐᛂࡋ࡚ࠊᑵປ࡟ࡼࡿࢫࢺࣞࢫࢆṇ☜࡟ᢕᥱࡍࡿࡇ࡜ࡢ㔜せᛶࡀὀ┠ࡉࢀࡿࡼ࠺࡟࡞ࡾࠊࡑࡢ⤖ᯝࠊᖹᡂ 27 ᖺ 12 ᭶ 1 ᪥ࡼࡾປാᏳ඲⾨⏕ἲ࡟ᇶ࡙ࡃࠕࢫࢺࣞࢫࢳ
࢙ࢵࢡไᗘࠖࡀ᪋⾜ࡉࢀࡓࠋࡋ࠿ࡋࢫࢺࣞࢫࢳ࢙ࢵࢡࡢ⤖ᯝ࡛ࢃ࠿ࡿࢫࢺࣞࢫ≧ἣࡀ࡝ࡢࡼ
࠺࡞ᚰ㌟ࡢ୙ㄪ࡜㛵ࢃࡗ࡚࠸ࡿࡢ࠿ࠊ࡟ࡘ࠸࡚ࡣ࠸ࡲࡔ༑ศ࡟᫂ࡽ࠿࡟࡞ࡗࡓ࡜ࡣ࠸࠼࡞࠸ࠋ≉࡟ᚠ⎔ჾ⑌ᝈ࡜ࡑࡢ༴㝤ᅉᏊ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࡣ࡯࡜ࢇ࡝᳨ウࡉࢀ࡚࠸࡞࠸ࠋࡑ࠺ࡋ

㸫㸫ࡓ≧ἣࢆ㋃ࡲ࠼ࠊࢫࢺࣞࢫࢳ࢙ࢵࢡࡢ⤖ᯝ࠿ࡽ⫋ሙ⎔ቃᨵၿ࡟ࠊᚠ⎔ჾ⑌ᝈࡢண㜵࡟ࠊࡲࡓᚰ㌟ࡢ೺ᗣࡢቑ㐍࡟ᙺ❧࡚ࡽࢀࡿ▱ぢࢆᚓࡿࡇ࡜ࢆࠊᮏ◊✲ࡢ┠ⓗ࡜ࡋࡓࠋᮏሗ࿌᭩ࡣ㸯㸧኱㜰ᗓୗࡢ໅ົ⪅࡟࠾ࡅࡿࢫࢺࣞࢫ≧ἣ࡜ᚰ㌟ࡢ೺ᗣ≧ែ㸰㸧ࢫࢺࣞࢫࢳ࢙ࢵࢡ࡟ᇶ࡙ࡃࢫࢺࣞࢫ≧ែ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃ࡢ㸰ࡘ࠿ࡽ࡞ࡿࠋ

㸫㸫㸯㸧኱㜰ᗓୗࡢ໅ົ⪅࡟࠾ࡅࡿࢫࢺࣞࢫ≧ἣ࡜ᚰ㌟ࡢ೺ᗣ≧ែ◊✲┠ⓗ኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮࡛ࡣࠊẖᖺ⣙ 10,000 ேࡢ኱㜰ᗓୗࡢ໅ົ⪅࡟ᑐࡋ࡚ᚠ⎔ჾ⑓೺デࢆᐇ᪋ࡋ࡚࠸ࡿࠋࢫࢺࣞࢫࢳ࢙ࢵࢡࡀ඲ᅜⓗ࡟㛤ጞࡉࢀࡿ௨๓࠿ࡽࠊࢫࢺࣞࢫࡀᚰ
㌟୧㠃࡟ᝏᙳ㡪ࢆཬࡰࡋ࠺ࡿࡇ࡜ࢆព㆑ࡋࠊ೺デ᫬࡟ࢫࢺࣞࢫ࡟㛵ࡍࡿၥデࢆ⾜࠸ࠊ໅ົ⪅ࡢࢫࢺࣞࢫ≧ἣࡢᢕᥱ࡟ດࡵ࡚ࡁࡓࠋࡑࡢ㝿࡟ᚓࡽࢀࡓࢹ࣮ࢱࢆ⏝࠸࡚ࠊ኱㜰ᗓୗࡢ໅ົ⪅࡟࠾ࡅࡿࢫࢺࣞࢫ㢖ᗘࡢ⛣ࡾኚࢃࡾࠊࢫࢺࣞࢫࡀ࡝ࡢࡼ࠺࡟ᚰ㌟ࡢ೺ᗣ≧ែ࡟ᙳ㡪ࢆ࠾ࡼࡰࡋ࡚࠸ࡿ࠿ࠊࡉࡽ࡟ࡣࠊ࡝ࡢࡼ࠺࡞⫋ሙ⎔ቃࡀࢫࢺࣞࢫ࡜㛵㐃ࡋ࡚࠸ࡿ࠿࡟ࡘ࠸᳨࡚ウࡍࡿࠋ᪉ἲ኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮࡟࡚ࠊ2012 ᖺᗘ㹼2016 ᖺᗘ࡟ᚠ⎔ჾ⑓೺デࢆཷデࡋࡓ໅ົ⪅ࢆᑐ㇟࡜ࡋࡓ㸦ྛᖺ⣙ 10,000 ே㸧ࠋࡲࡎࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࢆࠊ2012 ᖺ࠿ࡽ 2016 ᖺࡢྛᖺᗘ࡛ィ⟬ࡋࠊࡑࡢ⛣ࡾኚࢃࡾࢆㄪ࡭ࡓࠋḟ࡟ࠊ┤㏆ࡢ 2016 ᖺᗘࢹ࣮ࢱ㸦⏨ᛶ 5,797 ேࠊዪᛶ 5,909 ே㸧ࢆ⏝࠸࡚ࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿே࡜ࡑ࠺࡛࡞࠸ேࡢ㛫࡛ࠊୗグ 1)㹼6)ࡢ㡯┠ࡢ๭ྜࡀ࡝ࡢࡼ࠺࡟
␗࡞ࡿ࠿ࢆ᳨ウࡋࡓࠋ1㸧ᢚ࠺ࡘഴྥ

㸦ࡇࡢ 1 ࠿᭶㛫ࠊఱࢆࡍࡿ࡟ࡶ࡯࡜ࢇ࡝⯆࿡ࡀ࡞࠸≧ែࡀ⥆࠸࡚࠸࡚ࠊ࠿ࡘẼศࡀⴠࡕ㎸ࢇࡔࡾࠊᕼᮃࡀࢃ࠿࡞࠸࡜࠸࠺≧ែࡀ⥆࠸࡚࠸ࡿே㸧㸫㸫

2㸧

㧗⾑ᅽ⑕

㸦᭱኱⾑ᅽӍ140mmHg and/or ᭱ᑠ⾑ᅽӍ90mmHg and/or 㧗⾑ᅽ⑕ࡢ᪤ ࠶ࡾࡢே㸧3㸧⬡㉁␗ᖖ⑕

㸦LDL ࢥࣞࢫࢸ࣮ࣟࣝӍ120mg/dL and/or ୰ᛶ⬡⫫Ӎ150mm/dL and/or ⬡㉁␗ᖖ⑕ࡢ᪤ 
࠶ࡾࡢே㸧
4㸧

⢾ᒀ⑓

㸦HbA1cӍ6.5% and/or ✵⭡᫬⾑⢾್Ӎ126mg/dL and/or ⢾ᒀ⑓ࡢ᪤ ࠶ࡾࡢே㸧5㸧ᚰ⮚⑓ࡢ᪤ ࡢ࠶ࡿே6㸧⬻༞୰ࡢ᪤ ࡢ࠶ࡿேࡉࡽ࡟ࠊྠࡌࢹ࣮ࢱࢆ⏝࠸࡚ࠊୗグ 1)㹼4)ࡢࡼ࠺࡞⫋ሙ⎔ቃ࡟ࡼࡗ࡚ࠊࢫࢺࣞࢫࢆឤࡌࡿே
ࡢ๭ྜࡀ࡝ࡢࡼ࠺࡟␗࡞ࡿ࠿ࢆ᳨ウࡋࡓࠋ1㸧ࢫࢺࣞࢫゎᾘἲࡢ᭷↓2㸧┦ㄯ┦ᡭࡢ᭷↓3㸧㛗᫬㛫ປാ㸦㐌 40 ᫬㛫௨ୖ㸧4㸧୺࡟ᗙࡾ௙஦㸦௙஦᫬㛫ࡢ༙ศ௨ୖ㸧ࡇࢀࡽࡣࡍ࡭࡚⏨ዪู࡟ࠊࡑࡋ࡚ࠊᖺ㱋ࢆㄪᩚࡋ࡚ゎᯒࡋࡓࠋ୍᪉࡜௚᪉ࢆẚ㍑ࡍࡿ࡜ࡁࡣࠊ⤫ィᏛⓗ࡟ᕪࢆㄆࡵࡿ࡜ࡁࡢࡳ㸦ࢢࣛࣇ୰࡟ p<0.05 ࡜⾲♧㸧ࠕከ࠸ࠖࡲࡓࡣࠕᑡ࡞࠸ࠖ࡜⾲⌧ࡋࡓࠋ㸫㸫⤖ᯝ$ ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡢ⛣ࡾኚࢃࡾᅗ ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡢ⛣ࡾኚࢃࡾ ⏨ᛶࡣࠊ ᖺᗘ࡜ẚ㍑ࡋ࡚ࠊ ᖺᗘ௨㝆ࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜ࡟ᕪࡣࡳࡽࢀ࡞࠿ࡗࡓࠋ୍᪉ࠊዪᛶ࡛ࡣࠊ ᖺᗘ࡜ẚ㍑ࡋ࡚ࠊࠊࠊ࠾ࡼࡧ  ᖺᗘ࡛ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋ㸫㸫% ࢫࢺࣞࢫࡢ᭷↓࡟ࡼࡿᚰ㌟ࡢ೺ᗣ≧ែᅗ ࢫࢺࣞࢫ࡜ᢚ࠺ࡘഴྥ ⏨ዪ࡜ࡶ࡟ࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ⩌ࡣឤࡌ࡚࠸࡞࠸⩌࡟ẚ࡭࡚ࠊᢚ࠺ࡘഴྥ࡟࡞ࡗ࡚࠸ࡿேࡢ๭ྜࡀ㧗࠸ഴྥ࡟࠶ࡗࡓࠋᅗ ࢫࢺࣞࢫ࡜㧗⾑ᅽ⑕ ⏨ᛶ࡛ࡣࠊ㧗⾑ᅽ⑕ࢆ᭷ࡍࡿேࡢ๭ྜࡣࠊࢫࢺࣞࢫࡢ࠶ࡿ⩌࡜࡞࠸⩌࡛ᕪࡣ࡞࠿ࡗࡓࡀࠊዪᛶ࡛ࡣࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ⩌࡛㧗⾑ᅽ⑕࡜デ᩿ࡉࢀࡿேࡢ๭ྜࡀ㧗࠸ഴྥ࡟࠶ࡗࡓࠋ㸫㸫ᅗ ࢫࢺࣞࢫ࡜⬡㉁␗ᖖ⑕
 ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ⏨ᛶࡣࠊឤࡌ࡚࠸࡞࠸⏨ᛶࡼࡾ⬡㉁␗ᖖ⑕࡜デ᩿ࡉࢀࡿேࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋዪᛶ࡛ࡣࡑࡢࡼ࠺࡞ഴྥࡣࡳࡽࢀ࡞࠿ࡗࡓࠋᅗ ࢫࢺࣞࢫ࡜⢾ᒀ⑓⢾ᒀ⑓࡟┦ᙜࡍࡿேࡢ๭ྜࡣࠊ⏨ዪ࡜ࡶࠊࢫࢺࣞࢫࡢ࠶ࡿ⩌࡜࡞࠸⩌࡛ᕪࡣࡳࡽࢀ࡞࠿ࡗࡓࠋ㸫㸫ᅗ ࢫࢺࣞࢫ࡜ᚰ⮚⑓ ⏨ዪ࡜ࡶࠊࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ⩌ࡣࠊឤࡌ࡚࠸࡞࠸⩌࡟ẚ࡭࡚ࠊᚰ⮚⑓ࡢ᪤ ࡀ࠶ࡿேࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋᅗ ࢫࢺࣞࢫ࡜⬻༞୰ ⏨ዪ࡜ࡶࠊ⬻༞୰᪤ ࡢ๭ྜ࡟ࠊࢫࢺࣞࢫࡢ࠶ࡿ⩌࡜࡞࠸⩌࡛ᕪࡣࡳࡽࢀ࡞࠿ࡗࡓࠋ㸫㸫& ⫋ሙ⎔ቃ࡟ࡼࡿࢫࢺࣞࢫ≧ἣࡢ㐪࠸ᅗ ࢫࢺࣞࢫゎᾘἲ࡜ࢫࢺࣞࢫ ⏨ዪ࡜ࡶࠊࢫࢺࣞࢫゎᾘἲࡀ࡞࠸⩌ࡣࠊࢫࢺࣞࢫゎᾘἲࡀ࠶ࡿ⩌ࡼࡾࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋᅗ ┦ㄯ┦ᡭ࡜ࢫࢺࣞࢫ ⏨ዪ࡜ࡶࠊ┦ㄯ┦ᡭࡀ࠸࡞࠸⩌ࡣࠊ┦ㄯ┦ᡭࡀ࠸ࡿ⩌ࡼࡾࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋ㸫㸫ᅗ 㛗᫬㛫ປാ࡜ࢫࢺࣞࢫ ⏨ዪ࡜ࡶࠊ㐌  ᫬㛫௨ୖ໅ົࡋ࡚࠸ࡿ⩌ࡣࠊࡋ࡚࠸࡞࠸⩌ࡼࡾࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋᅗ ᗙࡾ௙஦࡜ࢫࢺࣞࢫ ⏨ᛶ࡛ࡣࠊ௙஦ࡢ኱༙ࢆᗙࡗ࡚ࡋ࡚࠸ࡿ⩌ࡣࠊࡑ࠺࡛࡞࠸⩌ࡼࡾࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡢ๭ྜࡀከ࠸ഴྥ࡟࠶ࡗࡓࠋዪᛶ࡛ࡣࡑࡢࡼ࠺࡞ഴྥࡣࡳࡽࢀ࡞࠿ࡗࡓࠋ㸫㸫⪃ᐹ ኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮࡟࡚ᚠ⎔ჾ⑓೺デࢆཷデࡋࡓ኱㜰ᗓୗࡢ໅ົ⪅ࡢࢫࢺࣞࢫ≧ἣ࡟ࡘ࠸࡚ࠊ⏕ά⩦័⑓࠾ࡼࡧ⫋ሙ⎔ቃ࡜㛵㐃௜ࡅ᳨࡚ウࡋࡓࠋ௨ୗࠊࡑࢀࡒࢀࡢ⤖ᯝ࡟ࡘ࠸࡚⪃ᐹࡍࡿࠋ ⏨ᛶ࡛ࡣࠊࡇࡇᩘᖺ࡛ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿேࡀቑຍࡋ࡚࠸࡞࠸ࡶࡢࡢࠊ༙ᩘ㏆ࡃࡀࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ࡜࠸࠺≧ἣ࡟࠶ࡗࡓࠋ୍᪉ࠊዪᛶࡣቑຍഴྥ࡟࠶ࡾࠊ2016 ᖺᗘ࡛ࡣ⏨ᛶ࡜ྠ⛬ᗘࡢேࡀࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ࡜࠸࠺⤖ᯝ࡛࠶ࡗࡓࠋࡇࢀࡣዪᛶࡢ♫఍㐍ฟࡀ㐍ࡳࠊ⫋ሙ࡛ࡢ❧ሙࡀ⏨ᛶ࡜኱ࡁ࡞ᕪࡀ࡞ࡃ࡞ࡗ࡚ࡁࡓࡇ࡜ࢆ཯ᫎࡋ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋዪᛶࡢ♫఍㐍ฟࡢὶࢀࢆጉࡆࡿࡇ࡜࡟࡞ࡽ࡞࠸ࡼ࠺࡟ࠊ௻ᴗഃࡣ໅ົ⪅ࡀᢪ࠼ࡿࢫࢺࣞࢫࡢ≧ἣࢆᢕᥱࡋࠊ᪩ᛴ࡟ᑐ⟇ࢆ❧࡚ࡿᚲせࡀ࠶ࡿ࡜⪃࠼ࡽࢀࡓࠋ ⏨ዪ࡟࠿࠿ࢃࡽࡎࠊࢫࢺࣞࢫࢆឤࡌࡿࡇ࡜࡛ࠊᢚ࠺ࡘഴྥࡸᵝࠎ࡞⏕ά⩦័⑓ࡢࣜࢫࢡࡀ㧗ࡃ࡞ࡿࡇ࡜ࡀࠊ኱㜰ᗓୗࡢ໅ົ⪅࡟࠾࠸࡚ࡶ☜ㄆࡉࢀࡓࠋࡇࡢ⤖ᯝ࠿ࡽࠊࢫࢺࣞࢫᑐ⟇ࡣࠊࡇࢀࡲ࡛௻ᴗࡀ⾜ࡗ࡚ࡁࡓ୍⯡೺ᗣデ᩿࡜ྠࡌࡼ࠺࡟ࠊ໅ົ⪅ࡢ೺ᗣࢆᏲࡿࡇ࡜࡟ࡘ࡞ࡀࡿ࡜⪃࠼ࡽࢀࡿࠋ ࡲࡓࠊ⏨ዪ࡜ࡶࠊᵝࠎ࡞⫋ሙ⎔ቃ࡜ࢫࢺࣞࢫࡢ㛵㐃ࡀㄆࡵࡽࢀࡓࠋࢫࢺࣞࢫゎᾘἲࡀ࠶ࡿ࠿࡝࠺࠿ࡣࠊ໅ົ⪅ᮏேࡢၥ㢟࡛࠶ࡿࡇ࡜ࡶከࠎ࠶ࡿࡀࠊゎᾘἲࢆ⮬ࡽぢࡘࡅฟࡏ࡞࠸ேࡀ࠸ࡿࡇ࡜ࡶ༑ศ⪃࠼ࡽࢀࡿࠋࡑࡢࡓࡵࠊ௻ᴗഃ࠿ࡽゎᾘἲ㸦౛࠼ࡤ௻ᴗෆ࡛ࢫ࣏࣮ࢶࢆࡍࡿ࡞࡝㸧ࡢᥦ᱌ࢆࡋࠊࡑࢀࢆᐇ⾜ࡍࡿࡇ࡜ࢆಁࡍࡇ࡜ࡶᚲせ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋᐙ᪘ࡸ཭ேࡀ┦ㄯ┦ᡭ࡜࡞ࡿேࡶ࠸ࡿࡀࠊ⫋ሙ࡛ࡢࢫࢺࣞࢫࡣ௙஦ࡀཎᅉ࡛࠶ࡿࡇ࡜࠿ࡽࠊ⫋ሙෆ࡟┦ㄯࡋࡸࡍ࠸㞺ᅖẼࢆసࡿࡇ࡜ࡀ㔜せ࡛࠶ࡿࠋ⫋ሙෆ࡛┦ㄯ┦ᡭࡀ࠸ࢀࡤࠊ┦ㄯ᫬࡟ᚓࡽࢀࡓၥ㢟Ⅼࡣࠊ௒ᚋࡢ⤒Ⴀᨵၿ࡟ᙺ❧ࡘࡇ࡜࡟ࡶ࡞ࡿࠋ㛗᫬㛫ປാࡣ⌧ᅾࠊ࡝ࡢ௻ᴗ࡟࡜ࡗ࡚ࡶ㸫㸫ᨵၿࡍ࡭ࡁၥ㢟࡜࡞ࡗ࡚࠸ࡿࠋ㛗᫬㛫ປാࢆᙉ࠸ࡽࢀࡿ≧ἣࡣࠊ௙஦ࡢ࣐ࢿ࣮ࢪ࣓ࣥࢺຊ୙㊊࡛࠶ࡿࡤ࠿ࡾ࠿ࠊ໅ົ⪅࡟ᑐࡋ࡚ࡢ೺ᗣ࣐ࢿ࣮ࢪ࣓ࣥࢺຊ୙㊊࡛࠶ࡿࡇ࡜ព࿡ࡍࡿࠋ⤒Ⴀ⪅ࠊ⟶⌮⪅ࡣࡇࡢⅬࢆㄆ㆑ࡋࠊࢫࢺࣞࢫᑐ⟇ࢆྵࡵࡓປാ⎔ቃࡢᨵၿ࡟ຊࢆධࢀࡿᚲせࡀ࠶ࡿ࡜࠸࠼ࡿࠋࡉࡽ࡟௒ᅇࡢᡂ⦼࠿ࡽࡣࠊᗙࡾ௙஦ࡀࢫࢺࣞࢫ※࡛࠶ࡿ࠿ࡶࡋࢀ࡞࠸࡜࠸࠺⤖ᯝࡀᚓࡽࢀࡓࠋࡇࡢࡇ࡜ࡣࠊ㛗᫬㛫ᗙࡾ௙஦࡛యࢆື࠿ࡉ࡞࠸ࡓࡵ࡟ࢫࢺࣞࢫࢆឤࡌࡿࡼ࠺࡟࡞ࡿ࡜ࡶゎ㔘࡛ࡁࡿࡋࠊ஦ົసᴗࡑࡢࡶࡢࡀࢫࢺࣞࢫࢆ୚࠼ࡿ࡜ࡶゎ㔘࡛ࡁࡿࠋ࠸ࡎࢀ࡟ࡋ࡚ࡶࠊᗙࡾ௙஦ࢆࡋ࡚࠸ࡿேࡣࢫࢺࣞࢫࡀࡓࡲࡾࡸࡍ࠸ྍ⬟ᛶࡀ࠶ࡿࡇ࡜ࢆព㆑ࡍࡿᚲせࡀ࠶ࡿࠋ⤖ㄽ ኱㜰ᗓୗࡢ໅ົ⪅ࡢ༙ᩘ㏆ࡃࡀࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿ࡜࠸࠺≧ἣ࡟࠶ࡗࡓࠋ⏨ዪ࡟࠿࠿ࢃࡽࡎࠊࢫࢺࣞࢫࢆឤࡌࡿࡇ࡜࡛ࠊᢚ࠺ࡘഴྥࡸᵝࠎ࡞⏕ά⩦័⑓ࡢࣜࢫࢡࡀ㧗ࡃ࡞ࡿࡇ࡜ࡀ☜ㄆࡉࢀࡓࠋࡲࡓᵝࠎ࡞⫋ሙ⎔ቃ࡜ࢫࢺࣞࢫࡢ㛵㐃ࡀㄆࡵࡽࢀࡓࠋ㸫㸫㸰㸧ࢫࢺࣞࢫࢳ࢙ࢵࢡ࡟ᇶ࡙ࡃࢫࢺࣞࢫ≧ែ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃◊✲┠ⓗᖹᡂ 27 ᖺ 12 ᭶ 1 ᪥ࡼࡾ᪋⾜ࡉࢀࡓປാᏳ඲⾨⏕ἲ࡟ᇶ࡙ࡃࠕࢫࢺࣞࢫࢳ࢙ࢵࢡไᗘ࡛ࠖࡣࠊᚰ⌮ⓗ࡞㈇ᢸࡢ⛬ᗘࢆᢕᥱࡋᚲせ࡟ᛂࡌ࡚㠃᥋ᣦᑟࢆᐇ᪋ࡍࡿࡇ࡜ࡀồࡵࡽࢀ࡚࠸
ࡿࠋࡇࡢᚰ⌮ⓗ࡞㈇ᢸࡢ⛬ᗘࡢホ౯࡟ࡣ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊ࡀ᥎ዡࡉࢀ࡚࠾ࡾࠊ⌧≧ᅜෆࡢከࡃࡢ௻ᴗ࡟࠾࠸࡚฼⏝ࡉࢀ࡚࠸ࡿࠋࡇࡢㄪᰝ⚊ࡣ໅ົ⪅ࡢࢫࢺࣞࢫ≧ἣࢆከゅⓗ࡟ホ౯ࡍࡿࡀࠊ୺࡟ࢫࢺࣞࢫ཯ᛂࡢ⛬ᗘ࡟ࡼࡗ࡚㧗ࢫࢺࣞࢫ⪅ࢆ㑅ᐃࡍࡿᇶ‽ࡀᥦ♧ࡉࢀ࡚࠸ࡿࠋࡇࡢࢫࢺࣞࢫ཯ᛂࢫࢥ࢔ཬࡧ㑅ᐃࡉࢀࡓ㧗ࢫࢺࣞࢫ⪅ࡀ㛗ᮇࡢ⑓Ẽఇᴗ࡜㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡣሗ࿌ࡉࢀ࡚࠸ࡿࡀࠊᚠ⎔ჾ⑌ᝈࢆྵࡴ㌟య⑌ᝈ࡜ࡢ㛵㐃ࡣ࡯࡜ࢇ࡝ሗ࿌ࡉࢀ࡚࠸࡞࠸ࠋࡇࢀࡲ࡛ᾏእཬࡧᅜෆࡢከࡃࡢ◊✲࡛⫋ᴗᛶࢫࢺࣞࢫࡣᚠ⎔ჾ⑌ᝈ࡜㛵ࢃࡗ࡚࠸ࡿࡇ࡜
ࡀ♧ࡉࢀ࡚࠾ࡾࠊ໅ົ⪅ࡢᚠ⎔ჾ⑌ᝈண㜵ᑐ⟇࡜ࡋ࡚ࡢ㔜せ࡞ᣦᶆࡢ୍ࡘ࡟࡞ࡿ࡜ᮇᚅࡉࢀ
ࡿࠋࡑࡢࡓࡵ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊࡟ࡼࡿࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈࡀ㛵ࢃࡗ࡚࠸ࡿ࠿ࢆ☜ㄆࡍࡿᚲせࡀ࠶ࡿࠋࡇ࠺ࡋࡓ⫼ᬒࢆ㋃ࡲ࠼ࠊᮏ◊✲࡛ࡣ኱㜰ᗓୗࡢ」ᩘࡢ௻ᴗࡢ໅ົ⪅ࡢ೺デ࠾ࡼࡧࢫࢺࣞࢫ
ࢳ࢙ࢵࢡࡢᡂ⦼ࢆ⏝࠸࡚ࠊ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊࡟ࡼࡿࢫࢺࣞࢫ཯ᛂ࡜ᵝࠎ࡞ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃ࢆㄪ࡭ࡿࡇ࡜ࢆ┠ⓗ࡜ࡋࡓࠋ㸫㸫᪉ἲ኱㜰ᗓୗࡢ௻ᴗ࣭ᅋయ࡟໅ࡵࡿ 20㹼59 ṓࡢ⏨ዪ࡛ 2016 ᖺࡶࡋࡃࡣ 2017 ᖺ࡟ࢫࢺࣞࢫ࡟㛵ࡍࡿㄪᰝ⚊࡟ᅇ⟅ࡋࡓ 1,064 ே㸦ᘓタࢥࣥࢧࣝࢱࣥࢺᴗ㸸474 ேࠊ᝟ሗ㏻ಙᴗ㸸384 ேࠊࡑࡢ௚㸦་⒪ಖ೺ᴗ➼㸧㸸206 ே㸧ࢆᑐ㇟࡜ࡋࡓࠋᑐ㇟⪅ࡣྠᖺ࡟ྛ௻ᴗࡶࡋࡃࡣ኱㜰ࡀࢇᚠ⎔ჾ⑓ண㜵ࢭࣥࢱ࣮࡟࡚೺ᗣデ᩿ࢆཷࡅࡓࠋࢫࢺࣞࢫ࡟㛵ࡍࡿㄪᰝ⚊࡟ࡣ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊ࢆ⏝࠸ࡓࠋࡇࡢㄪᰝ⚊࡟ࡣࢫࢺࣞ
ࢫ཯ᛂ࡟㛵ࡍࡿ 29 㡯┠ࡀ࠶ࡿࠋάẼ㸦3 㡯┠㸧ࠊ࢖ࣛ࢖ࣛឤ㸦3 㡯┠㸧ࠊ⑂ປឤ㸦3 㡯┠㸧ࠊ୙Ᏻឤ㸦3 㡯┠㸧ࠊᢚ࠺ࡘឤ㸦6 㡯┠㸧ࠊ㌟యឋッ㸦11 㡯┠㸧࡛࠶ࡿࠋࡇࢀࡽᑻᗘ
࡛ࡣ 4 ௳ἲ࡛ࢫࢺࣞࢫࡀ㧗࠸࡯࠺ࢆ 4 Ⅼࠊప࠸࡯࠺ࢆ 1 Ⅼ࡜ࡋ࡚ࠊࡑࡢྜィⅬࢆࢫࢺࣞࢫ཯ᛂࢫࢥ࢔࡜ࡋࡓ㸦‶Ⅼ㸸116ࠊ᭱పⅬ㸸29㸧ࠋᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡋ࡚ࡣࠊୗグࡢ㏻ࡾ 7 ࡘࡢ㡯┠⩌ࢆタᐃࡋࡓࠋձ ㌟య≧ἣ࣭Body mass index㸦BMI㸸kg/m2㸧࣭⭡ᅖ㸦cm㸧࣭⫧‶㸦BMIӍ25.0 kg/m2㸧ղ ⾑ᅽ≧ἣ࣭཰⦰ᮇ⾑ᅽ㸦mmHg㸧
࣭ᣑᙇᮇ⾑ᅽ㸦mmHg㸧࣭㧗⾑ᅽ㸦཰⦰ᮇ⾑ᅽӍ140 mmHg and/or ᣑᙇᮇ⾑ᅽӍ90 mmHg and/or 㝆ᅽ⸆ෆ᭹୰㸧㸫㸫ճ ⪏⢾⬟≧ἣ
࣭HbA1c㸦%㸧࣭⢾ᒀ⑓㸦HbA1cӍ6.5% and/or ✵⭡᫬⾑⢾Ӎ126 mg/dL and/or 㝶᫬⾑⢾Ӎ200mg/dL and/or ⢾ᒀ⑓἞⒪⸆ෆ᭹୰㸧մ ⬡㉁≧ἣ࣭ࢺࣜࢢࣜࢭࣜࢻ㸦TG㸸mg/dL㸧
࣭HDL ࢥࣞࢫࢸ࣮ࣟࣝ㸦HDL-C㸸mg/dL㸧
࣭LDL ࢥࣞࢫࢸ࣮ࣟࣝ㸦LDL-C㸸mg/dL㸧࣭⬡㉁␗ᖖ⑕ 1㸦TGӍ150 mg/dL and/or HDL-Cӌ40 mg/dL and/or LDL-CӍ140mg/dL and/or ⬡㉁␗ᖖ⑕἞⒪⸆ෆ᭹୰㸧յ ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ㸦MetS㸧࣭Ḣ⡿࡟࠾ࡅࡿᇶ‽ 2㸦ḟࡢ 5 㡯┠ࡢ࠺ࡕ 3 ࡘ௨ୖヱᙜ㸸⭡ᅖӍ85cm㸦⏨ᛶ㸧or Ӎ90cm㸦ዪᛶ㸧ࠊTGӍ150 mg/dLࠊHDL-Cӌ40 mg/dL㸦⏨ᛶ㸧or ӌ50 mg/dL㸦ዪᛶ㸧ࠊ཰⦰ᮇ⾑ᅽӍ130 mmHg and/or ᣑᙇᮇ⾑ᅽӍ85 mmHgࠊ✵⭡᫬⾑⢾Ӎ110mg/dL㸧࣭᪥ᮏ࡟࠾ࡅࡿᇶ‽ 3㸦⭡ᅖӍ85cm㸦⏨ᛶ㸧or Ӎ90cm㸦ዪᛶ㸧࡛࠶ࡾࠊ࠿ࡘḟࡢ 3 㡯┠ࡢ࠺ࡕ 2 ࡘ௨ୖヱᙜ㸸TGӍ150 mg/dL and/or HDL-Cӌ40 mg/dLࠊ཰⦰ᮇ⾑ᅽӍ130 mmHg and/or ᣑᙇᮇ⾑ᅽӍ85 mmHgࠊ✵⭡᫬⾑⢾Ӎ110 mg/dL㸧ն ⏕ά⩦័≧ἣ࣭⌧ᅾႚ↮㸦ࡣ࠸㸭࠸࠸࠼㸧࣭㣧㓇㸦ẖ᪥㸭ࡑࢀ௨እ㸧㸫㸫շ ⫢ᶵ⬟≧ἣ࣭࢔ࢫࣃࣛࢠࣥ㓟࢔࣑ࣀᇶ㌿⛣㓝⣲㸦AST㸸IU/L㸧࣭࢔ࣛࢽࣥ࢔࣑ࣀᇶ㌿⛣㓝⣲㸦ALT㸸IU/L㸧࣭AST㸭ALT ẚ࣭Ț࣮ࢢࣝࢱ࣑ࣝࢺࣛࣥࢫ࣌ࣉࢳࢲ࣮ࢮ㸦Ț-GTP㸸IU/L㸧ゎᯒ࡟ࡘ࠸࡚ࡣࠊࡲࡎᑐ㇟⪅ࡢ⫼ᬒ᝟ሗࢆㄪ࡭ࡓࠋḟ࡟⥺ᙧᅇᖐศᯒࡶࡋࡃࡣࣟࢪࢫࢸ࢕ࢵࢡᅇᖐศᯒࢆ⏝࠸࡚ྛ༴㝤ᅉᏊ࡬ࡢᅇᖐಀᩘ᥎ᐃ್ࡶࡋࡃࡣ࢜ࢵࢬẚࢆ⟬ฟࡋࠊࢫࢺࣞࢫ཯ᛂ࡜ྛᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃ࢆㄪ࡭ࡓࠋࢫࢺࣞࢫ཯ᛂࢫࢥ࢔ࡣṇつศᕸࢆ࡜ࡽ࡞࠿ࡗࡓࡓࡵࠊ⮬↛ᑐᩘኚ᥮ࢆ⾜ࡗࡓࢫࢺࣞࢫ཯ᛂࢫࢥ࢔ࢆ⏝࠸ࡓࠋࡲࡓྛ༴㝤ᅉᏊࢆ೺デ࡟࡚ᐃࡋ࡞࠿ࡗࡓᑐ㇟⪅ࡣゎᯒ࠿ࡽ㝖እࡋࡓࠋࡍ࡭࡚ࡢ༴㝤ᅉᏊ࡟࠾࠸࡚ᛶࠊᖺ㱋ࠊᴗ✀࡛ㄪᩚࡋࡓࠋࡉࡽ࡟ෆ᭹⸆ࡢᙳ㡪ࢆ㝖ࡃࡓࡵ࡟ࠊ୍ᐃࡢ㛵㐃㸦p<0.1㸧ࡀࡳࡽࢀࡓ༴㝤ᅉᏊ࡟ࡘ࠸࡚ࡣࠊࡑࡢ⑌ᝈ࡬ࡢ἞⒪⸆ෆ᭹୰ࡢᑐ㇟⪅ࢆ㝖እࡋࡓୖ࡛ྠᵝࡢゎᯒࢆ⧞ࡾ㏉ࡋࡓࠋ⤫ィゎᯒ࡟࡚୧ഃ᳨ᐃ p<0.05 ࢆ᭷ព࡜ࡋࡓࠋࡲࡓࠊࡍ࡭࡚ࡢゎᯒࡣ⤫ィゎᯒࢯࣇࢺ SASࣂ࣮ࢪࣙࣥ 9.4㸦SAS Institute Inc., Cary,NC, USA㸧ࢆ⏝࠸ࡓࠋ㸫㸫⤖ᯝ㸦௨ୗࠊ⤫ィゎᯒ⤖ᯝ࡟᭷ពᕪࡀࡳࡽࢀࡓ㡯┠࡟ࡘ࠸࡚ࡣ⥙᥃ࡅࢆࡘࡅࡿࡇ࡜࡜ࡍࡿ㸧 ᑐ㇟⪅ࡢᖹᆒᖺ㱋ࡣ 41.2 ṓࠊ⏨ᛶ 78.0㸣ࠊዪᛶ 22.0㸣࡛࠶ࡗࡓࠋᑐ㇟⪅ࡢ⫼ᬒ᝟ሗᑐ㇟⪅ᩘ

1064ᖹᆒࢫࢺࣞࢫ཯ᛂࢫࢥ࢔㸦ᶆ‽೫ᕪ㸧57.6 (14.4)
ᖹᆒᖺ㱋㸦ᶆ‽೫ᕪ㸧

41.2 (10.1)⏨ᛶ㸦㸧

830 (78.0)ᴗ✀ᘓタࢥࣥࢧࣝࢱࣥࢺ㸦㸧

474 (44.6)

᝟ሗ㏻ಙᴗ㸦㸧384 (36.1)

ࡑࡢ௚㸦㸧

206 (19.4)

⾲ ᑐ㇟⪅ࡢ⫼ᬒ᝟ሗ ࢫࢺࣞࢫ཯ᛂ࡜ྛᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࠊḟ࣮࣌ࢪ௨㝆࡟ิグࡍࡿࠋ

㸫㸫

㸫㸫

ᅗ ࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃㸦ࡑࡢ 㸸ᅇᖐಀᩘ᥎ᐃ್㸧㸫㸫ᅗ ࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃㸦ࡑࡢ 㸸࢜ࢵࢬẚ㸧ձ ㌟య≧ἣゎᯒᑐ㇟⪅ࡣ BMI㸸1,064 ேࠊ⭡ᅖ㸸929 ேࠊ⫧‶㸸1,064 ே࡛࠶ࡗࡓࠋ
ࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊBMI ್ࠊ⭡ᅖ್ࡣୖ᪼ࡋࡓࠋ⫧‶ࡢ๭ྜࡶୖ᪼
ࡍࡿഴྥࡣࡳࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-1ࠊ2-2㸧ղ ⾑ᅽ≧ἣゎᯒᑐ㇟⪅ࡣ཰⦰ᮇ⾑ᅽ㸸1,064 ேࠊᣑᙇᮇ⾑ᅽ㸸1,064 ேࠊ㧗⾑ᅽ㸸1,064 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊ཰⦰ᮇ⾑ᅽ್ࠊᣑᙇᮇ⾑ᅽ್ࡀୖ᪼ࡍࡿഴྥࡣࡳ
ࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㧗⾑ᅽࡢ๭ྜ࡟ࡘ࠸࡚ࡣࠊ᫂ࡽ࠿࡞ṇཬࡧ㈇ࡢ㛵㐃ࢆㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-1ࠊ2-2㸧ճ ⪏⢾⬟≧ἣゎᯒᑐ㇟⪅ࡣ HbA1c㸸757 ேࠊ⢾ᒀ⑓㸸993 ே࡛࠶ࡗࡓࠋHbA1c ್ࠊ⢾ᒀ⑓ࡢ๭ྜ࡜ࡶ࡟ࠊࢫࢺࣞࢫ཯ᛂ࡜ࡢ᫂ࡽ࠿࡞ṇཬࡧ㈇ࡢ㛵㐃ࢆㄆࡵ࡞࠿
ࡗࡓࠋ㸦ᅗ 2-1ࠊ2-2㸧մ ⬡㉁≧ἣゎᯒᑐ㇟⪅ࡣࢺࣜࢢࣜࢭࣜࢻ㸸993 ேࠊHDL-C㸸993 ேࠊLDL-C㸸993 ேࠊ⬡㉁␗ᖖ
⑕㸸993 ே࡛࠶ࡗࡓࠋ

㸫㸫ࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊHDL-C ್ࡣపୗࡋࠊLDL-C ್ࠊ⬡㉁␗ᖖ⑕ࡢ๭
ྜࡣୖ᪼ࡋࡓࠋࢺࣜࢢࣜࢭࣜࢻ್ࡣୖ᪼ࡍࡿഴྥࡣࡳࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ
㸦ᅗ 2-1ࠊ2-2㸧յ ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟゎᯒᑐ㇟⪅ࡣḢ⡿࡟࠾ࡅࡿᇶ‽ࠊ᪥ᮏ࡟࠾ࡅࡿᇶ‽࡜ࡶ࡟ 746 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊḢ⡿࡟࠾ࡅࡿᇶ‽ࡢ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡢ๭ྜࡣୖ᪼ࡋࡓࠋ᪥ᮏ࡟࠾ࡅࡿᇶ‽ࡢ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡢ๭ྜࡣୖ᪼ࡍࡿഴྥࡣࡳ
ࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-2㸧ն ⏕ά⩦័≧ἣゎᯒᑐ㇟⪅ࡣ⌧ᅾႚ↮㸸850 ேࠊẖ᪥㣧㓇㸸835 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊ⌧ᅾႚ↮⪅ࡢ๭ྜࡣቑຍࡋࡓࠋ᪥ᖖⓗ㣧㓇⪅ࡢ๭ྜ࡟ࡘ࠸࡚ࡣࠊ᫂ࡽ࠿࡞ṇཬࡧ㈇ࡢ㛵㐃ࢆㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-2㸧շ ⫢ᶵ⬟≧ἣゎᯒᑐ㇟⪅ࡣ AST㸸975 ேࠊALT㸸975 ேࠊAST㸭ALT ẚ㸸975 ேࠊȚ-GTP㸸993 ே࡛࠶ࡗࡓࠋ
ࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊAST㸭ALT ẚࡢ್ࡣపୗࡋࡓࠋALT ್ࡣୖ᪼ࡍ
ࡿഴྥࡣࡳࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋAST ್ࠊȚ-GTP ್࡟ࡘ࠸࡚ࡣࠊ᫂ࡽ࠿࡞ṇཬࡧ㈇ࡢ㛵㐃ࢆㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-1㸧㸫㸫㸫㸫ᅗ ࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃㸦ྛ⑌ᝈ἞⒪୰ࡢᑐ㇟⪅ࢆ㝖ࡃࠋࡑࡢ 㸸ᅇᖐಀᩘ᥎ᐃ್㸧㸫㸫ᅗ ࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢ㛵㐃㸦ྛ⑌ᝈ἞⒪୰ࡢᑐ㇟⪅ࢆ㝖ࡃࠋࡑࡢ 㸸࢜ࢵࢬẚ㸧ո ⾑ᅽ≧ἣ㸦㧗⾑ᅽ἞⒪୰ࡢ⪅ࢆ㝖ࡃ㸧ゎᯒᑐ㇟⪅ࡣ཰⦰ᮇ⾑ᅽ㸸975 ேࠊᣑᙇᮇ⾑ᅽ㸸975 ேࠊ㧗⾑ᅽ㸸975 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊ཰⦰ᮇ⾑ᅽ್ࠊᣑᙇᮇ⾑ᅽ್ࡀୖ᪼ࡍࡿഴྥࡣࡳ
ࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㧗⾑ᅽࡢ๭ྜ࡟ࡘ࠸࡚ࡣࠊ᫂ࡽ࠿࡞ṇཬࡧ㈇ࡢ㛵㐃ࢆㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-3ࠊ2-4㸧չ ⪏⢾⬟≧ἣ㸦⢾ᒀ⑓἞⒪୰ࡢࡶࡢࢆ㝖ࡃ㸧ゎᯒᑐ㇟⪅ࡣ HbA1c㸸729 ேࠊ⢾ᒀ⑓㸸939 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊ⢾ᒀ⑓ࡢ๭ྜࡣୖ᪼ࡋࡓࠋHbA1c ್ࡶୖ᪼ࡍࡿഴྥࡣࡳࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-3ࠊ2-4㸧պ ⬡㉁≧ἣ㸦⬡㉁␗ᖖ⑕἞⒪୰ࡢ⪅ࢆ㝖ࡃ㸧ゎᯒᑐ㇟⪅ࡣࢺࣜࢢࣜࢭࣜࢻ㸸933 ேࠊHDL-C㸸933 ேࠊLDL-C㸸933 ேࠊ⬡㉁␗ᖖ
⑕㸸933 ே࡛࠶ࡗࡓࠋࢫࢺࣞࢫ཯ᛂࡢ್ࡀ㧗ࡃ࡞ࡿ࡟ᚑࡗ࡚ࠊHDL-C ್ࡣపୗࡋࠊLDL-C ್ࠊ⬡㉁␗ᖖ⑕ࡢ๭
ྜࡣୖ᪼ࡋࡓࠋࢺࣜࢢࣜࢭࣜࢻ್ࡣୖ᪼ࡍࡿഴྥࡣࡳࡽࢀࡓࡀࠊ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋ㸦ᅗ 2-3ࠊ2-4㸧㸫㸫⪃ᐹᮏ◊✲࡛ࡣ኱㜰ᗓୗࡢ」ᩘࡢ௻ᴗࡢ໅ົ⪅࡟࠾࠸࡚ࠊ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊࡟ࡼࡿࢫࢺࣞࢫ཯ᛂ࡜ᵝࠎ࡞ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡀ㛵㐃ࡍࡿࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓࠋලయⓗ࡟ࡣBMIࠊ⭡ᅖࠊHDL-CࠊLDL-Cࠊ⬡㉁␗ᖖ⑕ࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ㸦Ḣ⡿࡟࠾ࡅࡿᇶ‽㸧ࠊ⌧ᅾႚ↮ࠊAST㸭ALT ẚࡀࢫࢺࣞࢫ཯ᛂ࡜᭷ព࡟㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋ㌟య≧ἣ࡟ࡘ࠸࡚ࡣࠊࡇࢀࡲ࡛ࢫࢺࣞࢫ཯ᛂࢫࢥ࢔ࡢ୍㒊࡛࠶ࡿ୙Ᏻᑻᗘ࡜⫧‶ࡀ㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡣሗ࿌ࡉࢀ࡚࠸ࡓ 4ࠋᮏ◊✲⤖ᯝࡣࡇࡢሗ࿌࡜▩┪ࡏࡎࠊࡲࡓ BMI ࡸ⭡ᅖ࡞࡝⫧‶࡟㛵ࡍࡿ್࡜ࡢ㛵㐃ࡶ᫂ࡽ࠿࡟ࡋࡓࠋ⾑ᅽ≧ἣ࡟ࡘ࠸࡚ࡣࠊ⫋ᴗᛶࢫࢺࣞࢫࡀ⾑ᅽ್ࡸ㧗⾑ᅽ࡜㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿ 5,6ࠋࡋ࠿ࡋᮏ◊✲࡛ࡣᙅ࠸㛵㐃ࡋ࠿ㄆࡵࡿࡇ࡜ࡀ࡛
ࡁࡎࠊࡼࡾᑐ㇟⪅ேᩘࢆቑࡸࡋࡓ᳨ウࡀᚲせ࡜⪃࠼ࡽࢀࡿࠋ⪏⢾⬟≧ἣ࡟ࡘ࠸࡚ࡶࠊࢫࢺࣞ
ࢫ཯ᛂ࡟ྵࡲࢀࡿᢚ࠺ࡘ⑕≧ࡣ࢖ࣥࢫࣜࣥ᢬ᢠᛶ 7 ࡸ 2 ᆺ⢾ᒀ⑓ 8 ࡟㛵ࢃࡗ࡚࠸ࡿ࡜ࡉࢀ
ࡿࠋᮏ◊✲࡛ࡣ඲ᑐ㇟⪅࡟࠾ࡅࡿゎᯒ࡛ࡣ㛵㐃ࡣㄆࡵ࡞࠿ࡗࡓࡀࠊ⢾ᒀ⑓἞⒪୰ࡢᑐ㇟⪅ࢆ㝖࠸ࡓゎᯒ࡛ࡣࠊ⢾ᒀ⑓ࡢ๭ྜ࡛᭷ព࡞㛵㐃ࢆࠊHbA1c ࡢ್࡛᭷ព࡟㏆࠸㛵㐃ࢆㄆࡵࡓࠋ
ࡇࡢࡇ࡜࠿ࡽ⢾ᒀ⑓἞⒪ࡀࢫࢺࣞࢫ཯ᛂ࡜⪏⢾⬟≧ἣࡢ㛵ಀࢆㄆࡵ㞴ࡃࡋ࡚࠸ࡿྍ⬟ᛶࡣྰᐃ࡛ࡁ࡞࠸ࠋ⬡㉁≧ἣ࡟ࡘ࠸࡚ࡣࠊࢫࢺࣞࢫ཯ᛂࢫࢥ࢔ࡢ୍㒊࡛࠶ࡿάຊᑻᗘ࡜ࢺࣜࢢࣜࢭ
ࣜࢻࠊHDL-CࠊLDL-C ࡀ㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿ 9ࠋᮏ◊✲⤖ᯝࡣࡇࡢሗ࿌࡜▩┪ࡏࡎࠊຍ࠼࡚⬡㉁␗ᖖ⑕࡜ࡢ㛵㐃ࡀ᫂ࡽ࠿࡜࡞ࡗࡓࠋ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ࡟ࡘ࠸࡚ࡣࠊᮏ◊✲࡛ࡣḢ⡿࡟࠾ࡅࡿᇶ‽࡜᪥ᮏ࡟࠾ࡅࡿᇶ‽࡜࡛⤖ᯝ࡟㐪࠸ࡀࡳࡽࢀࡓࠋ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡢデ᩿ᇶ‽࡟ࡘ࠸࡚ࡣ⌧ᅾࡶ㆟ㄽࡀ⥆࠸࡚࠾ࡾࠊ≉࡟᪥ᮏேࡢ⭡ᅖࡢุᐃᇶ‽࡟ࡘ࠸࡚ࡣᵝࠎ࡞㆟ㄽࡀ࠶ࡿ 10,11ࠋࢫࢺࣞࢫ཯ᛂ࡜࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࡣࠊ௒ᚋࡢ㆟ㄽࡢ⤖ᯝࢆᚅࡗ࡚෌᳨ウࡍࡿᚲせࡀ࠶ࡿ࡜ᛮࢃࢀࡿࠋ⏕ά⩦័≧ἣ㸫㸫࡟ࡘ࠸࡚ࡣࠊࡇࢀࡲ࡛ႚ↮࡜ᢚ࠺ࡘ⑕≧࡟ࡣ཮᪉ྥᛶࡢ㛵㐃ࡀᣦ᦬ࡉࢀ࡚࠸ࡓ 12,13ࠋࡇࢀࡽࡣᮏ◊✲⤖ᯝࢆᨭᣢࡍࡿࡶࡢ࡜⪃࠼ࡽࢀࡿࠋ⫢ᶵ⬟≧ἣ࡟ࡘ࠸࡚ࠊ୙Ᏻࡸᢚ࠺ࡘ⑕≧ࡣ㠀࢔ࣝࢥ࣮ࣝᛶ⬡⫫ᛶ⫢⑌ᝈ㸦NAFLD㸧ࡸ㠀࢔ࣝࢥ࣮ࣝᛶ⬡⫫ᛶ⫢⅖㸦NASH㸧࡜㛵㐃ࡍࡿࡇ࡜ࡀ♧ࡉࢀ࡚࠸ࡿ 14,15ࠋࡲࡓ AST㸭ALT ẚࡣ࢔ࣝࢥ࣮ࣝᛶ࡜㠀࢔ࣝࢥ࣮ࣝᛶࡢ⫢⑌ᝈ࡜ࢆุ᩿ࡍࡿࡢ࡟᭷⏝࡜ࡉࢀࡿ 16ࠋࡉࡽ࡟ NAFLD ࡸ NASH ࡣ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ࡜ࡶ
㛵㐃ࡍࡿ 17ࠋᮏ◊✲⤖ᯝࡣࠊࢫࢺࣞࢫ཯ᛂࡣ㠀࢔ࣝࢥ࣮ࣝ⫢ᶵ⬟㞀ᐖ࡜㛵㐃ࡀ࠶ࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿࠋ
៏ᛶⓗ࡞ࢫࢺࣞࢫࡀ㌟య࡟ᙳ㡪ࢆཬࡰࡍస⏝ᶵᗎ࡜ࡋ࡚ࡣࠊࡇࢀࡲ࡛୺࡟ 2 ࡘࠊෆศἪ⣔࡟ࡼࡿ┤᥋స⏝࡜⾜ືኚᐜ࡟ࡼࡿ㛫᥋స⏝ࡀᥦ♧ࡉࢀ࡚࠸ࡿࠋ៏ᛶⓗ࡞ࢫࢺࣞࢫࡣ኱⬻⓶㉁ࡸ኱⬻㎶⦕⣔࠿ࡽどᗋୗ㒊㸫஺ឤ⚄⤒㸫๪⭈㧊㉁⣔ࡸどᗋୗ㒊㸫ୗᆶయ๓ⴥ㸫๪⭈⓶㉁⣔ࢆάᛶ໬ࡉࡏࡿ 18ࠋࡇࢀ࡟ࡼࡾ⾑ᾮ୰ࡢ࢝ࢸࢥ࣑ࣛࣥࡸ⢾㉁ࢥࣝࢳࢥ࢖ࢻࡀቑຍࡋࠊ⾑ᅽୖ᪼ࠊ⢾᪂⏕ࡢቑຍ࡟ࡼࡿ⾑⢾ୖ᪼ࠊ㦵᱁➽ࡸ⬡⫫⤌⧊࡛ࡢ࢖ࣥࢫࣜࣥάືᛶపୗࢆࡶࡓࡽࡋࠊ㧗⾑ᅽࠊ⢾ᒀ⑓ࠊ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟ࡞࡝ࢆᘬࡁ㉳ࡇࡍ 19ࠋࡲࡓᚰ⌮ⓗࢫࢺࣞࢫࡣႚ↮ 20 ࡸ㐣㣗 4ࠊ㐠ື⩦័ࡢḞዴ 9 ࡞࡝ࡢ೺ᗣ࡟ᝏᙳ㡪ࢆཬࡰࡍ⏕ά⩦័ࢆࡶࡓࡽࡋࠊࡑࡢ⤖ᯝ࣓ࢱ࣎ࣜࢵࢡࢩࣥࢻ࣮࣒ࣟࡸࡑࡢ㢮⦕⑕≧ࢆᘬࡁ࠾ࡇࡍ࡜ࡉࢀ࡚࠸ࡿࠋᮏ◊✲ࡣᶓ᩿◊✲࡛࠶ࡾࠊࢫࢺࣞࢫ཯ᛂ࡜ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡢᅉᯝ㛵ಀ࡟ࡘ࠸࡚ࡣゝཬ࡛ࡁ࡞࠸ࠋࡲࡓ≉ᐃࡢᴗ✀ࡢ໅ົ⪅ࢆᑐ㇟࡜ࡋ࡚࠸ࡿࡓࡵࠊࡑࡢ௚ࡢᴗ✀ࡢ໅ົ⪅࡟࠾࠸࡚ࡶྠᵝࡢ㛵㐃ࡀࡳࡽࢀࡿ࠿ࠊ௒ᚋ᳨ウࡋ࡚࠸ࡃࠋ㸫㸫⤖ㄽ኱㜰ᗓୗࡢ≉ᐃ௻ᴗࡢ໅ົ⪅࡟࠾࠸࡚ࠊ⫋ᴗᛶࢫࢺࣞࢫ⡆᫆ㄪᰝ⚊࡟ࡼࡿࢫࢺࣞࢫ཯ᛂ࡜ᵝࠎ࡞ᚠ⎔ჾ⑌ᝈ༴㝤ᅉᏊ࡜ࡀ㛵㐃ࡍࡿࡇ࡜ࡀ☜ㄆࡉࢀࡓࠋ⌧≧ከࡃࡢ௻ᴗ࡛ࢫࢺࣞࢫࢳ࢙ࢵࢡࡢ⤖ᯝ࡜೺デ⤖ᯝࡣูࠎ࡟⟶⌮ࡉࢀ࡚࠸ࡿࠋࡑࢀࡽࢆ୍ඖ⟶⌮ࡋ࡚୧⪅ࢆྠ᫬࡟ホ౯ࡍࡿࡇ࡜࡛ࠊࡉࡽ࡞ࡿ⢭⚄ⓗ࣭㌟యⓗ೺ᗣࡢቑ㐍࡟ࡘ࡞ࡆ࡚࠸ࡃࡇ࡜ࡀ௒ᚋࡢ⏘ᴗ་⒪ࡢ⌧ሙ࡟ᮃࡲࢀࡿࠋㄽᩥⓎ⾲ᮏ◊✲⤖ᯝࡣᅜ㝿Ꮫ⾡㞧ㄅ㸦Ꮫ఍ㄅ㸧࡬ࡢᢞ✏࡟ྥࡅ࡚‽ഛ୰࡛࠶ࡿࠋཧ⪃ᩥ⊩
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