tag:blogger.com,1999:blog-2099976593812282512024-03-13T11:45:55.644+09:00Hospitalist ~なんでも無い科医の勉強ノート~特に専門は絞っていない内科医のブログ
*医学情報のブログです. 個別の相談には応じられません. 現在コメントの返事がうまくかけませんのでコメントを閉じています. コメントがあればFBページでお願いします
GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comBlogger1603125tag:blogger.com,1999:blog-209997659381228251.post-8560857944651779052023-12-13T15:09:00.001+09:002023-12-13T15:09:11.313+09:00お引越しのお知らせ<p>このブログページはこれ以上アップデートしません.</p><p>現在NOTEに移っております.</p><p><a href="https://note.com/calm_hornet327">https://note.com/calm_hornet327</a></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-19110275625021560342023-10-04T14:44:00.001+09:002023-10-04T14:44:12.597+09:00低Na血症の補正速度は?<p>各種ガイドラインにて, 低Na血症の補正速度は大体 8mEq/L/24時間を超えないようにすべきとの推奨がある.</p><p>これはそれ以上では浸透圧性脱髄症候群を生じるリスクがあるため.</p><p>しかしながら, どの程度の速度がリスクとなるか, というのは結構曖昧であったりする.</p><p><br /></p><p>古い論文では,</p><p>
(J Am Soc Nephrol 1994;4:1522-30)</p><p><b><span style="color: red;">血清 Na=<105mEq/Lの56 Casesを解析.</span></b></p><p>・その内14名が補正に伴う神経症状を認めた(恒久的10名, 一時的4名)</p><p> 神経症状; 痙攣, 意識障害, 構音障害, 歩行障害, 頭痛, 嘔気など</p><p>・神経症状出現 vs 非出現群の比較.</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #2d2d8a; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 27px; padding: 4px; width: 152px;" valign="middle"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Variable</span></p></td><td style="background-color: #2d2d8a; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 27px; padding: 4px; width: 96px;" valign="middle"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Cutoff</span></p></td><td style="background-color: #2d2d8a; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 27px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">All pt<br /></span><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経障害出現</span></p></td><td style="background-color: #2d2d8a; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 27px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Chronic HypoNa<br /></span><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経障害出現</span></p></td></tr><tr><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 13px; padding: 4px; width: 152px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">~120mEq/L</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">までの補正速度</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">=<0.55mEq/L/hr</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 13px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 12px; padding: 4px; width: 152px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 12px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>0.55mEq/L/hr</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 12px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">35%</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 12px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">56%</span></p></td></tr><tr><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 13px; padding: 4px; width: 152px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">24hr</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">での補正量</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">=<12mEq/L</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 13px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 12px; padding: 4px; width: 152px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 12px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>12mEq/L</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 12px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">33%</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 12px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">50%</span></p></td></tr><tr><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 13px; padding: 4px; width: 152px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">48hr</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">での補正量</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">=<18mEq/L</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td><td style="background-color: #e8e8ed; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 13px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0) rgb(45, 45, 138) rgb(45, 45, 138); border-style: solid; border-width: 1px 0px 1px 1px; height: 13px; padding: 4px; width: 152px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 96px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>18mEq/L</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 0px; height: 13px; padding: 4px; width: 82px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">33%</span></p></td><td style="background-color: white; border-color: rgb(45, 45, 138) rgb(45, 45, 138) rgb(45, 45, 138) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 13px; padding: 4px; width: 103px;" valign="top"><p style="margin: 0px 0px 0px 3.2px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">52%</span></p></td></tr></tbody></table><p> 24時間で12mEq/Lを越える上昇で神経障害が出現する結果.</p><p><br /></p><p>近年, 2つのコホートがでていたのでまとめてみる。</p><p><br /></p><p><b><span style="color: red;">カナダにおける多施設cohort</span></b></p><p>(NEJM Evid 2023; 2 (4) DOI: 10.1056/EVIDoa2200215)</p><p>・2010~2020年の入院患者において, 初期に低Na血症(<130mEq/L)を認める患者群を抽出し, 浸透圧性脱髄症候群(ODS)を発症した患者のリスク因子を評価した.</p><p>・ガイドラインを超える補正速度(>8mEq/L/日)を認めた場合「急速補正」と定義.</p><p><br /></p><p><span style="color: #800180;">低Na血症を認めた患者は22858件, 17254例.</span></p><p>・平均年齢68歳. 女性50%</p><p>・Na<110が1.2%, Na 110-119が11.9%であった.</p><p>・急速補正は17.7%で認められた.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDJNpUHKYbNxavdl4kSFKGlZrB_2Jw_RDfeaSw310fkel_T5d0BUuMNK1k96NidNenX7AVc63e85uXpXaofkXRrRQYmQkMZan-M7fk7-pRaxGy3hvCqf-1gTv8_ECJ5s5FXXcB91U4d2q-hmMwT9yhFdmvuI1NZnEcqvOHSLnlR8jlh6UdApRLEguZpWO9/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="466" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDJNpUHKYbNxavdl4kSFKGlZrB_2Jw_RDfeaSw310fkel_T5d0BUuMNK1k96NidNenX7AVc63e85uXpXaofkXRrRQYmQkMZan-M7fk7-pRaxGy3hvCqf-1gTv8_ECJ5s5FXXcB91U4d2q-hmMwT9yhFdmvuI1NZnEcqvOHSLnlR8jlh6UdApRLEguZpWO9/w552-h640/1.png" width="552" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3H8Jx_jgqLp28Q9Rpmb_4ijzYl1co1NJ7sVmB5PuuoL9quEFvP51KQgEjDoW2KJ1mHqatmQaZPFMo9EIWJOApUnwqD2wO9a23zu1k-mAOWI-WtbLZXw2E6hjhm746TvWP9T4ZY7FHPVojcTrDe-k0QXTHq1ylWTr4UKCenPKu_tmaULfdrME6ETpQpGUu/s506/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="398" data-original-width="506" height="504" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3H8Jx_jgqLp28Q9Rpmb_4ijzYl1co1NJ7sVmB5PuuoL9quEFvP51KQgEjDoW2KJ1mHqatmQaZPFMo9EIWJOApUnwqD2wO9a23zu1k-mAOWI-WtbLZXw2E6hjhm746TvWP9T4ZY7FHPVojcTrDe-k0QXTHq1ylWTr4UKCenPKu_tmaULfdrME6ETpQpGUu/w640-h504/1.png" width="640" /></a></div><p>・ODSと診断された例が12例(0.05%)
</p><p> 初期Na<120の症例のうち, ODSを発症したのが0.3%</p><p>・ODSを発症した12例の初期Na値は111[106-115]mEq/L(vs 非ODS群126[122-128])
</p><p> Na<110が7例(58%)と多い(vs 非ODS群では1.1%)
</p><p> その分血清浸透圧も低い</p><p>・急速補正例はODS群で5例(42%)(vs 非ODS群で15.9%)</p><p><span style="color: #2b00fe;"><br /></span></p><p><b><span style="color: red;">重度の低Na血症(<120mEq/L)で入院となった患者群を対象としたCohort study.</span></b></p><p>(NEJM Evid 2023; 2 (10) DOI: 10.1056/EVIDoa2300107)</p><p>・1993-2018年にMassachusetts General Hospital, Brigham and Women’s Hospitalに入院した重症低Na血症患者を対象.</p><p>・Naの補正速度と死亡リスク, CPM(Central Pontine Myelinolysis)リスクを評価.</p><p>・対象患者は3274例.
補正速度は<6mEq/L/24h, 6-10mEq/L/24h, >10mEq/L/24hで分類.</p><p> 補正速度<6が38%, 6-10が29%, >10が33%とほぼ同数認められた.</p><p><br /></p><p><span style="color: #800180;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1oB3CYxMfhL-HYeW4_eFU8cGIfTtgvFwu1yEctB4kWd9wiarEKdn0Q-_CVzB1Rn3WMWleAAzUqJkXC_89PdhD2Z8q4_jeDJ01_C21qzjposxxVCQTMtF4KBmCHfKXMuxgDkJyUyda-afoMV4652H2_MnC7qKW3-nMyxv4O1dvMMBwTZFz_lVw1kaQXcus/s636/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="284" data-original-width="636" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1oB3CYxMfhL-HYeW4_eFU8cGIfTtgvFwu1yEctB4kWd9wiarEKdn0Q-_CVzB1Rn3WMWleAAzUqJkXC_89PdhD2Z8q4_jeDJ01_C21qzjposxxVCQTMtF4KBmCHfKXMuxgDkJyUyda-afoMV4652H2_MnC7qKW3-nMyxv4O1dvMMBwTZFz_lVw1kaQXcus/w640-h286/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・院内死亡リスク: Na補正<6は死亡リスクが高く, >10の群では死亡リスクが低い結果.
</p><p> また高齢者や合併症が多い患者も死亡リスク因子となる.
</p><p> Propensity-score analysisでは補正速度<6のみ死亡リスクに関連</p><p><br /></p><p><span style="color: #800180;">補正速度の死亡リスク因子に関わる背景疾患</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3xY15MpUhyhW6urjCADeZYLbKj5Mi2cH3NLSFwhZ3u8dt_d8G31UuOoguunR2anEUFqXMxjZIFTWDH3WP1VJgVnp-cfY3CbOxe-tm_f499Ik1RWis8TcH0Q-HuTK_m0hRjSx6gj397kkiJbpIMB_tiJzEi97Dx0zFMHhT0KbeMlbksdMCj-Q99p7njE5r/s632/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="255" data-original-width="632" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3xY15MpUhyhW6urjCADeZYLbKj5Mi2cH3NLSFwhZ3u8dt_d8G31UuOoguunR2anEUFqXMxjZIFTWDH3WP1VJgVnp-cfY3CbOxe-tm_f499Ik1RWis8TcH0Q-HuTK_m0hRjSx6gj397kkiJbpIMB_tiJzEi97Dx0zFMHhT0KbeMlbksdMCj-Q99p7njE5r/w640-h258/1.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><p style="text-align: left;">・悪性腫瘍や心不全症例では緩徐なNa補正は死亡リスクを上昇させうる</p><p style="text-align: left;">・肝硬変では急性のNa補正は死亡リスクを低下させる</p><p style="text-align: left;"> (速度よりも原疾患に対する影響はつよいか)</p><p style="text-align: left;"><br /></p><p style="text-align: left;"><span style="color: #800180;">CPMの発症は7例のみ.</span></p><p style="text-align: left;">・補正速度は
8mEq/L/24hを越える例が2例: 19, 17
</p><p style="text-align: left;"> GL通り, <8mEq/L/24hで生じた例が5例: 3, 6, 6, 8, 8</p><p style="text-align: left;"><br /></p><p style="text-align: left;">--------------------------------</p><p style="text-align: left;"><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">まず, ODS自体, Na<110-120となるような低Na症例の0.2-0.3%程度と非常に稀な合併症.</span></span></p><p style="text-align: left;"><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">補正速度が速い場合, リスクにはなり得るが, ではガイドライン通りの補正速度ならば大丈夫かというと, それでも生じる.</span></span></p><p style="text-align: left;"><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">背景疾患(悪性腫瘍やアルコール依存, 低栄養など)や, 初期のNa濃度も重要なリスクとなる.</span></span></p><p style="text-align: left;"><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">また, 背景疾患によってはNa補正をはやめた方が予後がよい可能性もあり, 「ODSを怖がって迅速な補正をしない」ことの不利益にも眼を向けるべきであろう.</span></span></p></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-11997779139901271592023-09-29T19:27:00.001+09:002023-09-29T19:27:18.103+09:00Af + 脳梗塞症例における抗凝固薬開始のタイミングは?<p> 心房細動による心原性脳梗塞では, 急性期における梗塞再発リスクが0.1-1.3%と高く, なるべく早期に予防的抗凝固療法の開始が理想である.</p><p> しかしながら, 早期の抗凝固療法は脳出血のリスクとなる可能性もあるため, 開始のタイミングは難しい.</p><p><b><span style="color: red;">EHRA-ESCガイドラインでは</span></b></p><p>・TIAでは翌日より抗凝固開始</p><p>
Minor strokeでは3日後
(NIHSS<8で定義)
</p><p> Mild strokeでは6日後
(NIHSS 8-15で定義)</p><p>
Severe strokeでは12日後
(NIHSS >15) に開始することを推奨しており,</p><p>・これらは1-3-6-12 ruleと呼ばれる.</p><p>(Lancet Neurol. 2019 Jan;18(1):117-126.)(Europace. 2018 Aug 1;20(8):1231-1242.)</p><p><br /></p><p><span style="color: #800180;">他のガイドラインの推奨のまとめ</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi15TNtZ37c8YyuzPeY8c4WCuTKDkcE-SoroqEiA22RG3koO1AsBWlSj434pKaJv8pq0WDPClgL5IVmgt85isotQZ23r0S-KmXtDYo6B1vNOpoDE2fQOKi8arHRCD2IYUWZzJdarLut5Ud-xwqlwm1jthu023NrG_98AhabSfDP3JfuiPxNG2lpQV3zr5fs/s545/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="545" data-original-width="337" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi15TNtZ37c8YyuzPeY8c4WCuTKDkcE-SoroqEiA22RG3koO1AsBWlSj434pKaJv8pq0WDPClgL5IVmgt85isotQZ23r0S-KmXtDYo6B1vNOpoDE2fQOKi8arHRCD2IYUWZzJdarLut5Ud-xwqlwm1jthu023NrG_98AhabSfDP3JfuiPxNG2lpQV3zr5fs/w396-h640/1.png" width="396" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>ただ, これらよりも早期に開始しても出血リスクは増加しないとの報告も最近増えてきている</p><p><b><span style="color: red;"><br /></span></b></p><p><b><span style="color: red;">日本国内より, 1-2-3-4 ruleの提唱</span></b></p><p>(Stroke. 2022 May;53(5):1540-1549.)</p><p>・国内より2つのProspective cohortのデータを解析.
</p><p> TIA, NIHSS 0-7, 8-15, ≥16の脳梗塞症例において,
DOACの開始時期を評価.</p><p> DOAC開始の中央期間よりも早い症例を早期投与群と定義し,
早期投与と予後を比較した.</p><p>・1797例の患者において,
TIAでは2日, </p><p> 脳梗塞例では軽症, 中等症, 重症でそれぞれ 3,4,5日で開始していた.</p><p><span style="color: #800180;">両群における出血, 塞栓症のリスク</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4cNepihW78XN1rSeHBVwCGW9pWJgJhGl7h5utlsMkRyxhKyETObVEyGF2kNISdzNLXjgMq0rgrKLIEWJbrPaGQsUQ0J5LS4QgnNj__eyo7nxoWquwswje6VN1NEXYimmrj1wQx5KrtC7WytDbxOIMakza9N-ZJby2zJDrpgK_EvKrgDCqSk4yggmllbyp/s559/2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="246" data-original-width="559" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4cNepihW78XN1rSeHBVwCGW9pWJgJhGl7h5utlsMkRyxhKyETObVEyGF2kNISdzNLXjgMq0rgrKLIEWJbrPaGQsUQ0J5LS4QgnNj__eyo7nxoWquwswje6VN1NEXYimmrj1wQx5KrtC7WytDbxOIMakza9N-ZJby2zJDrpgK_EvKrgDCqSk4yggmllbyp/w640-h282/2.png" width="640" /></a></span></div><span style="color: #800180;"><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQaJ-kI9O34R479Ck2SwE9NQSARQs6LHQ1JqkYgxbHBLt8_m583mU5bfleQvvN3aamC3FXhNUN7INJ9lRwWXVFB00GHhtW9FO3Dl7Pio2qx34Q2eCWZxfMWAz8G7uzpIFpjBmoM9o3B58-ZzJr_ifrldnSdeWS-nA-LIfazPOn_j-Vmu11kkCDzRKcyFDP/s258/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="214" data-original-width="258" height="332" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQaJ-kI9O34R479Ck2SwE9NQSARQs6LHQ1JqkYgxbHBLt8_m583mU5bfleQvvN3aamC3FXhNUN7INJ9lRwWXVFB00GHhtW9FO3Dl7Pio2qx34Q2eCWZxfMWAz8G7uzpIFpjBmoM9o3B58-ZzJr_ifrldnSdeWS-nA-LIfazPOn_j-Vmu11kkCDzRKcyFDP/w400-h332/1.png" width="400" /></a></div><br /></span><p></p><p>・<span style="color: #800180;">早期群: 1-2-3-4日後に開始</span>した群は, 晩期群と比較してよりStroke再発リスクは低く, 大出血は両群で同等であった.</p><p><br /></p><p><b><span style="color: red;">ELAN: Nonvalvular Afを認める脳梗塞症例を対象とし,
抗凝固療法(DOAC)開始のタイミングを比較したRCT.</span></b></p><p>(N Engl J Med 2023;388:2411-21.)</p><p>・脳梗塞は軽症(梗塞巣≤1.5cm), </p><p> 中等症(中大脳動脈, 前大脳動脈, 後大脳動脈の皮質表在枝の分布にある梗塞), </p><p> 重症(中等症の動脈支配領域のさらに広範囲の梗塞や>1.5cmの脳幹, または小脳の梗塞)に分類し, それぞれでDOACの開始タイミングを設定し比較</p><p>・N=2013例</p><p><span style="color: #800180;">・早期開始群: 軽症, 中等症では48時間以内, 重症では6-7日目(1-2-2-6)</span></p><p><span style="color: #800180;"> 晩期開始群(ガイドラインによる推奨 1-3-6-12): 軽症では3-4日目, 中等症では6-7日目, 重症では12-14日目</span></p><p>・アウトカムは脳梗塞再発リスクと出血リスク.</p><p><br /></p><p><span style="color: #800180;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN39lVT5EY2sMycuhyphenhyphen4x5sRxmUTFpq6Pqehdaxaf82QWuItZmJjVjsvEZr2n9hHRXMCDRgaTcxjRBJee710kU5WMki5mDYyLjGS9Y0wtlC9Olwq9lOkPoVKAoLPkn9TvMxuuRTP3qAKgfgj40al-RA-WcDmjpTh91-3_6MWKmyyYPdN0pGSgmCZnnUNbc8/s491/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="491" data-original-width="446" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN39lVT5EY2sMycuhyphenhyphen4x5sRxmUTFpq6Pqehdaxaf82QWuItZmJjVjsvEZr2n9hHRXMCDRgaTcxjRBJee710kU5WMki5mDYyLjGS9Y0wtlC9Olwq9lOkPoVKAoLPkn9TvMxuuRTP3qAKgfgj40al-RA-WcDmjpTh91-3_6MWKmyyYPdN0pGSgmCZnnUNbc8/w582-h640/1.png" width="582" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・脳出血リスクは両者で有意差なし.</p><p>・脳梗塞再発リスクは有意差はないものの, 早期開始群で1%程度低下する可能性が示唆された.</p><p>・90日アウトカムでは,
複合アウトカムで
有意差を認める</p><p><br /></p><p>-------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">心房細動+脳梗塞症例における抗凝固の開始時期は従来のGLで推奨されている投与開始期間よりも大きく短縮される可能性がある.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">TIAでは早期に, 軽症では1-2日後, 中等症でも2-3日後, 重症では4-6日を目安とするとよいのかもしれない. ルール的には 1-2-3-5 的な?</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-88484544641349317682023-09-26T14:13:00.003+09:002023-09-26T14:13:16.743+09:00トキソプラズマの抗体保有率<p><span style="color: red;">トキソプラズマ症は<i>Toxoplasma gondii</i>による人畜共通原虫症.</span></p><p>・ネコ科の動物を終宿主とする細胞内寄生原虫であり,</p><p> 中間宿主としてヒトやブタ, ヤギなど哺乳類やニワトリ, カモなどの鳥類に感染する.</p><p><br /></p><p><span style="color: red;"><i>T. gondii</i>のライフサイクル</span></p><p>(Saudi J Biol Sci. 2021 Jan; 28(1): 962–969.)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFQhbSc8ibUesyZXoG7p4rzxBetCjAA3imujWxORADZb4C_gX_PF4pYLVuUDj8UniU4Yb0gcgHYewrC2G70wF8wMUxcjoBZ1hrhWpFxgdE0y89UxEkh2oAXojrQlp6svRFdSosYBgx8frRfPYmmUACgAW2ha5X3VIGpRr8G9NsUZGnB0QGsAuRHiq-yXyP/s864/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="666" data-original-width="864" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFQhbSc8ibUesyZXoG7p4rzxBetCjAA3imujWxORADZb4C_gX_PF4pYLVuUDj8UniU4Yb0gcgHYewrC2G70wF8wMUxcjoBZ1hrhWpFxgdE0y89UxEkh2oAXojrQlp6svRFdSosYBgx8frRfPYmmUACgAW2ha5X3VIGpRr8G9NsUZGnB0QGsAuRHiq-yXyP/w400-h309/1.jpg" width="400" /></a></div><p></p><p>・猫の糞とともに虫卵が排出され, 環境内で1-5日経過したものが感染性を有する</p><p>・他の動物が汚染された土や植物などを摂取し, 感染. 中間宿主となる.
</p><p> 体内でタキゾイドを放出し, 拡大. 神経や筋組織でシストを形成.</p><p>・猫がそのシストを含む肉を摂取すると感染.</p><p>・ヒトはシストや虫卵を摂取し
感染するが,
他に垂直感染もある</p><p>・74-77度や
中心温度66度以上,
また-12度の冷凍で
感染リスクは低下.</p><p><br /></p><p><b><span style="color: red;">ヒトへの感染</span></b></p><p>(Rio de Janeiro, Vol. 104(2): 221-233, March 2009)</p><p>・症状は無症候性〜免疫不全患者の重症感染症, </p><p> 妊婦が感染することで胎児に垂直感染を呈し, 先天性トキソプラズマ症となることがある.</p><p><br /></p><p><span style="color: #800180;">先天性トキソプラズマ症</span></p><p>・妊婦から胎盤を通過して胎児に垂直感染する</p><p>・不顕性感染〜死産, 水頭症, 脈絡膜炎, 脳内石灰化, 精神運動機能障害</p><p> リンパ節腫脹, 肝障害, 黄疸, 血球減少など</p><p><br /></p><p><span style="color: #800180;">後天性感染症</span></p><p>・急性症状: 無症状が多いが, 発熱やリンパ節腫脹, IM-like syndromeなど</p><p> 不明熱の原因にもなり得る.</p><p>・眼トキソプラズマ症: 先天性感染の再活性化が原因. 後部ブドウ膜炎, 視力障害, 眼痛など</p><p>・日和見感染症: HIV患者などでは潜伏感染していたトキソプラズマが再活性化し, 脳炎, 脈絡膜炎, 肺炎などの重篤な症状を呈する</p><p><br /></p><p><span style="color: #800180;">Toxoplasmosisによる腸炎</span></p><p>・経口の急性感染後, 重度の腸炎や小腸壊死を呈する症例や, 播種性トキソプラズマ症の初期に重症腸炎を呈する例など報告がある(Case Rep Gastrointest Med. 2017;2017:3491087.)(South Med J. 1995 Aug;88(8):860-1.)</p><p>・動物研究では, 経口感染後, 小腸に強い炎症を生じる.</p><p> 上皮細胞の軽度の落屑, 中等度〜重度の壊死を認める症例など.</p><p> 病理学的変化は回腸遠位で最も顕著であり, 十二指腸や空腸は保たれる</p><p>・また肝障害を呈する頻度も高く, 肝臓血管周囲や実質内に炎症性細胞浸潤を認める.</p><p>・寄生原虫は回腸に多数検出される.</p><p>・ヒトでの報告が少ない理由の1つに摂取される虫体量が考えられる.</p><p><br /></p><p><b><span style="color: red;">日本におけるToxoplasma gondiiの疫学</span></b></p><p><span style="caret-color: rgb(128, 1, 128);">(</span>Parasitology International 87 (2022) 102533<span style="caret-color: rgb(128, 1, 128);">)</span></p><p><span style="color: #800180;">ヒトにおけるT. gondii抗体の保有率</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_27Gt8UMzVaRMC9UXVghdHOpPJEhKpejmBWBSYC3MqEtlyI6INZb_fOejQPq76sZC3kSI2cqP33Q9jqyLFS3m-m4Jbz7ZHJe_NN_FkkWfn8mQpdblpyM64lGKS70vEfICyz4zSnTmEgPMqOtkMpIwXjFU7sWUiqoq2JwC0FKZAMudv7xZBq0Qo7I5wJ48/s441/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="441" data-original-width="331" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_27Gt8UMzVaRMC9UXVghdHOpPJEhKpejmBWBSYC3MqEtlyI6INZb_fOejQPq76sZC3kSI2cqP33Q9jqyLFS3m-m4Jbz7ZHJe_NN_FkkWfn8mQpdblpyM64lGKS70vEfICyz4zSnTmEgPMqOtkMpIwXjFU7sWUiqoq2JwC0FKZAMudv7xZBq0Qo7I5wJ48/w480-h640/1.png" width="480" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・一般人口における保有率は1割
北九州では高い.</p><p>・眼病変患者における保有率は
数%とむしろ低い.</p><p><br /></p><p><span style="color: #800180;">猫や他の動物の抗体保有率</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0QmSO5eA0qHBtl_LBf8lJ9MjMUFz9U9izOLB_hRzQSnMR2PE3ISDmmgP-Cybob9hc8keZyogPpQJtsh9filPoTLiwDqK0Vc0pJB-liDaS_GQlbRizaKnD65r5C6dSbb42tckFmH9FCKimgOy5l8pCz7pNp8syNNwUfYPoeUWlgL0XmyzWflmk2PWg1-p7/s1050/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="604" data-original-width="1050" height="368" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0QmSO5eA0qHBtl_LBf8lJ9MjMUFz9U9izOLB_hRzQSnMR2PE3ISDmmgP-Cybob9hc8keZyogPpQJtsh9filPoTLiwDqK0Vc0pJB-liDaS_GQlbRizaKnD65r5C6dSbb42tckFmH9FCKimgOy5l8pCz7pNp8syNNwUfYPoeUWlgL0XmyzWflmk2PWg1-p7/w640-h368/1.jpg" width="640" /></a></span></div><p></p><p>・猫は徳之島や西日本の野良猫で多く認められる.</p><p>・他の動物では羊, ヤギで多い
</p><p> 東北の羊でおよそ3割, 沖縄のヤギは75%に及ぶ.</p><p>・鶏は地域差がありそう. 宮崎では11%だが, 岐阜では0%</p><p><br /></p><p><span style="color: #800180;">野生動物での保有率</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeh548KHHsLmkR-WntazsNccy626v_FYi2aRzzPjObzH66oOJlwjF-XQ-ulZ3O8U1qBL0d7LRQ66iT4cLAKpF2uW8K1dAcztlujz7QD63RJ_q4ifJKXBB5VqC7BUCtgyFGIDRRKnIceV1jz5bl76cOe4L2b5gw_oj1VwcUYIvmW6JFXK3ZZJWqO3Nr6V6B/s510/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="510" data-original-width="356" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeh548KHHsLmkR-WntazsNccy626v_FYi2aRzzPjObzH66oOJlwjF-XQ-ulZ3O8U1qBL0d7LRQ66iT4cLAKpF2uW8K1dAcztlujz7QD63RJ_q4ifJKXBB5VqC7BUCtgyFGIDRRKnIceV1jz5bl76cOe4L2b5gw_oj1VwcUYIvmW6JFXK3ZZJWqO3Nr6V6B/w446-h640/1.png" width="446" /></a></span></div><p></p><p>・様々だが, 猪や蝦夷鹿は多く,
またカモシカも多そう</p><p><br /></p><p><span style="color: red;">Toxoplasmosisの治療(平成26年, 診療の手引きより)</span></p><p>・急性感染症で, 免疫正常, 軽症例では治療は不要.</p><p>・先天性トキソプラズマ症の治療は
3剤療法: ピリメタミン, スルファジアジン, ホリナート</p><p>・免疫不全者では, 上記3剤療法を4-8週間. その後は維持療法として免疫状態が改善するまで継続が推奨される.</p><p>・代替療法としてST合剤
また, </p><p> 上記3剤療法のスルファジアジンの代替として,
クリンダマイシン, アジスロマイシン, ダプソン, アドバコンのいずれかを使用することも可能.</p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-18527516764134275922023-09-23T23:04:00.003+09:002023-09-23T23:04:39.400+09:00心房細動に対する抗凝固療法についての2つの論文 2023/9月<p> 2023年9月(ごろ)にでました心房細動における抗凝固療法の重要な論文2つ.</p><p><br /></p><p><b><span style="color: red;">1つめ: Frailの高齢者でWarfarin→DOACとすると, 出血のみ増える</span></b></p><p><span style="caret-color: rgb(255, 0, 0);">(</span>Circulation. 2023 Aug 27. doi: 10.1161/CIRCULATIONAHA.123.066485.<span style="caret-color: rgb(255, 0, 0);">)</span></p><p><span style="color: red;">FRAIL-AF: Warfarinを使用中の75歳以上のAf患者で, 且つFrailを認める(Groningen Frailty Indicator score ≥3)患者群1330例を対象とし, </span></p><p>・Warfarinを継続する群と, DOACへ変更する群に割り付け比較したOpen-label RCT</p><p>・GFR<30mL/min/1.73m2とValvular Af群は除外</p><p>・12ヶ月間継続し, 塞栓症リスク, 出血リスクを比較した.</p><p>・DOAC切替群は当初INR <2.0で切り替えていたが, その場合切替直後の出血が増加したため, その後(DOAC群102例導入後)はINR<1.3で切替とした.</p><p><br /></p><p><span style="color: #800180;">母集団</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvEtbsZWdkCj2Ms4htHPI6sp35wNSxJzYsBtAslHt8Bsa6wV45yGvD4UB2bQgA_oefUKtv1Qnr_78QKqv8FuXvNX56NMFcGYpucU2x4KxuOitVnqlDPwbhCVd-8rSdW7hp6US-8afSwcroeZJr6IH4qVVsm2tlSG1Y9pLfED-IQJr9KXOw0HmXX3aGRIab/s538/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="538" data-original-width="457" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvEtbsZWdkCj2Ms4htHPI6sp35wNSxJzYsBtAslHt8Bsa6wV45yGvD4UB2bQgA_oefUKtv1Qnr_78QKqv8FuXvNX56NMFcGYpucU2x4KxuOitVnqlDPwbhCVd-8rSdW7hp6US-8afSwcroeZJr6IH4qVVsm2tlSG1Y9pLfED-IQJr9KXOw0HmXX3aGRIab/w544-h640/1.png" width="544" /></a></div><br /><p><span style="color: red;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: red;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNBsregdpze9Z7InfYFfgX5lZZjB3Vf_1CfziVteSXORFO95nPhLFUqMmDa58Tp8SqhCsfeE0I3ZY60vpCL1J-Z7g07ZWr3iZKUdU2keawGb_wUobUAZJvEAmLF9w6DK2t4_XJuvMwAiHoXM-0rq0FbpHo7kTiRZ2CD4OKLhJtJDwXt4f7Faw_u3i1X3x7/s682/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="274" data-original-width="682" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNBsregdpze9Z7InfYFfgX5lZZjB3Vf_1CfziVteSXORFO95nPhLFUqMmDa58Tp8SqhCsfeE0I3ZY60vpCL1J-Z7g07ZWr3iZKUdU2keawGb_wUobUAZJvEAmLF9w6DK2t4_XJuvMwAiHoXM-0rq0FbpHo7kTiRZ2CD4OKLhJtJDwXt4f7Faw_u3i1X3x7/w640-h258/1.png" width="640" /></a></span></div><p></p><p>・DOAC切替群で有意に出血リスクが増加したため, Studyは終了</p><p>・Major bleedingは有意差なし. CRNMの上昇が主.</p><p>・塞栓症イベントは有意差なし.</p><p><br /></p><p><span style="color: #800180;">増加する出血は</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcvRoNzKy0zOdzssfM-EMGtfOusXnSz9DW7oAgJNKXqPODErHaIlPqohhSVUHjfRDVgUz0LMPeSkKCBDf1uPYzZ_UdfDz6_zi1osEnJu3hoTlVSzq1rhuwgkVwO2FhnhBaCJdN3gsqeO2v2c7E_sjRbp4AiNGEi_EpGkuDB2peThggw_911YmvlgfIFmA-/s476/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="312" data-original-width="476" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcvRoNzKy0zOdzssfM-EMGtfOusXnSz9DW7oAgJNKXqPODErHaIlPqohhSVUHjfRDVgUz0LMPeSkKCBDf1uPYzZ_UdfDz6_zi1osEnJu3hoTlVSzq1rhuwgkVwO2FhnhBaCJdN3gsqeO2v2c7E_sjRbp4AiNGEi_EpGkuDB2peThggw_911YmvlgfIFmA-/w400-h263/1.png" width="400" /></a></span></div><p></p><p>・皮膚, 消化管, 泌尿生殖器系</p><p>・特に消化管はMajor bleedingも目立つ.</p><p><span style="color: #2b00fe;"><br /></span></p><p><span style="color: #2b00fe;">感想</span></p><p><span style="color: #2b00fe;">・やっぱり腎機能も不安定なフレイル高齢者でDOACは正直怖いですよね.</span></p><p><span style="color: #2b00fe;"> DOACはワルファリンと比べて出血リスクは低いという話ですが, 結局消化管については差はないし, こういうところで悪く出ちゃうのは想像に難くないよね.</span></p><p><br /></p><p>--------------------</p><p><br /></p><p><span style="color: red;"><b>2つめ: 無症候性のAfでの抗凝固ってどうするのか?</b></span></p><p>(N Engl J Med. 2023 Aug 25. doi: 10.1056/NEJMoa2303062.)</p><p>・埋め込み型デバイスや, 経皮型デバイスにより検出されたAf症例をAHREs(atrial high-rate episodes)またはSubclinical Afと呼ぶ.</p><p>・この場合の抗凝固療法の適応は定まったものはないが, 24h以上持続するような症例や, Strokeのリスクがある症例では抗凝固療法を推奨する意見がある.</p><p><br /></p><p><span style="color: red;">NOAH-AFNET 6: 高齢者におけるAHREsに対するNOAC(Edoxaban)を評価したDB-RCT.</span></p><p>・患者は65歳以上で, 埋め込み型デバイスによりAHREsが検出され, 今までECGでAfと診断されたことがない患者群. </p><p>・AHREsは≥170/minの心房拍動が6分以上持続する症例で定義</p><p>・さらに1つ以上のStrokeリスクを有する患者(CHA2DS2+V)(参考は<a href="http://hospitalist-gim.blogspot.com/2014/08/blog-post_79.html" target="_blank">こちら</a>)</p><p>・除外項目: ECGでAfが記録されている患者, 30日以内のACS, PCI, CABGの病歴, 余命が12ヶ月未満, 抗凝固薬が禁忌, DAPTが適応となる症例, 他に抗凝固療法が必要とされる疾患.</p><p><span style="color: #800180;">これらを満たす患者群をEdoxaban vs Placebo群に割り付け, 心血管死亡, Stroke, 塞栓症の頻度と発症までの期間を比較</span></p><p>・Edoxabanは60mg/d, 体重≤60kg, CCr 15-50mL/min, P-glycoprotein阻害作用がある薬剤との併用時は30mg/d</p><p>・Placebo群では偽薬またはアスピリンが含有されたものが用意され, 血管疾患や冠動脈疾患, 脳卒中の既往などによりアスピリンが適応と判断された場合はアスピリン含有Placeboが使用された.</p><p><span style="color: #800180;">患者群</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxXDFKXNr6299gBkH47Z009Jkog2rnoacXe9VnCpF9g5n3KdFgzKf4oE_67u75aRfh3FiLZnaA_b9HK7NYP1dkBIbhUTY2HZOkd3wK7jgJ000be95v9U8s4dfMwLLnzjVnZtuR8o1dKwph_DZ-n_TJIgGP4AXXgTq-w2SXQ3sCk6pCXbPpdfibJqm7JMCa/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="353" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxXDFKXNr6299gBkH47Z009Jkog2rnoacXe9VnCpF9g5n3KdFgzKf4oE_67u75aRfh3FiLZnaA_b9HK7NYP1dkBIbhUTY2HZOkd3wK7jgJ000be95v9U8s4dfMwLLnzjVnZtuR8o1dKwph_DZ-n_TJIgGP4AXXgTq-w2SXQ3sCk6pCXbPpdfibJqm7JMCa/w418-h640/1.png" width="418" /></a></span></div><p></p><p>・75歳以上が2/3</p><p>・AHREsの持続時間は2.8時間(0.8-9.4)</p><p>・CHA2DS2-VAScスコアは4[3-5]</p><p><br /></p><p><span style="color: #800180;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqYOLQrDvpvUh_e-JVZKo-qT4T8oG-8bK3pa2-m2DhZ33bkxZQcu6DeBrOVmPsJ_3p7Ha16sRuGa1bckSFKM9SbTkLf7DTWnRsWnIZvNtX99ABfUUMCcyM_WIkok0pYSBHYvcKXv11Eki-8X-2KFryO31BEfl4XpsTazgK8OqCUJPPDAd6AmRkFljp5xPz/s415/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="415" data-original-width="409" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqYOLQrDvpvUh_e-JVZKo-qT4T8oG-8bK3pa2-m2DhZ33bkxZQcu6DeBrOVmPsJ_3p7Ha16sRuGa1bckSFKM9SbTkLf7DTWnRsWnIZvNtX99ABfUUMCcyM_WIkok0pYSBHYvcKXv11Eki-8X-2KFryO31BEfl4XpsTazgK8OqCUJPPDAd6AmRkFljp5xPz/w630-h640/1.png" width="630" /></a></span></div><p></p><p>・Studyは安全性の懸念より途中で中断</p><p>・心血管イベントリスクは両者で有意差は認めないが<span style="color: #800180;">Edoxaban群では有意に出血リスクが上昇する結果</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9w5zGkl2kfvnniVnKB31coK5Cob3IxutYjrU-gALnSv0PiikFsEs0u4cKjTaGnh5ui-AlwckmBVW5i0I5IbAsonRY-1Ue8AqrUYsuV0QepN9C39UhlofzjoxmmcRjetAAZy9VsaH403jWMP4gAexJisFAKAWBDowpVfoERSP8JxIN5iDa2mCSnwYxIGFM/s493/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="478" data-original-width="493" height="620" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9w5zGkl2kfvnniVnKB31coK5Cob3IxutYjrU-gALnSv0PiikFsEs0u4cKjTaGnh5ui-AlwckmBVW5i0I5IbAsonRY-1Ue8AqrUYsuV0QepN9C39UhlofzjoxmmcRjetAAZy9VsaH403jWMP4gAexJisFAKAWBDowpVfoERSP8JxIN5iDa2mCSnwYxIGFM/w640-h620/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><div><span style="color: #2b00fe;">感想</span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">・今回は埋め込み型デバイス = つまり何かしらの心疾患がある高齢者.</span></div><div><span style="color: #2b00fe;"> その患者群で一過性の心房頻拍があっても抗凝固は害となる可能性が示唆された.</span></div><div><span style="color: #2b00fe;"> とはいえ, さらに長期間の予防効果は不明.</span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">・今後、スマートウォッチで検出された, とか色々ありそうで,</span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);"> そういう症例でも何かしらの介入が必要かどうか評価することはとても重要.</span></span></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-16187142873149826452023-09-22T09:52:00.002+09:002023-09-22T09:52:39.209+09:00偽痛風(CPPD disease)の分類基準(ACR/EULAR 2023)<p>ACR/EULAR 2023のCPPD疾患の分類基準がでました</p><p> (Ann Rheum Dis : 10.1136/ ard-2023-224575)</p><p><br /></p><p><span style="color: red;">まずDefinition criteria:</span></p><p>・関節炎所見/症状を認め,
他に原因となる疾患が認められない患者(RAや痛風etc)において, Crowned dens syndromeを満たす場合や関節液よりCPP結晶が認められる場合はCPPD疾患と診断</p><p>・それ以外ではスコアが>56点ならばCPPD疾患とする.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhPE64kF0DuVp3B5z8ia_iPkNHACFm5KswY-ebmRTfCjZn4GcsAj8tTCMhgezzGRQ3In-8mZ8A9P24HtH_RBORrqkjmtn-mqdn1SpPPVaJwEPAWyctvw_Hg6p6VMFCs45-picXSZ6ZRHAKPvgA6k_mufI4s5jqkjJLq2V5H7oyEgLJo2GbXQpAhsdmizL/s516/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="255" data-original-width="516" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhPE64kF0DuVp3B5z8ia_iPkNHACFm5KswY-ebmRTfCjZn4GcsAj8tTCMhgezzGRQ3In-8mZ8A9P24HtH_RBORrqkjmtn-mqdn1SpPPVaJwEPAWyctvw_Hg6p6VMFCs45-picXSZ6ZRHAKPvgA6k_mufI4s5jqkjJLq2V5H7oyEgLJo2GbXQpAhsdmizL/w640-h316/1.png" width="640" /></a></div><div><br /></div>・補足: <div> <a href="http://hospitalist-gim.blogspot.com/2015/01/crowned-dens-syndromeacute-calcific.html" target="_blank">Crowned dens syndrome</a></div><div> <a href="http://hospitalist-gim.blogspot.com/2019/03/blog-post_13.html" target="_blank">偽痛風による椎体炎</a></div><div><br /><p><span style="color: red;">CPPDの診療スコア</span></p><p>・一度でも認められた場合に算定
</p><p> 同一ドメインで複数認められた場合は最もスコアが高いものを採用</p><p>
画像検査は少なくとも1カ所以上の有症状関節で評価することが必要(CR, US, CT, DECT)</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(131, 131, 173); border-style: solid; border-width: 2px 1px 1px 2px; height: 8px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">項目</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(131, 131, 173); border-style: solid; border-width: 2px 1px 1px; height: 8px; padding: 4px; width: 312px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(131, 131, 173); border-style: solid; border-width: 2px 2px 1px 1px; height: 8px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">点数</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 22px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">A </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">年齢</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 22px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≤60</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">歳</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />>60</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">歳</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 22px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0<br />4</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 47px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">B </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節炎の経過</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 47px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">持続性</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">または典型的な炎症性関節炎ではない</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">持続性の炎症性関節炎</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />1</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">回のみの急性炎症性関節炎のエピソード</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">複数回の典型的な急性炎症性関節炎</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">*(*</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">急性の関節炎で</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">治療に関係なく改善するもの</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 47px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0<br />9<br />12<br />16</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 59px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">C </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">罹患関節の部位</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 59px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">第一</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">MTP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">典型的な炎症性関節炎は認めない</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">手関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">膝</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">第一</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">MTP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節以外</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">手関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">膝関節</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 59px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">-6<br />0<br />5<br />8<br />9</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 34px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">D </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関連する代謝性疾患</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">先天性ヘモクロマトーシス</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">原発性副甲状腺機能亢進症</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">低</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Mg</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">血症</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, Gitelman</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">症候群</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">低リン血症</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, CPPD</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">疾患の家族歴</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 34px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">なし</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">あり</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 34px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0<br />6</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 33px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">E </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">罹患関節の関節液所見</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 33px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">回精査し</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, CPP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">結晶が陰性</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />1</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">回精査し</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, CPP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">結晶が陰性</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">検査なし</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 33px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">-7<br />-1<br />0</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 47px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">F </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">画像検査にて手関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">手指関節の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(K/L</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">スコア</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≥2</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">で定義</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)<br />(CMC: </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">手根中手関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, STT: </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">帽状橈骨関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 47px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">以下の所見なし</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">/</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">検査なし</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">両側性の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化を認める</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br /></span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">次の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">つ異常の所見あり</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">: </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">第一</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">CMC</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化がないが</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">STT</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化を認める</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">第二</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">MCP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">第三</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">MCP</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節の</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">OA</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">変化</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 47px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0<br />2<br />7</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 1px 2px; height: 35px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">G </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">罹患関節の画像検査にて</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, CPPD</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">の証拠を認める</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px; height: 35px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">US, CT, DECT</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">で初見を認めない</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(CR</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">で所見を認めない</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">または</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">CR</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">未施行</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)<br />CR</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">で所見を認めない</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(US, CT, DECT</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">は未施行の場合</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">)<br />CR, US, CT, DECT</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">で所見を認める</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 1px 1px; height: 35px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">-4<br />0<br />16</span></p></td></tr><tr><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 2px 2px; height: 47px; padding: 4px; width: 207px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">H </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">症状に関わらず</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節に</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">CPPD</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">の証拠が認められる</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 1px 2px; height: 47px; padding: 4px; width: 312px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">なし</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />1</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />2-3</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節</span><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />≥4</span><span style="color: #0e002d; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">関節</span></p></td><td style="border-color: rgb(131, 131, 173); border-style: solid; border-width: 1px 2px 2px 1px; height: 47px; padding: 4px; width: 30px;" valign="top"><p style="margin: 0px;"><span style="color: #0e002d; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 8px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0<br />16<br />23<br />25</span></p></td></tr></tbody></table><br /></div><div><div>・この分類基準を用いた場合
Validation cohortにおいて
感度 99.2%, 特異度 92.5%でCPPDを示唆した.
</div><div> Derivationでは感度97.8%, 特異度87.9%</div><div><br /></div><div>・スコア>56のみの場合
(Definition criteriaでスコア判定となった患者群を対象),
感度 96.5%, 特異度 92.5%
</div><div> Derivationでは感度92.2%, 特異度87.9%</div></div><div><br /></div><div>補足</div><div> <a href="http://hospitalist-gim.blogspot.com/2014/07/blog-post_9.html" target="_blank">関節エコーによる偽痛風の評価</a></div><div> <a href="http://hospitalist-gim.blogspot.com/2016/03/vs.html" target="_blank">化膿性関節炎 vs 結晶性関節炎</a></div><div><br /></div><div>----------------------------------</div><div><br /></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">実際結構難しいのはRA患者や慢性関節炎患者に合併するCPPD、</span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">または慢性経過の結晶性関節炎ですがね</span></span></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-60932118246832114412023-09-13T09:18:00.001+09:002023-09-13T09:18:13.995+09:00Hemicrania continua: 持続性片側頭痛<p>症例: 30台男性. 慢性経過の持続性頭痛を主訴に受診.</p><p> 頭痛は30歳前半で発症し, 常に右前頭部の頭痛. さらにその頭痛が急性増悪を繰り返す. 初期は片頭痛と診断されていた. 頭痛は締め付けられるような頭痛.</p><p> 頭痛増悪時は突き刺されるような, 眼の奥の痛みであり, 流涙や鼻汁を伴う. また眼瞼が腫れぼったくなることもある. 悪心嘔吐あり. </p><p> 頭痛増強時はじっとしていられない.</p><p> 前兆症状は特にみとめられないとのこと.</p><p><br /></p><p> 頭部画像検査は特に異常は認めず. </p><p><br /></p><p>というような症例.</p><p><br /></p><p><br /></p><p><span style="color: red;">Hemicrania Continua(HC)は持続性片側頭痛と訳され, 群発頭痛, Paroxysmal Hemicrania(PH)と同じく, 三叉神経・自律神経性頭痛の1つである.</span></p><p>(Ann Indian Acad Neurol 2018;21:S23-30.)</p><p>・また, インドメタシンが著効する頭痛として有名. PHもインドメタシン反応性頭痛の1つである.</p><p>・持続性, 片側性の頭痛で, 流涙や結膜充血, 眼瞼下垂, 発汗, 鼻汁など自律神経症状を伴うことが多い.
</p><p>・頭痛は左右でどちらかのみ生じ, 交代しない = <span style="color: red;">Side-locked headacheの鑑別として重要</span></p><p><span style="color: red;"> 補足: <a href="http://hospitalist-gim.blogspot.com/2017/10/blog-post.html" target="_blank">Side-locked headache</a></span></p><p>・クリニックにおける頭痛の1.8%[1.0-3.3]がHCであり
そこまで稀な一次性頭痛ではない.</p><p>(Cephalalgia. 2023 Jan;43(1):3331024221131343.)</p><p>・Side-locked headacheのうち, HCは4番目の原因.
</p><p> 群発性頭痛, Side-locked migrane, cervicogenic headacheに次ぐ</p><p>・また, 三叉神経・自律神経性頭痛(TAC)で2番目に多い(群発性頭痛に次ぐ)</p><p><br /></p><p><b><span style="color: red;">HCの頭痛の特徴</span></b></p><p>・持続性の片側性頭痛に加えて, 増悪を繰り返す経過となる.</p><p>・基礎の慢性頭痛はVAS 3.3-5.2程度の中等度の頭痛であり,
身体活動を妨げる程度ではない.</p><p>・増悪する頭痛はさまざまな程度, 性質の痛みであり, 重度のことが多い
</p><p> VAS 9.0との報告もある.</p><p> 増悪は60分〜1日程度が多く, 頻度は1日1-5回 (Cephalalgia 2012;32(11) 860–868)</p><p>・自律神経症状も伴う; 流涙や眼瞼浮腫, 鼻汁, 鼻閉, 耳閉感,
前頭部の腫脹, 発赤, 発汗など.</p><p>・落ち着かない疼痛となる. </p><p>・また片頭痛様の症状(悪心嘔吐など)もあり
</p><p> HCにおいて悪心は44%, 羞明 35%, 聴覚過敏 22%.
</p><p> これらは片頭痛症例よりも少ない(80-90%)</p><p>(Cephalalgia. 2023 Jan;43(1):3331024221131343.)(Ann Indian Acad Neurol 2018;21:S23-30.)</p><p>・HCにおける自律神経症状の頻度</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrlgbhH8YgBXRn5zQGnec-e1yqyw91wKmYx6oE0tdHh-oGmf06150ze_nLkkML1UG4YRnuqa5To26efpZY0pApw8MwIv3TFmOOi5WRFsxJVgEUAioYv2EPPIdXikod2vkXG3HZ27G4SzWjrmcqUfSfivSw4Aagbp_aosGL2tf-5_VvFW5nOQjqHguGXARv/s695/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="341" data-original-width="695" height="314" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrlgbhH8YgBXRn5zQGnec-e1yqyw91wKmYx6oE0tdHh-oGmf06150ze_nLkkML1UG4YRnuqa5To26efpZY0pApw8MwIv3TFmOOi5WRFsxJVgEUAioYv2EPPIdXikod2vkXG3HZ27G4SzWjrmcqUfSfivSw4Aagbp_aosGL2tf-5_VvFW5nOQjqHguGXARv/w640-h314/1.png" width="640" /></a></div>(Cephalalgia. 2023 Jan;43(1):3331024221131343.)(Curr Pain Headache Rep. 2023 Aug 11. doi: 10.1007/s11916-023-01156-9.)<p></p><p><br /></p><p><b><span style="color: red;">HCの診断基準</span></b></p><div class="separator" style="clear: both; text-align: center;"><b><span style="color: red;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpv0iG_0dkveajIX-3qZA_V3Q04nVuzVx59eyWio8axge4KukpNThPEjwb4xVzMUoLWMr_d5AqgahBPUmZi0Ue0v3xvKL1SUnaBLMppb7VkQxPFc17lqKZjnC5RrRCC0DN6-FNlzlWCCMyLZ-qV5KvBDJHTEi3ket9vMNAiDQZRnIBq43jLStxChO5BoTz/s528/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="528" data-original-width="382" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpv0iG_0dkveajIX-3qZA_V3Q04nVuzVx59eyWio8axge4KukpNThPEjwb4xVzMUoLWMr_d5AqgahBPUmZi0Ue0v3xvKL1SUnaBLMppb7VkQxPFc17lqKZjnC5RrRCC0DN6-FNlzlWCCMyLZ-qV5KvBDJHTEi3ket9vMNAiDQZRnIBq43jLStxChO5BoTz/w464-h640/1.png" width="464" /></a></span></b></div><b><span style="color: red;"><br /></span></b><p></p><p><span style="color: #800180;">HCと片側固定された片頭痛の比較</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqVSTysJPIW5BQw9IedE-YKhP89CLM2HKCRrsZyihg0RVNhcZzOQE-RXgNi6eNg8zh2Zu2QVnKIrua2Nlxd05shFmnPv0J10MCa5awy4cg9qsiFtc9iyLAM8G_GhtTZzM0zpT8sM2_NmMDAStQJFAJnQFBDB8P5VLETxMe4CVx8MOIEjGfI5DLcUqDT6oY/s683/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="232" data-original-width="683" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqVSTysJPIW5BQw9IedE-YKhP89CLM2HKCRrsZyihg0RVNhcZzOQE-RXgNi6eNg8zh2Zu2QVnKIrua2Nlxd05shFmnPv0J10MCa5awy4cg9qsiFtc9iyLAM8G_GhtTZzM0zpT8sM2_NmMDAStQJFAJnQFBDB8P5VLETxMe4CVx8MOIEjGfI5DLcUqDT6oY/w640-h218/1.png" width="640" /></a></div>(Ann Indian Acad Neurol 2018;21:S23-30.)<br /><p><span style="color: #800180;">他の頭痛との比較</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_cG5kk58Ji2zOZpZZ11tbwvC-haq-OiOTdDE-6gET5ZleVYlyb2YScTCVW9dajF3-nRxFzg5Iq5sgHAVrv8oPfHGW0kWMSQEThlQrZlmjjEMhUMYmyTi60xX-9100JspT11UJiMNeCaiZmMbTKhnIVAxoaeuo6OaES7pwKlsB5w5ly_3RF9reQquwekOD/s600/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="459" data-original-width="600" height="490" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_cG5kk58Ji2zOZpZZ11tbwvC-haq-OiOTdDE-6gET5ZleVYlyb2YScTCVW9dajF3-nRxFzg5Iq5sgHAVrv8oPfHGW0kWMSQEThlQrZlmjjEMhUMYmyTi60xX-9100JspT11UJiMNeCaiZmMbTKhnIVAxoaeuo6OaES7pwKlsB5w5ly_3RF9reQquwekOD/w640-h490/1.png" width="640" /></a></div>(Curr Pain Headache Rep. 2023 Aug 11. doi: 10.1007/s11916-023-01156-9.)<br /><p><br /></p><p><b><span style="color: red;">HCの治療</span></b></p><p>・インドメタシンに反応する頭痛の1つであり, 診断においても重要(インドメタシン試験)</p><p> 治療は25mg tidより開始し, 1週間程度で増量する.
</p><p> 10-18%が≤75mgで完全に頭痛は消失.
</p><p> 40-50%が≤150mg/dで消失
</p><p> >40%が≥225mg/dで消失する.</p><p>・効果があればそのまま3-6ヶ月継続し, その後頭痛に応じて減量, 適切な継続量で継続. </p><p> 多くの症例で減量が可能.</p><p>・インドメタシンで副作用が出現した場合, 他のCOX-2阻害薬やNSAID, トピラマート, メラトニン, ガバペンチン, ベラパミル, ステロイドを検討する.</p><p><br /></p><p><span style="color: #800180;">インドメタシン試験</span></p><p>・75-150mg/日を経口投与(8時間毎に3回投与)
または100-200mgをIMし, 頭痛への反応性を評価する.</p><p>・頭痛の顕著な改善があればインドメタシン反応性頭痛としてHCもしくはPHを考慮.</p><p>・反応するタイミングは, 内服使用後2日以内に改善を示すことが多いが,
完全に頭痛が消失するまでは4週間程度かかる例もある.</p><p> IM投与例では2時間以内に疼痛が消失する.</p><p>・インドメタシン中止にて24時間以内に頭痛は再発する.</p><p><br /></p><p>インドメタシン筋注は国内には製剤なし.</p><p>インドメタシン内服は製造中止になっており, 現状プロドラッグであるインドメタシンファルネシル(インフリーCP®)やアセメタシン(ランツジール®)が使用可能である.</p><p>・インドメタシンファルシネル 200mg = インドメタシン25mg換算</p><p> (400mgより開始. 臨床上の有益性が上回れば増量可と添付文章に記載)</p><p> アセメタシン 30mg = インドメタシン25mg換算 </p><p> (1日最大用量 180mg: インドメタシン換算で150mg)</p><p><br /></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-26578293445271089932023-08-16T16:24:00.005+09:002023-08-17T07:07:21.813+09:00中枢神経の血管炎<p>中枢神経の血管炎には原発性のPACNS(Primary angiitis of the CNS)と全身性疾患に合併する二次性がある.</p><p><br /></p><p><b><span style="color: red;">続発性の原疾患としては, 以下のようなものがある; </span></b>(Frontiers in Bioscience 2004;9:946-55)</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #964305; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 14px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Group</b></span></p></td><td style="background-color: #964305; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 14px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>疾患</b></span></p></td></tr><tr><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 34px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Giant cell arteritis</span></p></td><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 34px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">側頭動脈炎</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, Takayasu</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">病</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />Overlap with Wegener</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">肉芽腫</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 48px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Necrotizing Forms of Vasculitis</span></p></td><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 48px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Wegener</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">肉芽腫</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><br />Churg-Strauss syndrome<br />Polyarteritis nodosa</span></p></td></tr><tr><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 14px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Hypersensitivity Forms of Vasculitis</span></p></td><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 14px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">薬剤性</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">毒素性</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 14px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Collagen Vascular Disorders</span></p></td><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 14px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">SLE, RA, PN, Sjogren’s Syndrome</span></p></td></tr><tr><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 56px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">感染症</span></p></td><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 56px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Syphilitic<br />Bacterial(Chlamydia pneumoniae)<br />Fungal<br />Viral(VZV, CMV, HCV, HIV)</span></p></td></tr><tr><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 14px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Lymphoma</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">によるもの</span></p></td><td style="background-color: white; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 14px; padding: 3px; width: 199px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(0, 0, 0) rgb(150, 67, 5) rgb(150, 67, 5); border-style: solid; border-width: 1px 0px 1px 1px; height: 14px; padding: 3px; width: 204px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">全身疾患によるもの</span></p></td><td style="background-color: #f5ede7; border-color: rgb(150, 67, 5) rgb(150, 67, 5) rgb(150, 67, 5) rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 0px; height: 14px; padding: 3px; width: 199px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sarcoidosis, Behcet’s disease</span></p></td></tr></tbody></table><div><br /></div><div><p>・<span style="color: #800180;">感染症によるCNS Vasculitis</span></p><p> Viral; VZV, HIV, HCV, CMV, Parvovirus B19 </p><p> Bacterial; 梅毒, Borrelia burgdorferi, 結核, Mycoplasma pneumoniae,
Bartonella henselae, Rickettisia spp </p><p> Fungal; Aspergillosis, Mucormycosis, Coccidioidomycosis, Candidosis </p><p> Parasitic; Cysticercosis </p><p>・<span style="color: #800180;">全身性血管炎</span></p><p> AAV, Behcet病, Polyarteritis nodosa,
Henoch-Schonlein purpura, Kawasaki病, Giant-cell arteritis, 高安病など</p><p> Wegener肉芽種の7-11%, CSSの1-8%でCNS症状あり</p><p> Behcet病では5.3-14.3%でCNS症状(+)</p><p>・<span style="color: #800180;">他の膠原病による血管炎</span></p><p> SLE, RA, Sjogren症候群, 皮膚筋炎, MCTD</p><p>・<span style="color: #800180;">薬剤性CNS Vasculitis</span></p><p> Allopurinol, Ephedrine, sympathomimetrics, Cocaine, Amphetamine
Heroin, Antibiotics </p><p>・<span style="color: #800180;">悪性腫瘍性CNS Vasculitis</span></p><p> Hodgkin’s lymphoma, Non-HL, Leukaemia, Lung Cancer </p><p>・<span style="color: #800180;">その他</span></p><p> Cogan’s syndrome, Inflammatory bowel disease, Urticarial hypocomplementaemic vasculitis</p><p>(Lancet 2012; 380: 767–77)</p><p><br /></p><p><span style="color: #800180;"><b>105名のCNS vasculitisの解析による原疾患の内訳. </b></span>(QJM 2005;98:643-54)</p><p>・PN 17名, PACNS 12名, MPA 11名,
EGPA 11名, GPA 20名, Adult Henoch Schonlein purpura 14名, SLE 15名, Cutaneous vasculitis 4名</p><p><br /></p><p><b><span style="color: red;">原発性のCNS血管炎(PACNS)</span></b></p><p>(Lancet 2012; 380: 767–77)(Current Rheumatology Reports (2018) 20: 37)</p><p>・<50yrの脳血管障害の原因の3-5%を占める. </p><p>・罹患率は2.4/100万人年と非常に稀.</p><p> 男女差は無く, 平均年齢は50歳. 50%が37-59歳で発症する.</p><p><br /></p><p><span style="color: #800180;">小血管〜中血管炎が主体.</span></p><p>・組織形は肉芽種性, リンパ球性, 壊死性血管炎.
</p><p>・肉芽腫性血管炎が最も多く, 58%を占める.</p><p>・リンパ球浸潤による血管炎は28%. 特に小児例や, 血管造影で所見(-)例でこのタイプが多い.</p><p>・壊死性血管炎は14%で, PNに類似した組織形.</p><p><br /></p><p><span style="color: #800180;">PACNSの経過や症状は様々</span></p><p>・急性発症〜CNS症状を認めない無症候性まである</p><p>・頭痛を伴う頻度が高い(>50%)が, Thunderclap headacheとなることは稀であり, 認める場合はRCVSをより疑う.</p><p>(RCVSとその鑑別については<a href="http://hospitalist-gim.blogspot.com/2019/02/rcvs-rcvs2.html" target="_blank">こちら</a>を参照)</p><p>・神経局所症状も多い症状であるが, それ単独で生じることは少なく,
原因不明の頭痛や意識障害などと併存することが一般的.</p><p>・体重減少や寝汗, 発熱, 皮疹など全身症状を伴うことは少ない</p><p>
認める場合は全身疾患に合併するCNS血管炎やCNS障害を考慮する</p><p>・CNS vasculitisの4%で腫瘤性病変(+).</p><p>・Cerebral amyloid angiopathyは29%</p><p>・頭蓋内出血は11-12%</p><p><br /></p><p><span style="color: #800180;">以下の場合はCNS血管炎を鑑別に挙げる</span></p><p>・複数の血管支配領域の脳梗塞や, CSFの炎症徴候を伴う脳梗塞</p><p>・脳卒中のリスク因子を有さない, 若年患者の脳梗塞</p><p>・感染症や悪性疾患が認められない慢性経過の髄膜炎</p><p>・無菌性髄膜炎の既往や, 認知機能障害を伴う慢性経過の頭痛</p><p>・原因不明の局所性, およびびまん性の神経機能障害</p><p><br /></p><p><span style="color: #cc0000;">血管造影 and/or 脳生検にて診断したPACNS 101名の解析
</span>(Ann Neurol 2007;62:442-51)</p><p>・PCNSVの年間発症率は2.4[0.3-4.4]/1000000</p><p>・診断時の年齢は47yr[17-84], 約半数が37-59yrに診断されている.
</p><p> 発症から診断までの時間は0.1yr, 75%が半年以上かかっている.</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>症状</b></span></p></td><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>頻度</b></span></p></td><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>症状</b></span></p></td><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>頻度</b></span></p></td><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>症状</b></span></p></td><td style="background-color: black; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>頻度</b></span></p></td></tr><tr><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">頭痛</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">63%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">視覚障害</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">42%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">対麻痺</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">四肢麻痺</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">7%</span></p></td></tr><tr><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">認知障害</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">50%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">視野障害</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">21%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Parkinsonism, </span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">錐体外路症状</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">1%</span></p></td></tr><tr><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">片麻痺</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">44%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">複視</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">16%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Prominent constitutional symptom</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 32px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9%</span></p></td></tr><tr><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">持続性の神経障害</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> or Stroke</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">40%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Blurred vision</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">11%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">発熱</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9%</span></p></td></tr><tr><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">構音障害</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">28%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">一側性の視覚障害</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, <br /></span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">一過性黒内障</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">1%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">嘔気</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">嘔吐</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 39px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">25%</span></p></td></tr><tr><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">TIA</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">28%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">乳頭浮腫</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">めまい</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">回転性めまい</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9%</span></p></td></tr><tr><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">失調運動</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">19%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">頭蓋内出血</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">8%</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">構音障害</span></p></td><td style="background-color: #cacaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">15%</span></p></td></tr><tr><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 186px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">痙攣</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">16%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 129px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">健忘</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 39px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9%</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 192px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">片側性の痺れ</span></p></td><td style="background-color: #e6e6e6; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 16px; padding: 3px; width: 38px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">13%</span></p></td></tr></tbody></table><p><span style="caret-color: rgb(128, 1, 128);">・</span>血液検査;
<span class="Apple-tab-span" style="white-space: pre;"> </span>ESR亢進は少なく, ESR>30mm/hrとなったのは19/85(22.4%)
<span class="Apple-tab-span" style="white-space: pre;"> </span></p><p> RF, ANA, 抗カルジオリピン抗体はほぼ99%で陰性を示す.
<span class="Apple-tab-span" style="white-space: pre;"> </span></p><p> ANCA, 補体, HIV, Lupus anticoagulantも通常陰性を示す.</p><p>・CSF所見;</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #3891a7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 99px;" valign="top"><p style="margin: 0px;"><span style="color: white; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CSF</b></span><span style="color: white; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>所見</b></span></p></td><td style="background-color: #3891a7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 16px; padding: 3px; width: 127px;" valign="top"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="background-color: #d6e8ed; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 99px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">平均</span><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">WBC</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">数</span></p></td><td style="background-color: #d6e8ed; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 16px; padding: 3px; width: 127px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5(0-535) cell/ml</span></p></td></tr><tr><td style="background-color: #ecf4f7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 99px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Leu >5</span></p></td><td style="background-color: #ecf4f7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 127px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">49.3%</span></p></td></tr><tr><td style="background-color: #d6e8ed; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 99px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Prot</span><span style="color: black; font-family: Hiragino Sans; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">濃度</span></p></td><td style="background-color: #d6e8ed; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 127px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">72(15-1034) mg/dL</span></p></td></tr><tr><td style="background-color: #ecf4f7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 99px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Prot >45mg/dL</span></p></td><td style="background-color: #ecf4f7; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px; height: 17px; padding: 3px; width: 127px;" valign="top"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">72.6%</span></p></td></tr></tbody></table><p>・血管造影; 血管造影にて血管炎と診断できたのは90.5%</p><p>・MRI所見; 異常を認めたのは97%. 最も多い異常は梗塞巣で53%を占める
<span class="Apple-tab-span" style="white-space: pre;"> </span></p><p> このうち, 多発性脳梗塞が85%(両側性83%, 皮質, 皮質下に分布63%)</p><p>・造影MRIで造影効果を認めたのは33%程度のみ.</p><p>・脳生検の感度は53-63%.</p><p><span style="color: #800180;"><br /></span></p><p><span style="color: #800180;">この報告における, 血管造影異常群と組織生検診断群で分けた解析</span>(Lancet 2012; 380: 767–77)</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGUkrK8ZABuYd8yok_bMEJctIKFHGs4ztpl2gNewO_iSgCoi9MjHlCwyi-aJZULC0xhivvrqxGqcOkwETuB4CwGqVprXsr1fD_sRAxsQk_RNTAL5Mla3pYKz3O1jayM2a-oYhHbzjtjXfBy1ZM0O4Yr_mgKquRhpwyNe7VXUfCC2r5CCfCgtK2vtFhGOmC/s543/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="543" data-original-width="285" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGUkrK8ZABuYd8yok_bMEJctIKFHGs4ztpl2gNewO_iSgCoi9MjHlCwyi-aJZULC0xhivvrqxGqcOkwETuB4CwGqVprXsr1fD_sRAxsQk_RNTAL5Mla3pYKz3O1jayM2a-oYhHbzjtjXfBy1ZM0O4Yr_mgKquRhpwyNe7VXUfCC2r5CCfCgtK2vtFhGOmC/w336-h640/1.png" width="336" /></a></div><br />・血管造影で異常あり
⇒ 中血管の病変あり<p></p><p>・血管造影で異常なく,
生検にて診断
⇒ 小血管, 毛細血管の病変.</p><p>・その違いで症状も異なると
考えられる</p><p><br /></p><p><span style="color: #cc0000;">Mayo clinicで1983-2011年に診断された163例</span>(Medicine 94(21):e738)</p><p>・105例が血管造影、58例が生検により診断.</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 18px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>症状/所見</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 18px; padding: 4px; width: 70px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 18px; padding: 4px; width: 222px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 18px; padding: 4px; width: 69px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 18px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">頭痛</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 18px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">59.5%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 18px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">複視</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 18px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">14%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">認知障害</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">54%</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">霧視, 視力低下</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">11%</span></p></td></tr><tr><td style="background-color: white; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">片麻痺</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">40.5%</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">片眼の症状, 一過性黒内障</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">1.2%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経症状, 脳卒中</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">40.5%</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">視神経乳頭浮腫</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">4.3%</span></p></td></tr><tr><td style="background-color: white; height: 18px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">失語</span></p></td><td style="background-color: white; height: 18px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">24.5%</span></p></td><td style="background-color: white; height: 18px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">頭蓋内出血</span></p></td><td style="background-color: white; height: 18px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9.8%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">TIA</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">25.8%</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">健忘症</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">6.1%</span></p></td></tr><tr><td style="background-color: white; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">失調</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">19%</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">対麻痺, 四肢麻痺</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">4.9%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">痙攣</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">20.2%</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">パーキンソン症状, 錐体外路徴候</span></p></td><td style="background-color: #dcdfe2; height: 18px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">0.6%</span></p></td></tr><tr><td style="background-color: white; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">視覚症状</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">37.4%</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">全身症状*</span></p></td><td style="background-color: white; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9.2%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 137px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">視野障害</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 70px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">18.4%</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 222px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">発熱</span></p></td><td style="background-color: #dcdfe2; height: 19px; padding: 4px; width: 69px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9.8%</span></p></td></tr></tbody></table>* 倦怠感, 関節痛, 食欲低下, 体重減少のうち1つ以上</div><div><p>・CSF所見</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiNVahZ_1X7moGWSX_8CXdyiyKYR1ss1ygL-xlzlretoy-0EpcYnnQ8dEvq70lzT1auiRjPcc90ngW-9xUVt173OUQxbDS06sle-qTXSk-uquBBAM-vAk8zNGwmBJG8otYQ_Lf0NNgWlhSsZfoOYTICKxkh0vGqVI4VMDQlspCo8DsLWDfTAgSQwZrXnZO/s674/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="314" data-original-width="674" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiNVahZ_1X7moGWSX_8CXdyiyKYR1ss1ygL-xlzlretoy-0EpcYnnQ8dEvq70lzT1auiRjPcc90ngW-9xUVt173OUQxbDS06sle-qTXSk-uquBBAM-vAk8zNGwmBJG8otYQ_Lf0NNgWlhSsZfoOYTICKxkh0vGqVI4VMDQlspCo8DsLWDfTAgSQwZrXnZO/w640-h298/1.png" width="640" /></a></div><p></p><p>・画像所見</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic1N8PniI5QJqtnP1faMvaoFWSUxYfQH4nt-XkNgNycY9VtgMWm-D3MqbNjiiF6knkJnyeISAb_5qlYf5A59QtmXTNP_3VdiUPB1eHYzc-hd_edI0w6bBdBH0WoA_buUW5V5715zSctUZklwvrdGwOEL3Y6ZyV0bTuoyMPSgxr2DpdJpl0_KLlVY75HxIW/s636/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="234" data-original-width="636" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic1N8PniI5QJqtnP1faMvaoFWSUxYfQH4nt-XkNgNycY9VtgMWm-D3MqbNjiiF6knkJnyeISAb_5qlYf5A59QtmXTNP_3VdiUPB1eHYzc-hd_edI0w6bBdBH0WoA_buUW5V5715zSctUZklwvrdGwOEL3Y6ZyV0bTuoyMPSgxr2DpdJpl0_KLlVY75HxIW/w640-h236/1.png" width="640" /></a></div><br /><p></p><p><b><span style="color: red;">PACNSの治療</span></b></p><p>(Current Rheumatology Reports (2018) 20: 37)(Lancet 2012; 380: 767–77)</p><p><span style="color: #800180;">基本はステロイド療法</span></p><p>・Prednisone 1mg/kg, または60mg/dで開始し, 数ヶ月かけて減量.</p><p> 平均投与期間は10カ月. ¾が=<19mo治療.</p><p>・PSLにて反応乏しければ以下の併用を考慮.</p><p> Cyclophosphamide 150mg/d(2mg/kg/d), 平均10mo投与の併用,
</p><p> Cyclophosphamide pulse(0.75g/m2/m 6mo)は連日内服よりも安全</p><p>・Azathioprine 100-150mg/d(1-2mg/kg/d), MTX 20-25mg/wk, Mycophenolate mofetil 1-2g/dによる寛解維持も有用
</p><p><br /></p><p><span style="color: #800180;">通常PSL+CYによる治療を行い,
それでもうまくゆかない場合はPACNSの診断を再考した上で
RTXやMMFを試す.</span></p><p>・疾患活動性の評価方法も課題.</p><p> MRI所見はそう頻回には施行が難しい.
また, 血管狭窄所見はしばしば残存するため, 病勢フォローには向かない. </p><p>
CSF所見のフォローは侵襲があるし, その妥当性は不明確</p><p>・抗CD20療法(Rituximab)はANCA関連血管炎に伴うCNS血管炎に対して, CYと同等に有用な可能性が示唆されているが, PACNSでは不明確 (J Clin Rheumatol. 2021 Mar 1;27(2):64-72.)</p><p>・Mayo clinicで診断されたPCNSV 163例のうち,
16例でMMFが使用され, 良好な疾患活動性の抑制が得られた (Seminars in Arthritis and Rheumatism 45 (2015) 55–59 )</p><p>・TNF阻害薬も有用との報告もある</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcgHZytkKjCJujRa3wjax11-43i3VUxpbUV-9YnpouGr4RQ827GKngOWYb2al6OSvSBws9Nw6gEWBcZnu-13YqJ3HW4kB33BfHJdTBGaJxLi8eRJTYDh4cl7xfaXAvu27Fu_jbY6I7PPNL3JI8i32RcMOxy5sPHvYgl7f8fxWRo9MIbWSWDioGMf1e1mqE/s690/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="527" data-original-width="690" height="488" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcgHZytkKjCJujRa3wjax11-43i3VUxpbUV-9YnpouGr4RQ827GKngOWYb2al6OSvSBws9Nw6gEWBcZnu-13YqJ3HW4kB33BfHJdTBGaJxLi8eRJTYDh4cl7xfaXAvu27Fu_jbY6I7PPNL3JI8i32RcMOxy5sPHvYgl7f8fxWRo9MIbWSWDioGMf1e1mqE/w640-h488/1.png" width="640" /></a></div>(Medicine 94(21):e738)<br /><p><br /></p></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-15853566460472720672023-07-31T13:29:00.000+09:002023-07-31T13:29:01.632+09:00中枢神経リンパ腫におけるCSFマーカーについて<p>中枢神経リンパ腫(CNS lymphoma: 以下CNSL)の診断は難しい.</p><p>Gold standardは脳生検であるが, そのハードルは高く, 髄液検査で異常細胞が検出されればよいものの, その細胞診の感度は<50%程度に過ぎない.</p><p>また, 髄液量も10.5ml以上採取することが推奨されるため, 意識していないと検体が足りないということも多々ある.</p><p>他には髄液のFCM, TCR遺伝子再配列, IgHの評価が有用である.</p><p><br /></p><p>CNSLの診断に有用な髄液マーカーにはどのようなものがあるだろうか?</p><p><br /></p><p><b><span style="color: red;">国内より, 複数のCSFマーカーを使用したCNS lymphomaの診断能を評価した報告</span></b></p><p>(Cancer Medicine. 2020;9:4114–4125.)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgAoEddP2f2ofXOxytsALESRgf5CoEqj34eEthuLVH7qxoSMJ8DfAC6yyh3HdSd5JDqE_QDQxrRnVDNjnKB-B6jOfcgJSoH9CjdNq1wqmco42BhuwnOQ_qRzytBOsNmACgxgzoqCaFegZlAlBV-oIm8-bWYCxgQZ90w4Rpq2oc77M53RGGwrbazM8ABYdF/s705/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="411" data-original-width="705" height="374" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgAoEddP2f2ofXOxytsALESRgf5CoEqj34eEthuLVH7qxoSMJ8DfAC6yyh3HdSd5JDqE_QDQxrRnVDNjnKB-B6jOfcgJSoH9CjdNq1wqmco42BhuwnOQ_qRzytBOsNmACgxgzoqCaFegZlAlBV-oIm8-bWYCxgQZ90w4Rpq2oc77M53RGGwrbazM8ABYdF/w640-h374/1.png" width="640" /></a></div><p></p><p>・髄液中のマーカーでは, CXCL-13, IL-10, β2-MG, sIL-2Rの組み合わせはCNS lymphomaの診断に有用であるとの結論.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtOiYP6N5Za87SCuMX2mCt33q3sr3eGvAE_Y_RX8f0o3leq1_6nC1w6u1_Rr4iVs-cApJ-zQy-Tr58mLK1CWOSsWsKV_icdETW5gSllfw8nufh5ol3LMNKnuWsiXvasJzS9KJ6VTHKdSj5MM209py2eNaRaFYpDSP_RjcE9S3BLaXwuJR6BYtkAbwSDPVG/s718/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="173" data-original-width="718" height="154" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtOiYP6N5Za87SCuMX2mCt33q3sr3eGvAE_Y_RX8f0o3leq1_6nC1w6u1_Rr4iVs-cApJ-zQy-Tr58mLK1CWOSsWsKV_icdETW5gSllfw8nufh5ol3LMNKnuWsiXvasJzS9KJ6VTHKdSj5MM209py2eNaRaFYpDSP_RjcE9S3BLaXwuJR6BYtkAbwSDPVG/w640-h154/1.png" width="640" /></a></div><p>・コマーシャルベースで考慮するならば,
IL-10, β2-MG, sIL-2Rの組み合わせであるが,
CXCL-13がどれも含まれており, そこが難点.</p><p><br /></p><p><span style="color: #800180;"><b>2018年のSystematic reviewより, 髄液マーカーのカットオフや分布, 感度特異度を評価したものをまとめる.</b> </span>(British Journal of Haematology, 2018, 182, 384–403)</p><p><span style="color: red;"><b>髄液中IL-10</b></span></p><p>・IL-10は悪性リンパ腫細胞や腫瘍内に浸潤しているMφからも産生, 分泌されている.</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Cutoff</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CNS L群の中央, 平均値</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SN</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SP</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Mabray (2016)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">転移性腫瘍, Glioma, 脱髄性病態</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>21.77pg/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">557.5pg/mL(167.5-947.5)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">62.8%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 28px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">95.5%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Nguyen-Them(2016)</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Glioma, Ependymoma, Medulloblastoma, 転移, 神経炎症性疾患</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>4pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">-</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">88.6%</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">88.9%</span></p></td></tr><tr><td style="background-color: white; height: 45px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Song(2016)</span></p></td><td style="background-color: white; height: 45px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">NHL, 中枢神経炎症性疾患, 感染症, 脱髄性疾患, 他の脳腫瘍</span></p></td><td style="background-color: white; height: 45px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>8.2pg/mL</span></p></td><td style="background-color: white; height: 45px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">74.7pg/mL(<5.0-1000)</span></p></td><td style="background-color: white; height: 45px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">95.5%</span></p></td><td style="background-color: white; height: 45px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">96.1%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasagawa(2015)</span></p></td><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Glioblastoma, Astrocytoma, Glioma, Ependymoma, 転移, 他腫瘍, MSなど</span></p></td><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>3pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">28pg/mL(</span><span style="color: black; font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≤</span><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2-4100)</span></p></td><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">94.7%</span></p></td><td style="background-color: #dcdfe2; height: 63px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">100%</span></p></td></tr><tr><td style="background-color: white; height: 28px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Rubenstein(2013)</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患, 原発性脳腫瘍, 転移</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>16.15pg/mL</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">*別記載</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">65.4%</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">92.6%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Rubenstein(2013)<br />HIV陰性群</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患, 原発性脳腫瘍, 転移</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>23pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">*別記載</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">64%</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">94%</span></p></td></tr><tr><td style="background-color: white; height: 28px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasayama(2012)</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">他のCNS腫瘍, CNS炎症</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9.5pg/mL</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">27pg/mL(<2-1610)<br />42pg/mL(5-118)</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">71%</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">100%</span></p></td></tr></tbody></table><div><p>・各病態ごとのIL-10値の分布</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>患者群 疾患</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>IL-10</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群 疾患</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>IL-10</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PCNSL 新規診断(43)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">282.9±113pg/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患(71)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5.6±2.3</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">SCNSL 新規診断(43)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">57±37pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">原発性脳腫瘍(8)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">10.9±5.6</span></p></td></tr><tr><td style="background-color: white; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PCNSL 再発例(17)</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">1663±483pg/mL</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">脳転移性腫瘍(12)</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5.3±1.5</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">SCNSL 再発例(13)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">302±126pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">CNS外の感染症, 腫瘍(46)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">3.6±1.4</span></p></td></tr></tbody></table><p>・CNSLでは大きくIL-10は上昇する. 一方で炎症性の病態でのIL-10の上昇は乏しい.</p><p><br /></p><p><b style="caret-color: rgb(255, 0, 0); color: red;">髄液中IL-6とIL-10/IL-6比</b></p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Cutoff</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CNS L群の中央, 平均値</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SN</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SP</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Song(2016)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">NHL, 中枢神経炎症性疾患, 感染症, 脱髄性疾患, 他の脳腫瘍</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>5.1pg/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5.2pg/mL(<2.0-109)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">54.6%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 45px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">70.1%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 135px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>0.72<br />(IL-10/IL-6比)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">12.6(0-115)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">95.6%</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">100%</span></p></td></tr><tr><td style="background-color: white; height: 62px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasagawa(2015)</span></p></td><td style="background-color: white; height: 62px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Glioblastoma, Astrocytoma, Glioma, Ependymoma, 転移, 他腫瘍, MSなど</span></p></td><td style="background-color: white; height: 62px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>2.2<br />(IL-10/IL-6比)</span></p></td><td style="background-color: white; height: 62px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">10.8pg/mL(1.2-127)</span></p></td><td style="background-color: white; height: 62px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">68.4%</span></p></td><td style="background-color: white; height: 62px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">96.1%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasayama(2012)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">他のCNS腫瘍, CNS炎症</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">4.0pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5.7pg/mL(1.2-264)<br />6.8pg/mL(4.4-13.9)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">77%</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">63%</span></p></td></tr></tbody></table><p>・CSF-IL-6はCNSLと他の病態との鑑別には有用とは言い難い.</p><p> IL-10/IL-6比も試されているが, IL-10のみで十分ともとれる.</p><p><br /></p><p><b style="caret-color: rgb(255, 0, 0); color: red;">髄液中CXCL-13</b></p><p>・CXCL-13はケモカインの1つであり, 樹状細胞より産生される.</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Cutoff</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CNS L群の中央, 平均値</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SN</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 16px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SP</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Mabray (2016)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">転移性腫瘍, Glioma, 脱髄性病態</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>103.0pg/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2960.5pg/mL(1125-4796)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">76.7%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 38px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">90.9%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Rubenstein(2013)</span></p></td><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患, 原発性脳腫瘍, 転移</span></p></td><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>90pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">*別記載</span></p></td><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">69.9%</span></p></td><td style="background-color: #dcdfe2; height: 60px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">92.7%</span></p></td></tr><tr><td style="background-color: white; height: 60px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Rubenstein(2013)<br />HIV陰性群</span></p></td><td style="background-color: white; height: 60px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患, 原発性脳腫瘍, 転移</span></p></td><td style="background-color: white; height: 60px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>116pg/mL</span></p></td><td style="background-color: white; height: 60px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">*別記載</span></p></td><td style="background-color: white; height: 60px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">71%</span></p></td><td style="background-color: white; height: 60px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">95%</span></p></td></tr></tbody></table><p>・各病態における分布</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>患者群 疾患</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CXCL13</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群 疾患</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CXCL13</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PCNSL 新規診断(43)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5926±2030pg/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">神経炎症性疾患(71)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">44.9±19</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">SCNSL 新規診断(43)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">1783±896pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">原発性脳腫瘍(8)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">84.5±60.7</span></p></td></tr><tr><td style="background-color: white; height: 11px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PCNSL 再発例(17)</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">996±312pg/mL</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">脳転移性腫瘍(12)</span></p></td><td style="background-color: white; height: 11px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">58.5±41.6</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 130px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">SCNSL 再発例(13)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 176px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">539±157pg/mL</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 148px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">CNS外の感染症, 腫瘍(46)</span></p></td><td style="background-color: #dcdfe2; height: 12px; padding: 4px; width: 170px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">11±3.6</span></p></td></tr></tbody></table><p>・これもCNSLでは他の病態と比較して桁違いに上昇する</p><p><br /></p><p>他のマーカー</p><p><span style="color: red;"><b>CSF-IL-2Rのまとめ</b></span></p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Cutoff</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CNS L群の中央, 平均値</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SN</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 11px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SP</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasagawa(2015)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Glioblastoma, Astrocytoma, Glioma, Ependymoma, 転移, 他腫瘍, MSなど</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>60.4 U/mL</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">225 U/mL(<54.5-2750)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">94.7%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 64px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">84.6%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasayama(2012)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">他のCNS腫瘍, CNS炎症</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">77 U/mL</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">100 U/mL(<50-978)<br />88 U/mL(<50-3495)</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">81%</span></p></td><td style="background-color: #dcdfe2; height: 29px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">83.3%</span></p></td></tr></tbody></table><p>・報告はさほど多くないが, 感度, 特異度は良好. 対象群として炎症性病態は少ないため, その点注意が必要である</p><p>・Sasayama(2012)におけるCNS炎症性病態は2例のみ</p><p><br /></p><p><span style="color: red;"><b>β2MGのまとめ</b></span></p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 100px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>対象群</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Cutoff</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>CNS L群の中央, 平均値</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SN</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 15px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>SP</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasagawa(2015)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Glioblastoma, Astrocytoma, Glioma, Ependymoma, 転移, 他腫瘍, MSなど</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>2.4mg/L</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">3.9mg/L(1.7-11.8)</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">89.4%</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 62px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">88.5%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Sasayama(2012)</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">他のCNS腫瘍, CNS炎症</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2056µg/L</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">4084µg/L(970-11239)<br />4983(2303-6166)</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">88%</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">90.3%</span></p></td></tr><tr><td style="background-color: white; height: 28px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Muniz(2014)<br />SCNSL症例</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">DLBCL, BLでCNS病変無し</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>2.56ng/mL</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 156px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">62%</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">90%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Kerstein(1996)<br />SCNSL, ALLによる中枢神経病変</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">NHL, ALLでCNS病変なし</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>1.67mg/L</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 156px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">81%</span></p></td><td style="background-color: #dcdfe2; height: 46px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">68%</span></p></td></tr><tr><td style="background-color: white; height: 28px; padding: 4px; width: 100px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Ernerudh(1987)<br />SCNSL</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 135px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">NHL, HDでCNS病変なし</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 89px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">>1.9mg/L</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 156px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">3.9±3.4mg/L</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 75px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">71%</span></p></td><td style="background-color: white; height: 28px; padding: 4px; width: 53px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 11px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">67%</span></p></td></tr></tbody></table><p>・古い論文が比較的多い. またこれも炎症性の病態との対比がすくないため注意.</p><p> Sasayama(2012)におけるCNS炎症性病態は2例のみ</p><p><br /></p><p>---------------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">CNSリンパ腫を疑う際に参考となるCSFマーカーとしては,</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">IL-10, CXCL13は有用であろう. これらは他腫瘍や炎症性の病態, 脱髄性の病態との鑑別でも有用と考えられる. しかしながらCXCL13はコマーシャルベースでは評価不可.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">他にIL-2Rやβ2-MGも利用可能であるが, 炎症性の病態との鑑別は不十分である.</span></span></p></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-68348800383162727172023-07-13T11:40:00.003+09:002023-07-13T11:40:56.232+09:00バルプロ酸による胸水貯留の特徴は?<p>原因不明の片側性, 滲出性胸水貯留の症例. 内服薬剤にバルプロ酸の記載があった.</p><p>たしか, 薬剤性の胸水貯留の原因にバルプロ酸があったはず... </p><p><br /></p><p>そこでバルプロ酸の胸水貯留にはどのような特徴があるのか, 調べてみる.</p><p><br /></p><p>(Clin Toxicol (Phila). 2021 Oct;59(10):869-876.)</p><p><b><span style="color: red;">バルプロ酸による胸水貯留</span></b></p><p><span style="color: red;">1970-2020年に報告されたバルプロ酸による胸水貯留例をReviewした報告</span></p><p>・他に原因が考えられるものを除外し, 28例がバルプロ酸による胸水貯留と判断された.</p><p>・胸水のタイプは主に4つに分類された;</p><p> > 多くが好酸球が優位な滲出性胸水となる(17/28, 60.7%)
. このうち末梢血好酸球増多は10例で認められた</p><p> > 他にはリンパ球が優位な滲出性胸水が2/28で報告.</p><p> > 漏出性胸水が3/28(10.7%)</p><p> > バルプロ酸による薬剤性Lupusに伴う胸水貯留が5/28(17.9%).
このうち好酸球性の胸水が3例. ANAは全例で陽性であり, 抗ヒストン抗体は2例で陽性であった.</p><p><br /></p><p><span style="color: #800180;">好酸球性胸水例: 開始後~2ヶ月程度が多い.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWEqRyFK3f2VVoNo4mbCspPEqaCiJ_zNv5O7_MRk40z96_sAgVIeEFtlKyYhojsG9dgsx91rMlL48yCkokl3d_Y6MvAxt6Pkhn0rwDRYCZ9j9-nh6tH0GfunkJ3DdsBy6pnsSmrJinWoBNULGX7raVPxppeUobWC7Xsk297GCTnre641yv9oWqwRHWzj4R/s612/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="441" data-original-width="612" height="462" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWEqRyFK3f2VVoNo4mbCspPEqaCiJ_zNv5O7_MRk40z96_sAgVIeEFtlKyYhojsG9dgsx91rMlL48yCkokl3d_Y6MvAxt6Pkhn0rwDRYCZ9j9-nh6tH0GfunkJ3DdsBy6pnsSmrJinWoBNULGX7raVPxppeUobWC7Xsk297GCTnre641yv9oWqwRHWzj4R/w640-h462/1.png" width="640" /></a></div><br /><p></p><p><span style="color: #800180;">リンパ球性胸水, 漏出性胸水例: 好酸球性よりも薬剤開始後時間が経過している印象</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuQEq1nZL0bxe1uo6WE8kePogoLau8Wl90fIJT9TJ42wPefgAvISR2T9SJxhj_2VgQ2sem2_x0-uBIhZYw4zJq2QnXHREBuQztUX3duCeizM8m-WV7H-vn-AYO-LEmHUGjTMmYWxspueF8ebG_POoF95QSd4hpu-yFY_s4ox2frdQIg4dRjif_gtyN1pPt/s711/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="179" data-original-width="711" height="162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuQEq1nZL0bxe1uo6WE8kePogoLau8Wl90fIJT9TJ42wPefgAvISR2T9SJxhj_2VgQ2sem2_x0-uBIhZYw4zJq2QnXHREBuQztUX3duCeizM8m-WV7H-vn-AYO-LEmHUGjTMmYWxspueF8ebG_POoF95QSd4hpu-yFY_s4ox2frdQIg4dRjif_gtyN1pPt/w640-h162/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p><span style="color: #800180;">薬剤性Lupus症例: 開始後早期のものもあるが,
数年経過して発症しているものが2/5あり.</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOOLxkSp-sf4mpnsY70uVFfjIugtp9OWDS6rOEHDgMRiC5LdyhWOgEeKqSpOVOAyXe0Vgea-gwVQ3kerQeEuWDP1VqJkMZ9KRXRGm9KaZrg9hJ0jiX09aCfb8EQwwcOkXlGHtfe8UCfdrNcR_F0O4DSRbINaSvqjJbrfq10YA9HzQ_d6QKOFjd_boCiRQB/s710/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="226" data-original-width="710" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOOLxkSp-sf4mpnsY70uVFfjIugtp9OWDS6rOEHDgMRiC5LdyhWOgEeKqSpOVOAyXe0Vgea-gwVQ3kerQeEuWDP1VqJkMZ9KRXRGm9KaZrg9hJ0jiX09aCfb8EQwwcOkXlGHtfe8UCfdrNcR_F0O4DSRbINaSvqjJbrfq10YA9HzQ_d6QKOFjd_boCiRQB/w640-h204/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p><span style="color: #800180;"><br /></span></p><p><span style="color: #cc0000;"><b>薬剤性Lupus以外の症例における評価</b></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #cc0000;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBXpS1ZaYrdcSi4rh7ShhB6Px9whXhZARGT0VjcN7ARaO8Y6By5BYf7n2U8s48um-xdWOMiFzixAW6bgn6wgywOJMqHqf2wlcC5zQut6qqlj-Ps91RgCnq-JVqbb9frFRAaUPBpW9eOByqawGWqfq5U01Gg8m4D6NvAsxEFaY_ch4aGi9Es0kDwWgRSYv6/s640/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="640" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBXpS1ZaYrdcSi4rh7ShhB6Px9whXhZARGT0VjcN7ARaO8Y6By5BYf7n2U8s48um-xdWOMiFzixAW6bgn6wgywOJMqHqf2wlcC5zQut6qqlj-Ps91RgCnq-JVqbb9frFRAaUPBpW9eOByqawGWqfq5U01Gg8m4D6NvAsxEFaY_ch4aGi9Es0kDwWgRSYv6/w640-h360/1.png" width="640" /></a></b></span></div><p></p><p>・両側性は8/23であり, 半数以上が片側性.
また, 心嚢液貯留も伴う例がある.</p><p><span style="color: #800180;"><br /></span></p><p><b><span style="color: #cc0000;">薬剤性Lupus例の評価</span></b></p><div class="separator" style="clear: both; text-align: center;"><b><span style="color: #cc0000;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIyPFAj0brxmTXs80SYU5dWMRo0Ggvl0srUAb6lGRlwHLdI7qn_xraFUz3NBhzKHP4Nmd_0ew24VWp8U-Otelp4aKUKrU7x78waKj_CDztWazdvsjOZuP06b1N9PLNMAuFw6_IkooOlZmQbk3oHGC3ydk17QW51c-MVRMuO6GucYOmjknrLpsXHFYi2QIz/s708/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="153" data-original-width="708" height="138" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIyPFAj0brxmTXs80SYU5dWMRo0Ggvl0srUAb6lGRlwHLdI7qn_xraFUz3NBhzKHP4Nmd_0ew24VWp8U-Otelp4aKUKrU7x78waKj_CDztWazdvsjOZuP06b1N9PLNMAuFw6_IkooOlZmQbk3oHGC3ydk17QW51c-MVRMuO6GucYOmjknrLpsXHFYi2QIz/w640-h138/1.png" width="640" /></a></span></b></div><p></p><p>・これも両側性は2/5. </p><p><span style="color: #800180;"><br /></span></p><p><span style="caret-color: rgb(128, 1, 128);">---------------------------------</span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">バルプロ酸による胸水貯留は稀な病態であるが, ありえる.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">薬剤開始後数カ月以内に生じる場合は主に好酸球優位の滲出性胸水となる.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">時間が経つとリンパ球優位の滲出性胸水や漏出性が生じえる.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);"><br /></span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">また, 数年の経過で薬剤性Lupusを発症し, 胸水貯留を生じるパターンもある.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">薬剤の中止により数カ月で改善する経過となる.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-71864058225080084792023-06-26T22:54:00.003+09:002023-06-26T22:54:43.055+09:00糖尿病性筋梗塞, 壊死性筋症<p>症例: コントロール不良の2型糖尿病患者(HbA1c 11%).</p><p>2週間前に左大腿部の腫瘤を自覚し, その後同部位の疼痛が出現した.</p><p>疼痛は強く, 体動困難となり救急要請.</p><p>来院時, CRP 12mg/dLと上昇あり, 左大腿部の強い浮腫と圧痛を認めた.</p><p>CT検査にて大腿部の筋に限局した強い筋浮腫と造影不良領域が認められ, 壊死を伴う筋炎と考えられた.</p><p><br /></p><p>当初感染症を疑い抗菌薬投与を行うも反応は乏しく,</p><p>試験切開や穿刺でも菌体は確認できなかった.</p><p>Focal myositisや感染性筋炎が疑われ, 筋生検も行ったところ, 感染巣は認められなかったものの, 壊死した筋組織, 強い筋浮腫が認められた.</p><p><br /></p><p>--------------------------------</p><p><br /></p><p><br /></p><p>稀であるが, たまに遭遇する糖尿病の合併症に, Diabetic amyotrophy(糖尿病性筋萎縮症)がある.</p><p>これは, 腰神経叢の虚血, 血管炎に伴う下肢近位筋の脱力や筋萎縮を主体とする病態である.</p><p>参考: <span style="caret-color: rgb(51, 51, 51); color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 18px;"><a href="http://hospitalist-gim.blogspot.com/2016/08/diabetic-amyotrophy.html" target="_blank">糖尿病による近位筋の脱力, 萎縮: Diabetic amyotrophy</a></span></p><p><span style="color: red;">こういった稀なDM合併症の一つに, 糖尿病性筋症, または糖尿病性壊死性筋症(Diabetic myonecrosis), 糖尿病性筋梗塞(Diabetic muscle infarction: DMI)と呼ばれる疾患がある.</span></p><p>筋炎Mimickerとして押さえておきたい.</p><p><br /></p><p><b><span style="color: red;">Diabetic myonecrosis, Diabetic muscle infarction</span></b></p><p>(AJR 2010; 195:198–204)(AACE Clinical Case Rep. 2019;5: e77-e81)</p><p>・DMによる微小血管障害が原因の
筋組織の虚血, 梗塞による筋障害.</p><p>・下肢の近位筋で多く, 大腿四頭筋, ヒラメ筋での報告が多い.
</p><p> 罹患部位の腫脹, 疼痛が主な症状となる.</p><p>・微小血管障害であり, 他の腎症やPAD, CADが合併しているDM例で多い.</p><p>・最初に報告されたのは1965年であり, それから2015年までに200例以下の報告例のみと稀な病態.</p><p><br /></p><p><b><span style="color: red;">2015年に発表されたLiterature reviewでは, 126例をReview.</span></b></p><p>(BMJ Open Diabetes Research and Care 2015;3:e000082.)</p><p>・女性例が54%であり, 平均発症年齢は44.6歳(20-67)
</p><p> 1型DMでは35.9歳[20-65]と若く,
2型DMでは52.2歳[34-67]と中年で多い</p><p>・またDM発症〜DMI発症までの期間は
</p><p> 1型DMで18.9年[5-33], 2型DMで11.0年[1-25]</p><p>・発症時のHbA1cは9.34%[5-21]
</p><p> 117/126で糖尿病性の合併症あり.
</p><p> 46.6%で網膜症, 腎症, 神経症を合併.
</p><p> 65.8%で2つ以上の合併症があり,
75%で腎症が認められた.</p><p>・DMIの機序は不明確であるが動脈硬化やDM性血管障害, 血栓症を伴う血管炎, 虚血による障害が指摘されている.</p><p><br /></p><p><b><span style="color: red;">DMIの診断/特徴</span></b></p><p>・DM患者における急性の筋痛や筋腫脹で疑う.
特に下肢で多い.</p><p>・また, コントロール不良のDM, DM性合併症の存在はさらに可能性を上げる.</p><p>・多くの患者は初診時に発熱は認めず(89%), 外傷歴もない(96.3%)</p><p>・DVTの除外や感染症の除外, 自己免疫性疾患(APS)の除外は重要.</p><p><br /></p><p><span style="color: #800180;">血液検査</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6s9lQa5ghuOiNdoX9n6XhVIpcAepLOJz-zIPbdIsdThYHNvvKGYKfYoTZg6k9UTT3blPyW7bZk1Al3Rx3GRTWihQW61mOxWPeVVpDZIdOYyDvEWweSwbDgzRSSb4IVLVXGZN4q4Ooc57D1ori4vOc9r4HsaB9yV3wS3SRuDCDhT-PNxDY1BzzvPAiwOpv/s697/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="134" data-original-width="697" height="124" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6s9lQa5ghuOiNdoX9n6XhVIpcAepLOJz-zIPbdIsdThYHNvvKGYKfYoTZg6k9UTT3blPyW7bZk1Al3Rx3GRTWihQW61mOxWPeVVpDZIdOYyDvEWweSwbDgzRSSb4IVLVXGZN4q4Ooc57D1ori4vOc9r4HsaB9yV3wS3SRuDCDhT-PNxDY1BzzvPAiwOpv/w640-h124/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・WBC上昇は42.5%で認められる.
</p><p> CRPやESRの亢進は8-9割で認められる</p><p>
CPKは68.4%で正常範囲.</p><p><br /></p><p><span style="color: #800180;">DMIの分布: 主に下腿近位で多い.</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLY08_zbyip_sCFSXo-XxSm39plRHK3yT_UgIQ3f36Vg6yBLm98_wnR_G8hhSguXDeB3syP-_hpuk2mXDK0FM1SFe_bUB41AFcrLv7g6DnWzCxbCkZFcxoQ65SCwibdgicqtV_50gHhCYirFKmOJDJjkPrXNE33CThz0Rd1dytPMcGbtL7zj8PPjZeU-AQ/s517/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="448" data-original-width="517" height="554" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLY08_zbyip_sCFSXo-XxSm39plRHK3yT_UgIQ3f36Vg6yBLm98_wnR_G8hhSguXDeB3syP-_hpuk2mXDK0FM1SFe_bUB41AFcrLv7g6DnWzCxbCkZFcxoQ65SCwibdgicqtV_50gHhCYirFKmOJDJjkPrXNE33CThz0Rd1dytPMcGbtL7zj8PPjZeU-AQ/w640-h554/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p><span style="color: #800180;">DMIの筋病理は非特異的であり, 筋壊死と浮腫を認める</span></p><p>・生検は感染症や腫瘍性病変の評価, 除外を目的として行われる.</p><p><span style="color: #800180;">MRI所見はT2WIでの高信号とT1WIの等〜低信号</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwO4NDRWSxCb9IakaaWhnHEK4eAtwltf14QHzXDUTIW0Xmn6kV49SGARtlR-Riw3m1u8kbRv29gu7BkdJSrLbqZ8Ex3_ZwInwTG6KLyntPSu7oumqlZDB9zx8Rzy1BNwMo68HENo1MXNkedRV2RvJJzgfn1ZU4pgm0bDW912NHw3KSLsmZ6pTULRXFuBtf/s359/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="359" data-original-width="299" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwO4NDRWSxCb9IakaaWhnHEK4eAtwltf14QHzXDUTIW0Xmn6kV49SGARtlR-Riw3m1u8kbRv29gu7BkdJSrLbqZ8Ex3_ZwInwTG6KLyntPSu7oumqlZDB9zx8Rzy1BNwMo68HENo1MXNkedRV2RvJJzgfn1ZU4pgm0bDW912NHw3KSLsmZ6pTULRXFuBtf/s320/1.png" width="267" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・T2WI高信号は76.8%, T1WI等〜低信号は14.6%の頻度</p><p><br /></p><p><span style="color: #800180;">DMIの治療は安静やNSAID, また抗血小板薬などが試される.</span></p><p>・基本的に保存的加療と血糖管理により1-3ヶ月かけて徐々に改善を認める.</p><p>・しかしながら再発例も1/3程度で認められる.</p><p><br /></p><p><b><span style="color: red;">DMIの病状のまとめ表 </span></b>(AACE Clinical Case Rep. 2019;5: e77-e81)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKFHtLhJjgFqoEwwNCVICCWtZ7vVF6N4M__py3rnv7O-FGRezRZ-P0i42kPavfrqV4DYyshGMKPJXxR1YwpidxrWib2tGGA6uaKUCx9gmIcXcz9DsK-dvBDa6R6kqHsw1sqwAQAWz-sy_uqGJU-EsrMde6NH_4SyathIwnYgmnS7anCpxAFHuAmtozUMc4/s604/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="404" data-original-width="604" height="428" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKFHtLhJjgFqoEwwNCVICCWtZ7vVF6N4M__py3rnv7O-FGRezRZ-P0i42kPavfrqV4DYyshGMKPJXxR1YwpidxrWib2tGGA6uaKUCx9gmIcXcz9DsK-dvBDa6R6kqHsw1sqwAQAWz-sy_uqGJU-EsrMde6NH_4SyathIwnYgmnS7anCpxAFHuAmtozUMc4/w640-h428/1.png" width="640" /></a></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRmXJG0VL-Ce6CGGEj8YceSJeofOrdaTaKBS7wA3bVbTt2L6vFdOOALXM0jy90sZkCSBbOk4swq_bp3CyenoSaQzAGVU4oJat0JnrROIHWaY_2QY_XLxRmr2Bb1mYWN77vxzodpbAKekB6afe-qsuyb0HHWXV4xr-Ebrxk8I5I38xCC1vbImkrO-e2hLOj/s610/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="390" data-original-width="610" height="410" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRmXJG0VL-Ce6CGGEj8YceSJeofOrdaTaKBS7wA3bVbTt2L6vFdOOALXM0jy90sZkCSBbOk4swq_bp3CyenoSaQzAGVU4oJat0JnrROIHWaY_2QY_XLxRmr2Bb1mYWN77vxzodpbAKekB6afe-qsuyb0HHWXV4xr-Ebrxk8I5I38xCC1vbImkrO-e2hLOj/w640-h410/1.png" width="640" /></a></div><br /><p><br /></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-72598667047144579002023-06-26T13:57:00.001+09:002023-06-26T13:57:09.701+09:00くりかえす扁桃腺炎に対する扁桃切除の有効性<p> NATTINA trial: (Lancet 2023; 401: 2051–59)</p><p>繰り返す扁桃腺炎ではしばしば扁桃切除術が選択される.</p><p>扁桃腺炎の頻度や, 重症度が緩和される報告は多数あるが, 今回は各群N=200規模のStudyが発表された.</p><p><br /></p><p><b><span style="color: red;">16歳以上の繰り返す扁桃腺炎患者を対象とし,
扁桃切除術群 vs 通常の治療群に割り付け比較したRCT.</span></b></p><p>・日常生活を妨げるような扁桃腺炎症状があり, </p><p>
過去1年以内に7回以上, または過去2年以内に5回/年以上, 過去3年以内に3回/年以上の頻度で繰り返す症例を対象.</p><p>・アウトカムは24ヶ月における咽頭炎の頻度, 症状の強さを比較.</p><p><br /></p><p><b><span style="color: #800180;">母集団</span></b></p><p><b></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis0yMdrYLe4dMSIAKgVRlifc9qBhPfrB9nAiKXnqjr58zKiDHQHfs-DUm9cZr1yposIH_NU0M1_GWgv0z_oJFdp_l9FPaZDs0XIiRiWFo-icBvnMOIMAbaGTz2acycgzuU_lTuRZQO2GDARx0wFdDwjSLKNpz7SEBO4mxOXoTZVcgwNHh8zya7_gkQDH-N/s868/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="582" data-original-width="868" height="430" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis0yMdrYLe4dMSIAKgVRlifc9qBhPfrB9nAiKXnqjr58zKiDHQHfs-DUm9cZr1yposIH_NU0M1_GWgv0z_oJFdp_l9FPaZDs0XIiRiWFo-icBvnMOIMAbaGTz2acycgzuU_lTuRZQO2GDARx0wFdDwjSLKNpz7SEBO4mxOXoTZVcgwNHh8zya7_gkQDH-N/w640-h430/1.jpg" width="640" /></a></b></div><b><br /></b><div><span style="color: red;"><b>アウトカム<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigDf_9NHm017SMm4CcTTmmz7yrOTMfkEJf_oMsOU4WdJquAupAshQvvYFgLsdfqk0_NZArUDUKDTxcmhal2EXR0nNMvqMDRXnqOtjOLBDHNCcFQBLyEyjMHd41f_M9IAh1-CuyCDCHNxZa1YBN4f4qqknbEAAv0jwMKyOPeal1rPjWstcn3IYqPaAOtXuh/s465/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="465" data-original-width="311" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigDf_9NHm017SMm4CcTTmmz7yrOTMfkEJf_oMsOU4WdJquAupAshQvvYFgLsdfqk0_NZArUDUKDTxcmhal2EXR0nNMvqMDRXnqOtjOLBDHNCcFQBLyEyjMHd41f_M9IAh1-CuyCDCHNxZa1YBN4f4qqknbEAAv0jwMKyOPeal1rPjWstcn3IYqPaAOtXuh/w428-h640/1.png" width="428" /></a></div><br /></b></span></div><div>・24ヶ月における咽頭痛の期間は,</div><div>
切除群で23日[11-46]
, 保存群で30日[14-65]と
有意に切除群で短縮される.</div><div>・Baselineの頻度や重症度を考慮すると</div><div>
扁桃栓切除によるIRR 0.53[0.43-0.65]と
ほぼ半減する結果.</div><div><br /></div><div><div>・TOI-14(Tonsil Outcome Inventory-14)も有意に低下</div><div> TOI-14は0-35点は軽症
36-48が中等症
49-70が重症<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0Sh8ZkjSvA8bnQ5dsFdwDnkdzQazqSVafui-6bPsatt-YE2BeahDCkUkfdS8QCp7j93pU7TY54ooNDJifTWZytLR2cVBdw8w5dJswELgmZN-tTV4UE8vybaUEmkpb5yRMh8gksZ7u-dd3krAphdCg1A3L3q5TYaqac1Ls__DhqQnhAs0P3Iq2iJrQSMPY/s437/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="437" data-original-width="311" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0Sh8ZkjSvA8bnQ5dsFdwDnkdzQazqSVafui-6bPsatt-YE2BeahDCkUkfdS8QCp7j93pU7TY54ooNDJifTWZytLR2cVBdw8w5dJswELgmZN-tTV4UE8vybaUEmkpb5yRMh8gksZ7u-dd3krAphdCg1A3L3q5TYaqac1Ls__DhqQnhAs0P3Iq2iJrQSMPY/w456-h640/1.png" width="456" /></a></div><br /></div></div><p></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-72773614647362896412023-06-05T15:31:00.003+09:002023-06-05T15:31:38.265+09:00腹痛発作時にリンパ球が増多する症例<p> 症例: 中年の女性. これまで年に数回, 急性の腹痛で救急受診歴がある患者さん.</p><p> 誘因は様々〜認めず, 急性の腹痛を生じ体動困難となり受診.</p><p> 受診後 補液や検査中に改善し, 帰宅となることが多い.</p><p> これまで複数回, 発作時に腹部造影CTも評価されているが, その際に十二指腸〜空腸の腸管の浮腫が認められ, 腸炎疑い, とされている. </p><p><br /></p><p> 血液検査ではCRP 0.5mg/dL程度の軽度の上昇のみ. という症例の相談を受けた.</p><p><br /></p><p>腹部CTを見直すと確かに軽度の腸管浮腫があるのみで, 他に原因はない.</p><p>血液検査を見ると, 一つの違和感に気づいた.</p><p>それは, 発作で受診した時のリンパ球分画が常に高い(60%)ということ.</p><p>WBCは8000-9000と軽度上昇. 好中球は20-30%と低下し, Eo, Baは正常範囲.</p><p>Lyは60%台と高く, フォローの採血では速やかに低下(入院した際の翌日のLabでも低下)</p><p>他に生化学の検査では異常なし.</p><p><br /></p><p>---------------------------------</p><p><br /></p><p><br /></p><p>このようなLabの動態を示す病態を, 自分は過去数回経験している.</p><p>それは,<b> アナフィラキシー</b>なのだ.</p><p><br /></p><p><br /></p><p><br /></p><p><span style="color: #2b00fe;">そこで色々論文を漁ると, 以下の論文があった.</span></p><p><br /></p><p><b><span style="color: red;">Shock vitalの症例において, 血球分画を解析し, 比較した報告.</span></b></p><p>(American Journal of Emergency Medicine (2005) 23, 763–766)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif7rNTJdvI5FAHbBTumk_X95yquSf5oaTKKIHZsSABsTsqIycdPvX7cupMuQcKq2ehphPGTQG_y58zfQdAkUeTVQnDAf_3IZmzAaXmj8PO8_CuJka7vYfJ_t111JltCJfpWUju64b_g95FPqnACvHBnVvF4JKysYG5yrrt97xVt7DenlHKywUCd_dr9g/s671/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="193" data-original-width="671" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif7rNTJdvI5FAHbBTumk_X95yquSf5oaTKKIHZsSABsTsqIycdPvX7cupMuQcKq2ehphPGTQG_y58zfQdAkUeTVQnDAf_3IZmzAaXmj8PO8_CuJka7vYfJ_t111JltCJfpWUju64b_g95FPqnACvHBnVvF4JKysYG5yrrt97xVt7DenlHKywUCd_dr9g/w640-h184/1.png" width="640" /></a></div><p></p><p>・アナフィラキシーショック 17例
</p><p> 出血性ショック 105例</p><p>
心原性ショック 35例
</p><p> 敗血症性ショック 18例を比較した.</p><p><br /></p><p><span style="color: #800180;">アナフィラキシーショック群と他の原因のLabを比較すると,</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_AdQ5G6327lssn_ToOdy0ZM_h-j1jCt1dbeE9dXEP7AADLyAZ7ey6qDJSs8V0l5anC2ltlEb85VVOS9Gee8UBZpPzJOm40Z0XfW00-KMYp-Ac8ssq7NBu0nuWPqk_Wv3VbQt8VacwiKUWxNW23JHGANKSruPKSW-d5LBiq8t636RnYt0P9ZxOI66dyg/s661/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="220" data-original-width="661" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_AdQ5G6327lssn_ToOdy0ZM_h-j1jCt1dbeE9dXEP7AADLyAZ7ey6qDJSs8V0l5anC2ltlEb85VVOS9Gee8UBZpPzJOm40Z0XfW00-KMYp-Ac8ssq7NBu0nuWPqk_Wv3VbQt8VacwiKUWxNW23JHGANKSruPKSW-d5LBiq8t636RnYt0P9ZxOI66dyg/w640-h214/1.png" width="640" /></a></span></div><p></p><p>・白血球増多が少なく, Neu分画が低く,
さらにLy分画が多い. </p><p> 左方移動が生じにくいショックと言える.</p><p><span style="color: #800180;"><br /></span></p><p><span style="color: #800180;">Ly(%)の分布</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbVJrhfq7ezzAP0ih6EAdb6hXqF7CNsgLgYpODjigqHTS2seYU12RiQ4Z6-JKzvDxeIMNa-rEwKBcxcaITsVKr4B2vp-Tb_qiwAd946b8dJORvYSQAd6A1RplvfUisAfWthNFkUr3_rLosB215nTW1ZxHOOgE2dGOfAoOVyDBjPVpBZHp1hLse96uTsg/s1068/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="604" data-original-width="1068" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbVJrhfq7ezzAP0ih6EAdb6hXqF7CNsgLgYpODjigqHTS2seYU12RiQ4Z6-JKzvDxeIMNa-rEwKBcxcaITsVKr4B2vp-Tb_qiwAd946b8dJORvYSQAd6A1RplvfUisAfWthNFkUr3_rLosB215nTW1ZxHOOgE2dGOfAoOVyDBjPVpBZHp1hLse96uTsg/w400-h226/1.jpg" width="400" /></a></div><p></p><p>・アナフィラキシーでは40%を上回る例が多い.
</p><p> 出血性や心原性では広く分布.
</p><p> 敗血症では左方移動が生じるため, Lyは低い.</p><p><br /></p><p><span style="color: #800180;">なぜLyが上昇するのだろうか?</span></p><p>・これについては, 上記論文ではViral Infection説とカテコラミン説が挙げられているが, その双方ともアナフィラキシー症例のみでの説明はむずかしく, 原因は不明と結論されている.</p><p><br /></p><p><span style="color: #800180;">カテコラミン説</span></p><p>(Brain Behavior and Immunity 1996;10:77-91)</p><p>・カテコラミンを投与すると
~30分で末梢循環中のLyが増加し,
その後好中球の増加が認められ, Lyは低下する現象が観察される.</p><p>・カテコラミンはNK細胞や顆粒球数に影響するが,
B細胞やT細胞数には影響しない.</p><p>・Lyの増加はβ2刺激が, 顆粒球の増加はα刺激が関連し,
Lyは脾臓のプールより導入され,
顆粒球は主に肺のプールより導入される.</p><p>・感情ストレスや運動ストレス下でも同様のLy増多が生じうる.</p><p><br /></p><p><span style="color: #800180;">最近の報告では, 20-30歳の健常者を, 14度の冷水で
クーリングした研究があった.</span></p><p>(INTERNATIONAL JOURNAL OF HYPERTHERMIA 2021, VOL. 38, NO. 1, 696–707)</p><p>・冷水曝露後はカテコラミンや
コルチゾールは上昇する.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-fe08smDL1OQ5fU5CgYrQzS5FH_SBPSBzH07iZ0E6iXUT3tjWkOJjQjpNgPHqLpnBCkFwUGn7ab4T3TegZGL7WfKd4tAzBYpCfzw1GvpSUTMj1fOlYb6LmWnVdW2d1ckk_uEmgeEMJR5y-wLpjOnkmwrVjGBewUSVdDflq-RndBK5TbpjjlRKM70TNQ/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="228" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-fe08smDL1OQ5fU5CgYrQzS5FH_SBPSBzH07iZ0E6iXUT3tjWkOJjQjpNgPHqLpnBCkFwUGn7ab4T3TegZGL7WfKd4tAzBYpCfzw1GvpSUTMj1fOlYb6LmWnVdW2d1ckk_uEmgeEMJR5y-wLpjOnkmwrVjGBewUSVdDflq-RndBK5TbpjjlRKM70TNQ/w270-h640/1.png" width="270" /></a></div><br /><p></p><p>・一方, Lyは増加すると思いきや, むしろ低下している. Neuは徐々に上昇.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP3ko0aFHgihroXV_b05P4vMx6WjcJ0JQ0Nwjo8TYwjdY_ktZfbbLaSUXzeY1NBBPwoQ7S3plTd4Q2_7QyM8pJ4Lszjtsb7YNOjW26Zwab_JEhPlfolxBGz7yVXeDSv1JnecdXy9lqSKj_cNGpwAb0QJJB_xtBeLSRY_gznKEvX4t2oKe7qmba97WWOw/s522/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="367" data-original-width="522" height="450" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP3ko0aFHgihroXV_b05P4vMx6WjcJ0JQ0Nwjo8TYwjdY_ktZfbbLaSUXzeY1NBBPwoQ7S3plTd4Q2_7QyM8pJ4Lszjtsb7YNOjW26Zwab_JEhPlfolxBGz7yVXeDSv1JnecdXy9lqSKj_cNGpwAb0QJJB_xtBeLSRY_gznKEvX4t2oKe7qmba97WWOw/w640-h450/1.png" width="640" /></a></div><div><br /></div>--------------------------------<div><br /></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">冒頭の症例以外にも,</span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">繰り返す急性〜亜急性経過の腹痛, 腸管浮腫 + 発作時にLy分画70%台, 翌日には改善という症例を経験しており, </span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">その症例は結果的にアナフィラキシー発作 → 全身性肥満細胞症であった.</span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);"><br /></span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">アレルギーに関連したサイトカインが一過性のLyの主に脾臓から末梢血への遊走を促進させるのかは定かではない.</span></span></div><div><br /></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">それ以外に脾臓プールの関連(脾腫?)などの要素も関わっているのか? </span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);"><br /></span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">ちょっとアナフィラキシーの症例集めてみる.</span></span></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-24798193612350817792023-05-31T13:48:00.002+09:002023-05-31T13:48:40.987+09:00GCAに対するIL-17A阻害薬(セクキヌマブ)<p>・GCAに対する治療では, TNF阻害薬やアザチオプリン, シクロホスファミドなどのデータは乏しく, または効果が期待できない結果が得られている.</p><p>・一部の報告ではMTXは効果が期待できるが, それも結論が得られていない</p><p>・IL-6阻害薬は効果が証明された薬剤の一つであるが,
CRPを抑制することでモニタリングが困難となる欠点がある.</p><p><br /></p><p>・GCAの血管炎病変では, 外膜の活性化樹状細胞とIFNγを産生するTh-1細胞とIL-17を産生するTh-17細胞の集積が認められる.
</p><p> IL-17Aが多く発現していることから, IL-17Aを阻害することで病勢のコントロールができる可能性が示唆されている.</p><p><br /></p><p><b><span style="color: red;">TitAIN trial: 初発/再発性のGCAでBio未使用, PSL 25-60mg/dを使用中である患者を対象としたphase II DB-RCT.</span></b></p><p>(Lancet Rheumatol 2023; 5: e341–50)</p><p>・<span style="color: #800180;">上記患者群をSecukinumab(IL-17A抗体) 300mgを週1回, 4週間. 以後4週毎
とPlacebo群に割り付け, 28wkにおける寛解維持率を比較した.
</span></p><p> また52wkまでフォローし, PSL累積投与量, PSL減量成功率など比較</p><p>・PSLは両群で26wkにOffとするように減量.</p><p>・12wkまでに寛解が達成できなかった患者群や寛解後に再燃した患者, PSL減量が守れなかった患者群は責任医師の臨床判断にてPSLを使用(Escape群とした)
(Secukinumab, Placeboは継続)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzG2ZomDJsE0c3RRdjsRjnztRLmtVaZPCllpWOoSToyr1VnfhH_xTUUW3qLbMcmvUUM6MdINasoHKYdEBjDJc-6ZCADwSPJulLgQvqvr0PNYy1ywRrqAapV0t7NFColGwsxiQkVZ2ORvt5m96d5g8uiFblMIRkzckH1Mn9cdbC7HUH6it3z0roUwj_Pg/s308/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="240" data-original-width="308" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzG2ZomDJsE0c3RRdjsRjnztRLmtVaZPCllpWOoSToyr1VnfhH_xTUUW3qLbMcmvUUM6MdINasoHKYdEBjDJc-6ZCADwSPJulLgQvqvr0PNYy1ywRrqAapV0t7NFColGwsxiQkVZ2ORvt5m96d5g8uiFblMIRkzckH1Mn9cdbC7HUH6it3z0roUwj_Pg/w400-h312/1.png" width="400" /></a></div><br /><p><br /></p><p><b><span style="color: red;">アウトカム</span></b></p><div class="separator" style="clear: both; text-align: center;"><b><span style="color: red;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE2n0bZKZIqU9p3YrBwBty-_V43rcQA6DO3iIb4zR-7a_CCss0hVIK7t43IdmUCSBoJzpH_MrGqUtGdTfPOX5Ut9LhS2MskqFBqGmwtV-0g9eklY_nlzMwV4rYKhaKj6-ss0fgLz-hE5WKVN30XiOrIAQ4XbMPJYrrLzfU38JAH2JwDFoNvA7rlDXrrg/s347/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="347" data-original-width="273" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE2n0bZKZIqU9p3YrBwBty-_V43rcQA6DO3iIb4zR-7a_CCss0hVIK7t43IdmUCSBoJzpH_MrGqUtGdTfPOX5Ut9LhS2MskqFBqGmwtV-0g9eklY_nlzMwV4rYKhaKj6-ss0fgLz-hE5WKVN30XiOrIAQ4XbMPJYrrLzfU38JAH2JwDFoNvA7rlDXrrg/w315-h400/1.png" width="315" /></a></span></b></div><b><span style="color: red;"><br /></span></b><p></p><p>・28wk時点での寛解率は介入群で70% vs Placebo群で20%
</p><p> RD 0.50[0.29-0.67]と有意に介入群で良好</p><p>・52wkでの寛解率は
59% vs 8%と有意に介入群で良好</p><p>・再燃までの期間は
Placebo群で197日[101-280]
介入群では計算不可</p><p>・PSL投与量は,</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 24px; padding: 4px; width: 112px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 24px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>介入</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 24px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Placebo</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 25px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">~28wk</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 25px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2506mg[990-6156]</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 25px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2359[441-4996]</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">~52wk</span></p></td><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">2506[990-6156]</span></p></td><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">3466[441-6274]</span></p></td></tr><tr><td style="background-color: white; height: 26px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">Escape群</span></p></td><td style="background-color: white; height: 26px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">9例</span></p></td><td style="background-color: white; height: 26px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">19例</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PSL</span><span style="color: black; font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≤</span><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5mg @19wk</span></p></td><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">88%</span></p></td><td style="background-color: #dcdfe2; height: 25px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">50%</span></p></td></tr><tr><td style="background-color: white; height: 25px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PSL</span><span style="color: black; font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≤</span><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5mg @28wk</span></p></td><td style="background-color: white; height: 25px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">83%</span></p></td><td style="background-color: white; height: 25px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">45%</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 26px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">PSL</span><span style="color: black; font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">≤</span><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">5mg @52wk</span></p></td><td style="background-color: #dcdfe2; height: 26px; padding: 4px; width: 132px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">90%</span></p></td><td style="background-color: #dcdfe2; height: 26px; padding: 4px; width: 121px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">76%</span></p></td></tr></tbody></table><br /><div> IL-17A阻害薬投与群でPSLの減量成功例は多く, 1年間の総投与量も減少できる結果</div><div><br /></div><div>----------------------------</div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">まだ選択肢が少ない疾患であり, 選択肢が増えるのは歓迎できる.</span></span></div><div><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">Phase 3にも期待.</span></span></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-84758607505326758002023-05-18T13:40:00.001+09:002023-05-18T13:40:21.048+09:00後天性第XIII因子欠損症<p>高齢者の筋肉内血腫や皮下出血など出血が顕著な症例.</p><p>PTやAPTTは正常で血小板減少や機能には異常はない...</p><p><br /></p><p>PT, APTTが正常な凝固障害として想起するのが後天性VWDと後天性第XIII因子欠損症である</p><p>出血時間が伸びる場合はVWDを疑うものの, 今回は正常であったという程で考える</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggWvWVpHDetfQ44Ull1dexLHF2Bb-Xzdkw8ZMMSBURtSxl-27kvnIcTEzgefxP__Z7KqhOS7K5MgOTnVlog7IeCJsam0n1oaj48l3Vm3jgPy4yWvzW_hlVeC06enjK4AEALZDw2nKNh0c5UFwodHNZ50D4C-hzzWUKx3ZhzHKpvMx2fCkdowU8MvEreg/s868/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="569" data-original-width="868" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggWvWVpHDetfQ44Ull1dexLHF2Bb-Xzdkw8ZMMSBURtSxl-27kvnIcTEzgefxP__Z7KqhOS7K5MgOTnVlog7IeCJsam0n1oaj48l3Vm3jgPy4yWvzW_hlVeC06enjK4AEALZDw2nKNh0c5UFwodHNZ50D4C-hzzWUKx3ZhzHKpvMx2fCkdowU8MvEreg/w400-h263/1.png" width="400" /></a></div><br /><p><br /></p><p>ということでお勉強です</p><p><br /></p><p><span style="font-weight: bold;"><span style="color: red;">後天性XIII因子欠損症</span> </span>(Transfus Apher Sci . 2018 Dec;57(6):724-730.)</p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm 0mm 0mm 10.5pt; text-align: left; text-decoration: none; text-indent: -10.5pt; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・第<span lang="EN-US">XIII</span>因子はα<span lang="EN-US">, </span>γフィブリン鎖を結合することで<span lang="EN-US">, </span>凝血塊を安定化させる作用を示す<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm 0mm 0mm 10.5pt; text-align: left; text-decoration: none; text-indent: -10.5pt; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 欠乏により出血や創傷治癒の遅延の原因となる<span lang="EN-US">. <o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・第<span lang="EN-US">XIII</span>因子欠損症では<span lang="EN-US">APTT, PT, </span>血小板数や機能は正常であり<span lang="EN-US">, </span>原因が不明な出血傾向がある患者において<span lang="EN-US">, </span>後天性<span lang="EN-US">vWD</span>と共に想起することは重要</span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・症状は無症候性〜重度な出血まで様々</span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 出血部位は筋肉内出血や皮下出血が<span lang="EN-US">7</span>割を占める<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 他に頭蓋内出血が<span lang="EN-US">13-18%, </span>腹腔内や後腹膜出血も認められる<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span style="color: #800180;">日本国内より免疫性第<span lang="EN-US">XIII</span>因子欠損症<span lang="EN-US">(</span>後述<span lang="EN-US">) 93</span>例をまとめた報告</span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">(Blood Rev . 2017 Jan;31(1):37-45.)<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・患者の平均年齢は<span lang="EN-US">65.8</span>±<span lang="EN-US">18.1</span>歳<span lang="EN-US">, </span>中央年齢<span lang="EN-US">70</span>歳であり<span lang="EN-US">, </span>高齢者ほど頻度は増加する<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> また男性例が<span lang="EN-US">51</span>例<span lang="EN-US">, </span>女性例が<span lang="EN-US">42</span>例と若干男性例が多かった<span lang="EN-US">. <o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・出血部位は筋肉内出血が<span lang="EN-US">68%, </span>皮下出血が<span lang="EN-US">60%と多い.</span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 頭蓋内出血が<span lang="EN-US">11</span>%<span lang="EN-US">, </span>腹腔内・後腹膜出血が<span lang="EN-US">19%</span>で認められた<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 術後の出血も<span lang="EN-US">16%</span>で報告された<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="color: red; font-family: inherit; font-size: small;">後天性第<span lang="EN-US">XIII</span>因子欠損症の機序は免疫性<span lang="EN-US">, </span>非免疫性に分類される<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・免疫性では第<span lang="EN-US">XIII</span>因子の中和作用を持つインヒビターと<span lang="EN-US">, </span>第<span lang="EN-US">XIII</span>因子のクリアランスを亢進させる非中和型の抗体がある<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・非免疫性では産生の低下<span lang="EN-US">, </span>また消費の亢進が挙げられる<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・それぞれの機序と背景疾患は以下<span lang="EN-US">.<o:p></o:p></span></span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium; font-variant-caps: normal;"><tbody><tr><td colspan="2" style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 212.3pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">機序<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: windowtext windowtext windowtext currentcolor; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">病態の特徴<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: windowtext windowtext windowtext currentcolor; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">関連する背景疾患<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td style="border-color: currentcolor windowtext windowtext; border-image: none; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 106.15pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">免疫性<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.15pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">第<span lang="EN-US">XIII</span>因子の阻害<span lang="EN-US">, </span>代謝の促進<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">第<span lang="EN-US">XIII</span>因子活性の高度低下<span lang="EN-US">(<10%)<br /></span>重度の出血<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">第<span lang="EN-US">XIII</span>因子抗体の存在<span lang="EN-US">*<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">クロスミキシング試験による第<span lang="EN-US">XIII</span>因子活性評価が鑑別に有用<span lang="EN-US">.<o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">SLE, </span>関節リウマチ<span lang="EN-US"><br /></span>悪性腫瘍<span lang="EN-US">(</span>固形腫瘍<span lang="EN-US">, </span>血液腫瘍<span lang="EN-US">)<br /></span>薬剤性<span lang="EN-US">(</span>主にイソニアジド<span lang="EN-US">, </span>他にプロカインアミド<span lang="EN-US">, </span>アミオダロン<span lang="EN-US">, </span>ペニシリン<span lang="EN-US">, </span>シプロフロキサシン<span lang="EN-US">)<br />MGUS<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">47%</span>は背景疾患が不明な特発性<span lang="EN-US">.<o:p></o:p></span></span></p></td></tr><tr><td rowspan="2" style="border-color: currentcolor windowtext windowtext; border-image: none; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 106.15pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">非免疫性<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.15pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">消費の亢進<span lang="EN-US"><o:p></o:p></span></span></p></td><td rowspan="2" style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">第<span lang="EN-US">XIII</span>因子活性の軽度低下<span lang="EN-US">(20-70%)<br /></span>出血は少ない<span lang="EN-US">, </span>または軽度<span lang="EN-US"><br /></span>他の凝固因子の低下も伴うことが多い<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">外科手術<span lang="EN-US">, <br />DIC,<br /></span>炎症性腸疾患<span lang="EN-US"><br />IgA</span>血管炎<span lang="EN-US"><br /></span>敗血症<span lang="EN-US"><br /></span>血栓症<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.15pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">産生の低下<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 106.2pt;" valign="top" width="142"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">肝疾患<span lang="EN-US"><br /></span>白血病<span lang="EN-US"><br /></span>薬剤性<span lang="EN-US">(</span>バルプロ酸<span lang="EN-US">, </span>トシリツマブ<span lang="EN-US">)<o:p></o:p></span></span></p></td></tr></tbody></table><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">*</span>コマーシャルベースには測定困難<span lang="EN-US">. </span>中和抗体では<span lang="EN-US">Bethesda</span>アッセイ<span lang="EN-US">, </span>非中和抗体では<span lang="EN-US">Binding</span>アッセイを用いる<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US"><span style="font-family: inherit; font-size: small;">(Transfus Apher Sci . 2018 Dec;57(6):724-730.)(Haemophilia . 2021 May;27(3):454-462.)(Blood Rev . 2017 Jan;31(1):37-45.)<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US"><o:p><span style="font-family: inherit; font-size: small;"> </span></o:p></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><br /></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・基本的に免疫性第<span lang="EN-US">XIII</span>因子欠損の方が第<span lang="EN-US">XIII</span>因子活性は低下<span lang="EN-US">(<10%, </span>平均<span lang="EN-US">8.5</span>±<span lang="EN-US">8.2%)</span>し<span lang="EN-US">, </span>出血も重度となる<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 非免疫性では活性は<span lang="EN-US">20-70%</span>程度と軽度の低下となり<span lang="EN-US">, </span>出血症状も軽度であることが多い<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 第<span lang="EN-US">XIII</span>因子活性が低いほど<span lang="EN-US">, </span>重度の出血に関連する<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><br /></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・検査は第<span lang="EN-US">XIII</span>因子活性と第<span lang="EN-US">XIII</span>因子抗原の評価を行う<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 免疫性第<span lang="EN-US">XIII</span>因子欠損症の診断基準は以下の通り<span lang="EN-US">.</span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><br /></span></span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium; font-variant-caps: normal;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 84.8pt;" valign="top" width="113"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">可能性あり<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: windowtext windowtext windowtext currentcolor; border-image: none; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0mm 5.4pt; width: 339.9pt;" valign="top" width="453"><p align="left" class="MsoListParagraph" style="margin-left: 18pt; text-align: left; text-indent: -18pt;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">1.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> </span></span>主に高齢者における最近発症した出血症状<span lang="EN-US"><o:p></o:p></span></span></p><p align="left" class="MsoListParagraph" style="margin-left: 18pt; text-align: left; text-indent: -18pt;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">2.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> </span></span>先天性の第<span lang="EN-US">XIII</span>因子欠損や他の凝固因子障害の家族歴を認めない<span lang="EN-US"><o:p></o:p></span></span></p><p align="left" class="MsoListParagraph" style="margin-left: 18pt; text-align: left; text-indent: -18pt;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">3.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> </span></span>過去の外科手術や侵襲的処置<span lang="EN-US">, </span>外傷で出血症状を認めていない<span lang="EN-US"><o:p></o:p></span></span></p><p align="left" class="MsoListParagraph" style="margin-left: 18pt; text-align: left; text-indent: -18pt;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">4.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> </span></span>抗凝固療法や抗血小板薬の過剰使用がなく<span lang="EN-US">, </span>薬剤では出血が説明できない<span lang="EN-US"><o:p></o:p></span></span></p><p align="left" class="MsoListParagraph" style="margin-left: 18pt; text-align: left; text-indent: -18pt;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US">5.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"> </span></span>第<span lang="EN-US">XIII</span>因子活性や抗原が<span lang="EN-US"><50%</span>と低下している<span lang="EN-US">.<o:p></o:p></span></span></p></td></tr><tr><td style="border-color: currentcolor windowtext windowtext; border-image: none; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 84.8pt;" valign="top" width="113"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">準確診<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 339.9pt;" valign="top" width="453"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">上記<span lang="EN-US">1-5</span>を満たし<span lang="EN-US">, </span>さらに第<span lang="EN-US">XIII</span>因子インヒビターが認められる<span lang="EN-US">(</span>クロスミキシング試験の<span lang="EN-US">2</span>時間値で再度活性が低下することで証明<span lang="EN-US">)<o:p></o:p></span></span></p></td></tr><tr><td style="border-color: currentcolor windowtext windowtext; border-image: none; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0mm 5.4pt; width: 84.8pt;" valign="top" width="113"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">確診<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-color: currentcolor windowtext windowtext currentcolor; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0mm 5.4pt; width: 339.9pt;" valign="top" width="453"><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;">上記<span lang="EN-US">1-5</span>を満たし<span lang="EN-US">, </span>さらに抗<span lang="EN-US">XIII</span>因子抗体が証明される<span lang="EN-US"><o:p></o:p></span></span></p></td></tr></tbody></table><p align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US"><span style="font-family: inherit; font-size: small;">(Thromb Haemost . 2016 Sep 27;116(4):772-774.)</span></span></p><div><span lang="EN-US"><span style="font-family: inherit; font-size: small;"><br /></span></span></div><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"> </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・出血症状があり<span lang="EN-US">, </span>第<span lang="EN-US">XIII</span>因子活性<span lang="EN-US">(</span>±抗原<span lang="EN-US">)</span>の低下が認められれば後天性第<span lang="EN-US">XIII</span>因子欠損症を考慮する<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-size: small;">・さらにクロスミキシング試験にてインヒビターが証明されれば免疫性第XIII因子欠損症と診断する.</span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: medium;">・抗第</span><span lang="EN-US" style="font-family: inherit;">XIII</span><span style="font-family: inherit; font-size: medium;">因子抗体が証明できれば確定診断となるものの</span><span lang="EN-US" style="font-family: inherit;">, </span><span style="font-family: inherit; font-size: medium;">コマーシャルベースでは検査はできない</span><span lang="EN-US" style="font-family: inherit;">.</span></p><p align="left" class="MsoNormal" style="text-align: left;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><br /></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span style="color: #800180;">免疫性と非免疫性の鑑別では<span lang="EN-US">, </span>クロスミキシング試験における残存第<span lang="EN-US">XIII</span>因子活性の評価が有用</span><span lang="EN-US">(Haemophilia . 2021 May;27(3):454-462. )<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・免疫性<span lang="EN-US">, </span>非免疫性の後天性第<span lang="EN-US">XIII</span>因子欠損症患者において<span lang="EN-US">, </span>第<span lang="EN-US">XIII</span>因子抗原<span lang="EN-US">, </span>活性を評価<span lang="EN-US">, </span>比較した報告では<span lang="EN-US">, </span>免疫性の方がより抗原<span lang="EN-US">, </span>活性共に低値であるがその値には重なりも多く認められた(A)(B)<span lang="EN-US">. </span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: inherit; font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHwdRzBOLvMGh05DUl0zUeNslxBi0sbYP_P75kudnpZzEq6bQvzeiF8ZTm7HIYK7HkJrNjop055QEFYUsNCLv9GLu-dAW2by9OWBXRCla8l0GJwefMxGz2WgtytUoALLnXgKOgsb1TS8OLcDrg6fhEOXGh8_x489sk5K2xlLlVJUv-XUfKDUyPcM1Rww/s700/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="652" data-original-width="700" height="596" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHwdRzBOLvMGh05DUl0zUeNslxBi0sbYP_P75kudnpZzEq6bQvzeiF8ZTm7HIYK7HkJrNjop055QEFYUsNCLv9GLu-dAW2by9OWBXRCla8l0GJwefMxGz2WgtytUoALLnXgKOgsb1TS8OLcDrg6fhEOXGh8_x489sk5K2xlLlVJUv-XUfKDUyPcM1Rww/w640-h596/1.png" width="640" /></a></span></div><span style="font-family: inherit; font-size: small;"><br /></span><p></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・クロスミキシング試験後に再度第<span lang="EN-US">XIII</span>因子活性を評価した「残存第<span lang="EN-US">XIII</span>因子活性」では免疫性群で活性低下が持続する一方<span lang="EN-US">, </span>非免疫性群では活性は軽度改善を認め<span lang="EN-US">, </span>その差は明確となった(D)<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"><br /></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: medium;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="color: red;"><span style="font-family: inherit; font-size: medium;">後天性第</span><span lang="EN-US" style="font-family: inherit;">XIII</span><span style="font-family: inherit; font-size: medium;">因子欠損症の治療</span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・出血を安定させるために<span lang="EN-US">, </span>第<span lang="EN-US">XIII</span>因子製剤を投与する<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 乾燥濃縮人血液凝固第<span lang="EN-US">XIII</span>因子<span lang="EN-US">(</span>ブロガミン<span lang="EN-US">P®)</span>が使用可能である<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> すぐに手配ができない場合は新鮮凍結血漿を用いる<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・非免疫性では第<span lang="EN-US">XIII</span>因子活性を<span lang="EN-US">>10%</span>に維持するように投与を行う<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> また侵襲検査や外科手術時には<span lang="EN-US">>50%</span>を目標に投与を行う<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 治療可能な背景疾患への対応も重要である<span lang="EN-US">.</span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><span lang="EN-US"> </span>トラネキサム酸を併用することで<span lang="EN-US">, </span>出血リスクを低下させる報告もある<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・免疫性第<span lang="EN-US">XIII</span>因子欠損症ではさらに免疫抑制療法が推奨される<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> ステロイドやカルシニューリン阻害薬<span lang="EN-US">, </span>シクロホスファミドが用いられる<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> 適応外使用となるがリツキシマブも効果的である<span lang="EN-US">. </span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"> また免疫グロブリン静注療法も効果が期待できる<span lang="EN-US">. </span>背景疾患への治療も重要である<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;"><br /></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-family: inherit; font-size: small;">・免疫性第<span lang="EN-US">XIII</span>因子欠損症の長期予後は不明確ではあるが<span lang="EN-US">, 50-68%</span>の患者で免疫抑制療法が終了できたとの報告もあり<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-US"><o:p><span style="font-family: inherit; font-size: small;"><br /></span></o:p></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-US"><o:p><span style="font-family: inherit; font-size: small;">---------------------------</span></o:p></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-US"><o:p><span style="font-family: inherit; font-size: small;"><span style="color: #2b00fe;">自己免疫疾患や血液疾患に合併し, さらにPTやAPTTでは異常がでないが出血傾向となる病態</span></span></o:p></span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="color: #2b00fe; font-size: small;">把握しておくと良いと思う.</span></p><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><br /><p align="left" class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; margin: 0mm; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><style class="WebKit-mso-list-quirks-style">
<!--
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{mso-style-unhide:no;
mso-style-qformat:yes;
mso-style-parent:"";
margin:0mm;
text-align:justify;
text-justify:inter-ideograph;
mso-pagination:none;
font-size:10.5pt;
mso-bidi-font-size:11.0pt;
font-family:"游明朝",serif;
mso-ascii-font-family:游明朝;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:游明朝;
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:游明朝;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-font-kerning:1.0pt;}
span.MsoCommentReference
{mso-style-noshow:yes;
mso-style-priority:99;
mso-ansi-font-size:9.0pt;
mso-bidi-font-size:9.0pt;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
mso-style-unhide:no;
mso-style-qformat:yes;
margin-top:0mm;
margin-right:0mm;
margin-bottom:0mm;
margin-left:42.0pt;
mso-para-margin-top:0mm;
mso-para-margin-right:0mm;
mso-para-margin-bottom:0mm;
mso-para-margin-left:4.0gd;
text-align:justify;
text-justify:inter-ideograph;
mso-pagination:none;
font-size:10.5pt;
mso-bidi-font-size:11.0pt;
font-family:"游明朝",serif;
mso-ascii-font-family:游明朝;
mso-ascii-theme-font:minor-latin;
mso-fareast-font-family:游明朝;
mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:游明朝;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-font-kerning:1.0pt;}
.MsoChpDefault
{mso-style-type:export-only;
mso-default-props:yes;
mso-bidi-font-size:11.0pt;
font-family:"游明朝",serif;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;
mso-ligatures:none;}
/* Page Definitions */
@page
{mso-page-border-surround-header:no;
mso-page-border-surround-footer:no;}
@page WordSection1
{size:595.3pt 841.9pt;
margin:99.25pt 30.0mm 30.0mm 30.0mm;
mso-header-margin:42.55pt;
mso-footer-margin:49.6pt;
mso-paper-source:0;
layout-grid:18.0pt;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:687947530;
mso-list-type:hybrid;
mso-list-template-ids:1302364216 1558987630 67698711 67698705 67698703 67698711 67698705 67698703 67698711 67698705;}
@list l0:level1
{mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:18.0pt;
text-indent:-18.0pt;}
@list l0:level2
{mso-level-number-format:aiueo-full-width;
mso-level-text:"\(%2\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:44.0pt;
text-indent:-22.0pt;}
@list l0:level3
{mso-level-number-format:decimal-enclosed-circle;
mso-level-text:%3;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:66.0pt;
text-indent:-22.0pt;}
@list l0:level4
{mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:88.0pt;
text-indent:-22.0pt;}
@list l0:level5
{mso-level-number-format:aiueo-full-width;
mso-level-text:"\(%5\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:110.0pt;
text-indent:-22.0pt;}
@list l0:level6
{mso-level-number-format:decimal-enclosed-circle;
mso-level-text:%6;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:132.0pt;
text-indent:-22.0pt;}
@list l0:level7
{mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:154.0pt;
text-indent:-22.0pt;}
@list l0:level8
{mso-level-number-format:aiueo-full-width;
mso-level-text:"\(%8\)";
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:176.0pt;
text-indent:-22.0pt;}
@list l0:level9
{mso-level-number-format:decimal-enclosed-circle;
mso-level-text:%9;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:198.0pt;
text-indent:-22.0pt;}
-->
</style>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-86125031922541314692023-05-17T22:13:00.001+09:002023-05-17T22:13:18.219+09:00感染性心内膜炎 Duke基準の2023年改訂: 2023 Duke-ISCVID基準<p>感染性心内膜炎の診断基準であるDuke基準は1994年にオリジナルが発表され,</p><p>2000年に現在よく使用される修正Duke基準となった.</p><p><br /></p><p>さらにそれから画像検査技術の発達; 心臓CTやMRI, PET/CTなど,</p><p> 培養検査の発達; PCRなどがあり, 修正Duke基準に追加する形で各ガイドラインが画像基準などを組み込んでいるのが現状.</p><p><br /></p><p>修正Duke基準から23年. あらたなDuke基準. 来る.</p><p><br /></p><p><b><span style="color: red; font-size: medium;">2023 Duke-ISCVID基準</span></b> (Clin Infect Dis. 2023 May 4;ciad271. doi: 10.1093/cid/ciad271.)</p><p>修正Duke基準からの変更点は太字としました.</p><p><b><span style="color: red;">Major criteria</span></b></p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 12px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Major criteria</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 12px; padding: 4px; width: 520px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>内容</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 102px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">A) 微生物学的基準</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 102px; padding: 4px; width: 520px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(1)血液培養陽性<br /><b>・心内膜炎の原因となる細菌*が別々で採取された2セット以上で陽性となる.<br />・時折, たまに心内膜炎の原因となる細菌が別々に採取された3セット以上で陽性となる.<br /></b>(2)血清学的検査陽性<br /><b>・Coxiella burnetii, Bartonella spp, Tropheryma whippleiのPCRや核酸検査が陽性<br /></b>・Coxiella burnetiiのphase I IgG >1:800, または1回でも血液培養で分離される<br /><b>・Bartonella henselaeまたはBartonella quintanaのIgM, IgGが検出され, IgG </b></span><span style="color: black; font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>≥</b></span><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>1:800を満たす</b></span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 85px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">B) 画像基準</span></p></td><td style="background-color: #dcdfe2; height: 85px; padding: 4px; width: 520px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(1) 心エコー, <b>心臓CT</b>検査所見<br />・疣贅の証明, 弁/弁尖の穿孔, 弁/弁尖の瘤形成, 膿瘍, 仮性瘤, 心内瘻孔</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・心エコーにおいて, 新規の著明な弁逆流を認める. 以前認めた逆流所見の増悪や変化のみでは不十分とする<br />・以前の画像と比較して, 新たに人工弁の部分剥離が認められる.</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>(2) PET/CT所見<br />・自然弁, 人工弁, 上行大動脈グラフト(弁を含む), 心内デバイス(リードや人工物)の異常な代謝信号を認める</b></span></p></td></tr><tr><td style="background-color: white; height: 25px; padding: 4px; width: 112px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>C) 外科基準</b></span></p></td><td style="background-color: white; height: 25px; padding: 4px; width: 520px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>心臓手術において, 直接観察された心内膜炎所見を認める.<br />画像基準やその後の組織所見, 微生物学的基準を満たす必要がない.</b></span></p></td></tr></tbody></table>* 心内膜炎の起因菌として典型的な細菌: S. lugdunensis, E. Faecalis, 肺炎球菌と溶連菌を除く連鎖球菌, Granulicatella spp, Abiotrophia spp, Gemella spp.
<div>人工弁や心内デバイス留置患者では典型的と判断する菌: CNS, Corynebacterium striatum, C. Jeikeium, Serratia marcescens, Pseudomonas aeruginosa, Cutibacterium acnes, NTM, Candida spp.</div><div><br /></div><div><b><span style="color: red;">Minor criteria</span></b></div><div><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 19px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>Minor criteria</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 19px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>内容</b></span></p></td></tr><tr><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 115px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">A 背景因子</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 115px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・<b>心内膜炎の既往</b></span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・人工弁</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・心臓弁手術の既往</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・先天性心疾患</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・中等度以上の弁逆流症や弁狭窄症</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・<b>心血管植え込み型電子デバイス</b></span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・閉塞性肥大型心筋症</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・静注薬物濫用</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 10px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">B 発熱</span></p></td><td style="background-color: #dcdfe2; height: 10px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">38度以上の発熱</span></p></td></tr><tr><td style="background-color: white; height: 25px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">C 塞栓所見/徴候</span></p></td><td style="background-color: white; height: 25px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">臨床的, 画像的に認められる動脈塞栓, 肺の敗血症性塞栓, <b>脳膿瘍や脾膿瘍,</b> 細菌性動脈瘤, 頭蓋内出血, 眼瞼結膜出血, Janeway lesion, 化膿性紫斑</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 10px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">D 免疫学的徴候</span></p></td><td style="background-color: #dcdfe2; height: 10px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">リウマチ因子陽性, Osler結節, Roth斑, 免疫複合体性糸球体腎炎</span></p></td></tr><tr><td style="background-color: white; height: 116px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">E 微生物学的証拠<br />(Major criteriaには及ばない)</span></p></td><td style="background-color: white; height: 116px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">・心内膜炎の起因菌となる細菌が血液培養より検出されたが, Major criteriaは満たさない</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>・心臓組織, 心内デバイス, 塞栓以外の無菌部位より採取された培養より心内膜炎の起因菌となる細菌が検出される. または弁やワイヤーより, 皮膚常在菌のPCRが1回のみ検出され, 他に心内膜炎を示唆する証拠が認められない場合.</b></span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 50px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>F 画像基準</b></span></p></td><td style="background-color: #dcdfe2; height: 50px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>人工弁, 上行大動脈グラフト(弁を含む), 心内デバイス留置後3ヶ月以内で, PET/CTにより異常な代謝信号が認められた.</b></span></p></td></tr><tr><td style="background-color: white; height: 52px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">G 身体所見基準</span></p></td><td style="background-color: white; height: 52px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">心エコーが困難な状況で, 聴診により新規に弁逆流が認められた場合<br />以前に認められた心雑音の増悪や変化のみでは不十分である</span></p></td></tr></tbody></table><br /></div><div><b><span style="color: red;">判定</span></b></div><div><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black; font-variant-caps: normal;"><tbody><tr><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 25px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: white; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;"><b>判断</b></span></p></td><td style="background-color: #0b4eb3; border-color: transparent transparent rgb(0, 0, 0); border-style: solid; border-width: 0px 0px 1px; height: 25px; padding: 4px; width: 483px;" valign="middle"><p style="font-family: Helvetica; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 12px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td rowspan="2" style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 133px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="font-family: Hiragino Kaku Gothic ProN; font-size: xx-small;">Definite</span></p></td><td style="background-color: white; border-color: rgb(0, 0, 0) transparent transparent; border-style: solid; border-width: 1px 0px 0px; height: 70px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">A) 病理学的基準<br />(1) 臨床的に心内膜炎を疑う状況で, 疣贅や心臓組織, 人工弁や心内デバイス, 上行大動脈グラフト, 動脈塞栓より微生物が検出される.<br />(2) 心臓組織, 人工弁や上行大動脈グラフト, 心内デバイス, 塞栓より検出された疣贅より, 活動性の心内膜炎を示唆する所見が認められる</span></p></td></tr><tr><td style="background-color: #dcdfe2; height: 55px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">B) 臨床基準<br />(1) 2つ以上のMajor criteriaを満たす<br />(2) 1 Major + 3 Minor criteria</span></p><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">(3) 5 Minor criteriaを満たす</span></p></td></tr><tr><td style="background-color: white; height: 25px; padding: 4px; width: 149px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="font-family: Hiragino Kaku Gothic ProN; font-size: xx-small;">Possible</span></p></td><td style="background-color: white; height: 25px; padding: 4px; width: 483px;" valign="middle"><p align="center" style="margin: 0px; text-align: center;"><span style="color: black; font-family: Hiragino Kaku Gothic ProN; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size-adjust: none; font-size: 10px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-ligatures: common-ligatures; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">A) 1 Major + 1 Minor criteria<br />B) 3 Minor criteria</span></p></td></tr></tbody></table></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-46155842796256755202023-05-17T12:12:00.003+09:002023-05-17T15:11:05.244+09:00CMV-DNA PCRやアンチゲネミアのカットオフ<p>免疫不全患者における発熱や肺炎, 消化管障害などではCMVの再活性化の可能性がある.</p><p>よく評価されるのはCMVアンチゲネミアや, CMV-PCR検査であるが, </p><p>CMVに起因する臓器障害が微妙な場合, どの程度上昇していれば有意と考えるべきなのだろうか? </p><p><br /></p><p>これも参考: <span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="caret-color: rgb(51, 51, 51); color: #333333;"><a href="http://hospitalist-gim.blogspot.com/2021/04/cmv.html" target="_blank">自己免疫疾患におけるCMV再活性化のリスク</a></span></p><p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="caret-color: rgb(51, 51, 51); color: #333333; font-size: 18px;"><br /></span></p><p><span style="color: red; font-family: inherit;"><span style="caret-color: rgb(51, 51, 51);"><b>CMV-PCR定量と治療閾値</b></span></span></p><p><span style="color: #333333; font-family: inherit;"><span style="caret-color: rgb(51, 51, 51);">・幹細胞移植患者や臓器移植患者では, CMV-DNA PCRをフォローし, 陽性となった場合に早期に治療を行うPreemptive therapyは推奨されている. </span></span></p><p><span style="color: #333333;"><span style="caret-color: rgb(51, 51, 51);"> しかしながら, そのカットオフ値は明確ではなく, フォローにて上昇傾向がある場合などの治療を検討することとなる.</span></span></p><p><span style="color: #333333;"><span style="caret-color: rgb(51, 51, 51);">・故に, 例えば免疫抑制療法を行っている患者群において, CMV-PCRが陽性である, またアンチゲネミアが陽性となった場合, </span></span></p><p><span style="color: #333333;"><span style="caret-color: rgb(51, 51, 51);"> それを元に治療を行うべきかどうか, </span></span></p><p><span style="color: #333333;"><span style="caret-color: rgb(51, 51, 51);"> またどの値をCutoffとして治療に踏み切るかは不明確である.</span></span></p><p><span style="color: #333333;"><span style="caret-color: rgb(51, 51, 51);"><br /></span></span></p><p><b><span style="color: red;">移植前にCMV seropositiveが確認された臓器移植患者(心臓, 肝臓, 腎臓)を対象としたProspective cohort study.</span></b></p><p>(Journal of Clinical Virology 56 (2013) 13–18)</p><p>・移植前にSeropositiveが確認 = CMV lower risk群という判断となる.</p><p>・2008-2009年に導入された患者群をDerivation cohortとし,
CMV Preemptive therapyの最適なViral load cutoffを評価.</p><p>・さらに2010-2011年に導入された患者群において, Validationを行った.</p><p>・血液検査は移植後100日までは2週に1回, 100-180日は4週に1回施行</p><p>
移植後1年間フォローされ, CMVによる臓器障害をフォローされた.</p><p>・Derivation cohortでは141例, Validation cohortでは252例を評価.</p><p><span style="color: #800180;">CMVの治療は以下の要領で行われた;</span></p><p>・Derivation: 2回以上連続してCMV-DNR 1000-3000 copies/mLを認める場合, またはCMVに起因する臓器障害を認めた場合に開始.
</p><p> 治療は21日以上, または2回連続してPCRが陰性化すれば終了.</p><p>・Validation: Derivationで規定されたCutoffが2回以上連続して上回る場合, またはCMVに起因する臓器障害を認めた場合に開始.</p><p><br /></p><p><span style="color: #800180;"><b>アウトカム</b></span></p><p>・Validationでは,</p><p> 56.7%でPCRが陽性となり, このうち34.5%がValganciclovirを使用
</p><p> 10.7%(9例)がCMV diseaseと判断(胃炎, 腸炎が主)
. CMVに起因した死亡例は無し.</p><p> CMV disease例のViral loadは, 6620 copies/mL [2755-115500]であった.</p><p>>> <span style="color: #800180;">Preemptive therapyのカットオフは2600copies/mLで
</span></p><p><span style="color: #800180;"> 感度89.9%[85.6-93.0], 特異度88.9%[56.5-98.0]</span></p><p><span style="color: #800180;"> NPV 99.6%と, この値を下回れば, Preemptive therapy無しでもCMV diseaseを発症しない良い指標となると結論づけられた.</span></p><p><br /></p><p>・Validation cohortにおいて, ≥2600copies/mLをCutoffとした結果,</p><p> 252例中107例でCMV-PCR陽性.
</p><p> このうち50.4%でValganciclovirを投与され,
7.6%(9例)でCMV diseaseと診断.</p><p> CMV disease例のViral loadは, 3620 copies/mL [1950-24700]</p><p>>> <span style="color: #800180;">このCutoffにおける感度 91.8%[87.9-94.4], 特異度75.0%[40.9-92.9]
</span></p><p><span style="color: #800180;"> NPV 99.2%[97.2-99.8]とNPVは良好.</span></p><p><br /></p><p>他の報告では,</p><p><span style="color: red;"><b>骨髄移植を行った708例において, CMV網膜炎のリスク因子を評価した報告</b></span></p><p>(Ophthalmology 2012;119:1892–1898)</p><p>・708例中363例でCMV viremiaが認められた.
</p><p> 網膜炎を評価された270例中, 15例でCMV網膜炎を診断.</p><p>・網膜炎に関連する因子は
Peak CMV DNA blood levelのみ(HR 25.0[3.0-210.8])</p><p> <span style="color: #800180;">CMV DNA >7.64 x 104copies/mL (76400)は,
感度93.3%, 特異度68.6%でCMV網膜炎合併</span>を示唆.</p><p> また, 長期間のviremiaもリスク因子となる.</p><p><br /></p><p>-----------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">といった報告があり, PCRで評価する場合は2000-3000 copies/mL程度を指標として覚えておくとよいかもしれない.(数100 copies/mLで驚く必要はない)</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);"><br /></span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">アンチゲネミアとPCRの相関性はどのようなものだろうか?</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);"><br /></span></span></p><p><span style="color: red;"><b>CMV antigenemiaとPCRの相関性</b></span></p><p><br /></p><p><span style="color: red;"><b>腎移植, 肝移植後の患者群において,
CMVのantigenemia(pp65)と血清PCR定量検査を評価</b></span></p><p>(Mikrobiyol Bul . 2016 Jan;50(1):44-52.)</p><p>・両者を48時間以内の時間差で評価した症例を抽出し, 後ろ向きに解析</p><p>・AntigenemiaとDNA双方陰性は47%, 双方陽性が17%
</p><p> Antigenemia陰性, PCR陽性は78サンプルで認められたが,
</p><p> その逆, Antigenemia陽性, PCR陰性は認められなかった.</p><p>・Antigenemiaは23[1-230]/200000WBC
</p><p> PCRは12595[180-106311]copies/mL
両者の相関性は認められた(r=0.785)</p><p>・<span style="color: #800180;">Antigenemia ≥1/200000WBCは, PCR ≥205copies/mLを示唆</span>(Sn 92%, Sp 90%)</p><p><br /></p><p><span style="color: red;"><b>肝移植後患者33例において, 定量PCR, pp65 Agを評価</b></span></p><p>(Journal of Clinical Virology 33 (2005) 138–144)</p><p>・<span style="color: #800180;">pp65 Ag ≥ 10/200000WBCは,
CMV-PCR ≥1330 copies/mLに対する感度58.3%, 特異度98%</span></p><p><span style="color: #800180;"> ≥20/200000WBCは, 上記に対する感度87%, 特異度98%. </span></p><p>・つまり,<span style="color: #800180;"> pp65 Ag ≥10ならばCMV-PCR ≥1330copies/mLとなることを
強く示唆するものの,</span></p><p><span style="color: #800180;"> <10でも否定は難しい(LR- 0.42).</span></p><p><br /></p><p><span style="color: red;"><b>骨髄移植, 臓器移植後の免疫不全患者における
CMV-PCRとAntigenemiaを比較した報告.</b></span></p><p>(J. Med. Virol. 64:275 - 282, 2001.)</p><p>・検査はGanciclovirやFoscarnetによる治療がされていない164検体を用いて行われた.</p><p>・このうち47検体はPCR <400 copies/mL 且つAg陰性</p><p>
4検体はAg弱陽性(1-10/200000WBC), PCR <400</p><p>
51検体はPCR ≥400, Ag陰性</p><p>
62検体はPCR ≥400, Ag陽性</p><p>・PCR<400ではAgはほぼ陰性と言える
</p><p> Agが陽性では,
PCR ≥400の可能性は高い
(1-10では24/28)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMqrcBtZHZZSArtXpX6tE9WthzdZQAoIhI2pLvul1bClTgHVgMn4AG5TVRP53VUT5ZIB2BWIi28RSHFTM0PpLUV1LZzwAfjFbfdw2RKxrKsSQRtLrCbDeqqpD2LJNmutt248tJwW2COyWABfRvb-sZeFhzFF5XrJqtuSX1ZNj50g8MgekEBGqXab1OSQ/s384/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="232" data-original-width="384" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMqrcBtZHZZSArtXpX6tE9WthzdZQAoIhI2pLvul1bClTgHVgMn4AG5TVRP53VUT5ZIB2BWIi28RSHFTM0PpLUV1LZzwAfjFbfdw2RKxrKsSQRtLrCbDeqqpD2LJNmutt248tJwW2COyWABfRvb-sZeFhzFF5XrJqtuSX1ZNj50g8MgekEBGqXab1OSQ/s320/1.png" width="320" /></a></div><p></p><p>・背景疾患とAgの値別のPCR定量結果</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlxeq3vYjSSM0nw4SItn29_eyhmMJ-N8CJQqMcLRmZBcMG5Bw5cmlaIsgBGnES9ZuflESemq3N2I0NKQvQenopp5z8XsCUPm27S-jd9hEr5_ohxsUTa3qtWKST0EXNWTFTS4jz5ujw3T8779sfocwnJF4vb5_EC8gzRzmg554ktG2jGmF0CEQnQZA7JQ/s641/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="222" data-original-width="641" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlxeq3vYjSSM0nw4SItn29_eyhmMJ-N8CJQqMcLRmZBcMG5Bw5cmlaIsgBGnES9ZuflESemq3N2I0NKQvQenopp5z8XsCUPm27S-jd9hEr5_ohxsUTa3qtWKST0EXNWTFTS4jz5ujw3T8779sfocwnJF4vb5_EC8gzRzmg554ktG2jGmF0CEQnQZA7JQ/w640-h222/1.png" width="640" /></a></div><p></p><p> Agが高値ほどCMV-DNA量も多い傾向があるが,
相関性はそこまで強くない.</p><p> Agが陰性でもDNAは検出されることが多い.</p><p> AgとPCRはかなりばらつきが大きい.</p><p>・<span style="color: #800180;">前述のPreemptive therapyのカットオフを2600 copies/mLとした場合,</span></p><p><span style="color: #800180;"> Agが>10/200000WBCに値すると考えておく良いかもしれない.</span></p><p><span style="color: #800180;"> ただし1-10やAg陰性例でもPCR >2600/mLとなる例があるため, Ag単独を指標とするのは無理がある. 経過での増悪傾向の評価も重要である.</span></p><p><span style="color: #800180;"><br /></span></p><p><span style="caret-color: rgb(128, 1, 128);"><span style="color: #2b00fe;">--------------------------------</span></span></p><p><span style="caret-color: rgb(128, 1, 128);"><span style="color: #2b00fe;">免疫不全患者におけるCMVの治療閾値としては, PCRは2000-3000 copies/mL程度を一つの指標として押さえておくと良いかもしれない.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(128, 1, 128);">アンチゲネミアはばらつきが大きい. 陰性でも否定はできないが, >10/200000WBC, 特に>20となるのは要注意と言えるかもしれない.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-88374601924532576332023-04-13T14:30:00.002+09:002023-04-13T14:57:04.164+09:00薬剤性パーキンソニズムの症状/所見<p>朝のカンファレンスで薬剤性のParkinsonismでは, Parkinson病(PD)と比較して, 振戦が少ないとの話があった.</p><p>確かにそんな話はある. でも実際どの程度少ないのだろうか? と疑問に思った.</p><p>ちなみにJAMAの論文から, PDにおける症状の頻度は以下の通りである;</p><p>(JAMA. 2014;311(16):1670-1683.)</p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black;"><tbody><tr><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px 2px; height: 16px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">運動症状</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Timing</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 2px 1px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">頻度</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">(%)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 16px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">安静時振戦</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断時</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">晩期</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~70%(</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断時</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 17px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Bradykinesia</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 17px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断時</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 17px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">全例</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px 2px; height: 16px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">固縮</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断時</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">晩期</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 2px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~90%</span></p></td></tr></tbody></table><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black;"><tbody><tr><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px 2px; height: 14px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">早期の非運動症状</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Timing</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">頻度</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">(%)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 16px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">嗅覚障害</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断前よりあることも</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">25-97%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 15px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">倦怠感</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断前よりあることも</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~60%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 15px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">抑うつ</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断前よりあることも</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~25%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 16px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">REM</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">睡眠障害</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断前</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 15</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年以上前〜</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 16px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~30%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px 2px; height: 14px; padding: 4px; width: 183px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">便秘</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断前よりあることも</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 2px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~30%</span></p></td></tr></tbody></table><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black;"><tbody><tr><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px 2px; height: 13px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">晩期の非運動症状</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 1px 1px; height: 13px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Timing</span></p></td><td style="background-color: rgba(0, 0, 0, 0.25); border-color: rgb(0, 0, 0); border-style: solid; border-width: 2px 2px 1px 1px; height: 13px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">頻度</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">(%)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">治療抵抗性の体軸症状</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">症状出現〜</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">5-10</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> </span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Freezing/</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">姿勢不安定</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">/</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">転倒</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~90% (15</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年以内</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 嚥下障害</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~50% (15</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年以内</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 15px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">精神症状</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">症状出現〜</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">5-10</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 15px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 不安</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~55%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">自律神経症状</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">症状出現〜</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">5-10</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 起立時のふらつき</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~15%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 唾液分泌過多</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~30%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 排尿障害</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">頻尿</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~35%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 夜間尿</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~35%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 性行為不全</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~20%</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 14px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">認知機能障害</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 14px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">経過と伴に増加</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 14px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 1px 2px; height: 15px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 軽度認知症</span></p></td><td style="border: 1px solid rgb(0, 0, 0); height: 15px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 1px 1px; height: 15px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">~35%(</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">診断時</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">), 50%(5</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">)</span></p></td></tr><tr><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px 2px; height: 13px; padding: 4px; width: 211px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 認知症</span></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 1px 2px; height: 13px; padding: 4px; width: 184px;" valign="top"><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p></td><td style="border-color: rgb(0, 0, 0); border-style: solid; border-width: 1px 2px 2px 1px; height: 13px; padding: 4px; width: 184px;" valign="top"><p style="margin: 0px;"><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">>80%(20</span><span style="color: #582401; font-family: Hiragino Sans; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">年以内</span><span style="color: #582401; font-family: Arial; font-size: 16px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">)</span></p></td></tr></tbody></table><br /><div><p>これによると, 安静時振戦の頻度は「~70%程度(診断時)」とある.</p><p><br /></p><p>薬剤性のParkinsonism(DIP)の症状を評価している論文を探してみると, 1つ興味深い報告を見つけたのでシェアする. 原因薬剤のクラス別に報告してあるものである.</p><p>(Neurol Sci (2017) 38:319–324)</p><p><b><span style="color: red;">薬剤性Parkinsonism(DIP)はParkinsonismの代表的な原因の1つ</span></b></p><p>・原因薬剤として多く報告されているのは
第一世代/第二世代の向精神病薬とCa-ch阻害薬.</p><p> 他にはバルプロ酸, 消化管蠕動促進薬(スルピリドなど)</p><p>・古典的なDIPの基準として,
薬剤中止後6ヶ月以内に改善することが必要とされているが,
中止後も持続/進行する症例が~25%で報告されており,
不顕性の変性が薬剤の使用により顕在化した症例も含まれている可能性が示唆されている.</p><p><br /></p><p><span style="color: #800180;">DIPの臨床的特徴として,</span></p><p>・急性/亜急性の, 左右対称性の錐体外路症状であり,
Levodopaに反応せず, PDと比較して安静時振戦の頻度が少ないとされる</p><p>・この報告はD2 dopamine receptor阻害薬(主に第一世代向精神病薬)によるDIP症例で観察された報告に基づく(この報告における振戦の頻度は4割程度).(J Neurol Neurosurg Psychiatry. 1988 Jun; 51(6): 850–854.)</p><p><br /></p><p><b><span style="color: red;">Parkinsonism診療の専門施設における前向きStudy</span></b></p><p>・Parkinsonismを認める患者群(安静時振戦, 固縮, Bradykinesia, 姿勢不安定のうち2つ以上を認める患者)において, DIPと診断された症例を評価した.</p><p>・DIPは以下の3要素を有する患者群と定義:
</p><p> 原因となる薬剤を使用しており
</p><p> 開始前には認められず</p><p> 中止後6ヶ月以内に改善した.</p><p>・薬剤は第一世代向精神病薬, 第二世代, Ca-ch阻害薬の3つに分類し
, それぞれにおける症状を比較.</p><p>・Action tremorの原因となる薬剤を使用中の患者は除外された.</p><p><br /></p><p><span style="color: #800180;">2677例のParkinsonism患者のうち,
264例(9.86%)がDIPを疑われた. </span></p><p>・このうち20例は1剤以上の原因薬剤を使用したため除外
</p><p> 第一世代(CN)が95例 → 薬剤中止後改善が78例</p><p>
第二世代(SN)が23例 → 薬剤中止後改善が21例</p><p>
Ca-ch阻害薬(CCB)が80例 → 薬剤中止後改善が58例 であった.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdO7sIFsKotiUfWxjzL6eV7Py-4D5hrOybeAk_TmPzlxID3Gb8CRrM2mYi8QBgqx67NVBKjR6vMVTJnIapz69TZ-UeL0E4Gvr7h-nPBm8g1SYcH3JzUd-KAgt8OvVFrjSBI7dG9w5644D25apoG59FW0ZzHWUtWBD1SWgZFXajSWrj0OT00p0L0PI_Q/s932/1.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="548" data-original-width="932" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFdO7sIFsKotiUfWxjzL6eV7Py-4D5hrOybeAk_TmPzlxID3Gb8CRrM2mYi8QBgqx67NVBKjR6vMVTJnIapz69TZ-UeL0E4Gvr7h-nPBm8g1SYcH3JzUd-KAgt8OvVFrjSBI7dG9w5644D25apoG59FW0ZzHWUtWBD1SWgZFXajSWrj0OT00p0L0PI_Q/w400-h235/1.jpg" width="400" /></a></div><br /><p></p><p><span style="color: #800180;"><b>各原因薬剤における比較</b></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKe_epkH1OsFDyj_KBUmI8lIdkBkdncM38SFzHvDTcMNMml5oeBoHefv4tqO5PpHnZONmLSvdwHNte2uSkApc0oWw3BmEr-KnxP9-509VFBCEk80ns1HeHZTeMKeAv7fk2kxkD-jql34Laz73wH8TJ--NI5v1hnrak3FyaRcyzTljQb6950Z6hYWiDA/s632/1.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="396" data-original-width="632" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKe_epkH1OsFDyj_KBUmI8lIdkBkdncM38SFzHvDTcMNMml5oeBoHefv4tqO5PpHnZONmLSvdwHNte2uSkApc0oWw3BmEr-KnxP9-509VFBCEk80ns1HeHZTeMKeAv7fk2kxkD-jql34Laz73wH8TJ--NI5v1hnrak3FyaRcyzTljQb6950Z6hYWiDA/w640-h402/1.png" width="640" /></a></b></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><b><br /></b></span></div><p></p><p>・薬剤開始〜発症まで最も長いのはCCBでおよそ半年.
</p><p> DIPの期間もCCBで最も長い(改善までの期間も長い?)</p><p>・症状からは,
</p><p> Rigid-akineticはCN, SNで多く, およそ半数. CCBでは稀
</p><p> 安静時振戦のみ認める例はCNで4割と最も多く, CCBやSNでは少ない.
</p><p> CCBはMixed tremorの頻度が高い → 安静時振戦はCCBでは認めるが, 姿勢時振戦も同様に多く認められる.</p><p>・前述の通りPD自体の安静時振戦は~70%であり, やはり薬剤性は少ないといえる.</p><p> CCBではMixedの頻度が高く, 振戦の頻度は差はないのかもしれない.</p><p> 少なくとも向精神病薬によるDIPでは安静時振戦は少ないと言える可能性が高い(それでも2-4割で認められるが)</p></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-42058365625450015322023-04-05T22:01:00.001+09:002023-04-05T22:01:03.974+09:00スタチンの使い方: 強度 vs LDL-C目標値<p>高コレステロール血症に対するスタチンの使用方法として,</p><p>強度を設定し使用する方法と, LDLコレステロール値を設定して調節する方法がある.</p><p><br /></p><p>以前は強度で記載されていたが, 最近のガイドラインは併記されている.</p><p>国内のガイドラインは目標値設定. </p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">ACC/AHA </span><span style="font-size: 8.5pt;">ガイドライン(<span lang="EN-US">2018</span>)におけるスタチンの推奨と治療目標<span lang="EN-US"><o:p></o:p></span></span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; color: black;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 70.65pt;" valign="top" width="94"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">予防<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">患者群<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">スタチン強度<span lang="EN-US">, </span>治療目標<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td rowspan="3" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 70.65pt;" valign="top" width="94"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">二次予防<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">以前にも動脈硬化性疾患既往がある<span lang="EN-US">. </span>または高リスク因子<span lang="EN-US">*</span><sup>1</sup>を有する<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">高強度スタチン<span lang="EN-US">.</span></span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;"><span lang="EN-US">LDL</span>コレステロール<span lang="EN-US"><70mg/dL<o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">高リスク因子<span lang="EN-US">(</span>-<span lang="EN-US">). >75</span>歳<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">中強度スタチン<span lang="EN-US">. </span>高強度がすでに使用されている場合は継続<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">高リスク因子<span lang="EN-US">(</span>-<span lang="EN-US">). ≤75</span>歳<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">高強度スタチン<span lang="EN-US">.</span></span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;"><span lang="EN-US">LDL</span>コレステロール<span lang="EN-US">50%</span>以上の低下<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td rowspan="4" style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 70.65pt;" valign="top" width="94"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">一次予防<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">LDL</span><span style="font-size: 8.5pt;">コレステロール<span lang="EN-US">≥190mg/dL<o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">高強度スタチン<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">LDL</span><span style="font-size: 8.5pt;">コレステロール<a name="_Hlk122439405"><span lang="EN-US">70 mg/dL -190mg/dL</span>未満</a><span lang="EN-US">, 40-75</span>歳<span lang="EN-US">. </span>糖尿病<span lang="EN-US">(-), 10</span>年間動脈硬化性疾患リスク<span lang="EN-US">≥7.5%<o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">リスク<span lang="EN-US">7.5-20%, </span>またはリスク因子<span lang="EN-US">*<sup>2</sup></span>がある場合は<span lang="EN-US">LDL</span>コレステロール<span lang="EN-US"> 30-49%</span>の低下<span lang="EN-US">(</span>中強度スタチン<span lang="EN-US">),</span>リスク<span lang="EN-US">≥20%</span>では<span lang="EN-US">≥50%</span>の低下を目標<span lang="EN-US">(</span>高強度スタチン<span lang="EN-US">)<o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">LDL</span><span style="font-size: 8.5pt;">コレステロール<span lang="EN-US">≥160mg/dL, 20-39</span>歳<span lang="EN-US">. </span>若年発症の動脈硬化性疾患の家族歴がある<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">スタチンを考慮する<span lang="EN-US"><o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 212.45pt;" valign="top" width="283"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">40-75</span><span style="font-size: 8.5pt;">歳の糖尿病<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 141.6pt;" valign="top" width="189"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 8.5pt;">中強度スタチン<span lang="EN-US">. </span>動脈硬化リスクが他にあれば高強度<span lang="EN-US"><o:p></o:p></span></span></p></td></tr></tbody></table><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">*</span><sup><span style="font-size: 8.5pt;">1</span></sup><span lang="EN-US" style="font-size: 8.5pt;">12</span><span style="font-size: 8.5pt;">ヶ月以内の冠動脈疾患<span lang="EN-US">, </span>心筋梗塞既往<span lang="EN-US">, </span>脳梗塞既往<span lang="EN-US">, </span>症候性の末梢動脈疾患のうち<span lang="EN-US">1</span>つ以上<span lang="EN-US">.<br /></span> <span lang="EN-US">65</span>歳以上<span lang="EN-US">, </span>ヘテロの家族性高コレステロール血症<span lang="EN-US">, </span>冠動脈バイパス術<span lang="EN-US">/</span>経皮的冠動脈インターベンション既往<span lang="EN-US">, </span>糖尿病<span lang="EN-US">, </span>慢性腎臓病<span lang="EN-US">, </span>喫煙者<span lang="EN-US">, </span>スタチン最大投与量を使用しても<span lang="EN-US">LDL-C ≥100mg/dL</span>が持続<span lang="EN-US">, </span>うっ血性心不全の既往 のうち複数が認められる<span lang="EN-US">.<o:p></o:p></span></span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;">*</span><sup><span style="font-size: 8.5pt;">2 </span></sup><span style="font-size: 9pt;">動脈硬化性疾患家族歴(男性では<</span><span lang="EN-US" style="font-size: 9pt;">55 </span><span style="font-size: 9pt;">歳,女性では<</span><span lang="EN-US" style="font-size: 9pt;">65 </span><span style="font-size: 9pt;">歳)<span lang="EN-US">, </span></span><span lang="EN-US" style="font-size: 9pt;">LDL</span><span style="font-size: 9pt;">コレステロール</span><span lang="EN-US" style="font-size: 9pt;">160-189 mg/dL, </span><span style="font-size: 9pt;">メタボリック症候群(腹囲の拡大,トリグリセリド></span><span lang="EN-US" style="font-size: 9pt;">150mg/dL</span><span style="font-size: 9pt;">,高血圧,高血糖,</span><span lang="EN-US" style="font-size: 9pt;">HDL</span><span style="font-size: 9pt;">コレステロール低値[男性<</span><span lang="EN-US" style="font-size: 9pt;">40 mg/dL</span><span style="font-size: 9pt;">,女性<</span><span lang="EN-US" style="font-size: 9pt;">50 mg/dL</span><span style="font-size: 9pt;">]のうち,</span><span lang="EN-US" style="font-size: 9pt;">3</span><span style="font-size: 9pt;">項目以上を満たす)<span lang="EN-US">, </span>慢性腎臓病<span lang="EN-US">, </span>慢性炎症性疾患(関節リウマチや乾癬,</span><span lang="EN-US" style="font-size: 9pt;">HIV</span><span style="font-size: 9pt;">感染症など)<span lang="EN-US">, </span>早期閉経の既往(</span><span lang="EN-US" style="font-size: 9pt;">40</span><span style="font-size: 9pt;">歳以前での閉経),妊娠に関連した動脈硬化性疾患疾患リスクを上昇させる合併症(子癇など)<span lang="EN-US">, </span>心血管疾患リスクが高い人種(南アジアなど)<span lang="EN-US">,</span></span><span lang="EN-US" style="font-size: 9pt;"> </span><span style="font-size: 9pt;">持続的な高トリグリセリド血症(≧</span><span lang="EN-US" style="font-size: 9pt;">175 mg/dL</span><span style="font-size: 9pt;">)<span lang="EN-US">,</span></span><span lang="EN-US" style="font-family: HiraMinPro-W3, serif; font-size: 8.5pt;"> </span><span style="font-size: 9pt;">足関節上腕血圧比(<span lang="EN-US">ABI</span>)</span><span lang="EN-US" style="font-size: 9pt;"><0.9</span><span lang="EN-US" style="font-size: 8.5pt;"><o:p></o:p></span></p><p align="right" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm; text-align: right;"><i><span lang="EN-US" style="font-size: 8.5pt;">Circulation. 2019 Jun 18;139(25):e1082-43<o:p></o:p></span></i></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 8.5pt;"> </span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US">ESC/EAS</span>ガイドライン(<span lang="EN-US">2019</span>)における心血管疾患リスク分類と治療目標<span lang="EN-US"><o:p></o:p></span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; color: black;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 56.45pt;" width="75"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7.5pt;">リスク</span><span lang="EN-US" style="font-size: 7.5pt;"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 290.6pt;" width="387"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 7.5pt;">患者群<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 77.65pt;" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7.5pt;">治療目標<span lang="EN-US">(LDL-C)</span></span><span lang="EN-US" style="font-size: 7.5pt;"><o:p></o:p></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 56.45pt;" width="75"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">最高リスク</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 290.6pt;" width="387"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">・動脈硬化性疾患を臨床的または画像的に指摘されている<span lang="EN-US">(</span>冠動脈疾患既往<span lang="EN-US">, </span>狭心症<span lang="EN-US">,</span><a name="_Hlk122428428">経皮的冠動脈インターベンション</a><span lang="EN-US">, </span><a name="_Hlk122428450">冠動脈バイパス術</a>既往など<span lang="EN-US">, </span>脳卒中<span lang="EN-US">, </span></span><span style="font-family: HiraMinPro-W3, serif; font-size: 7.5pt;">一過性脳虚血発作</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">, </span><span style="font-family: HiraMinPro-W3, serif; font-size: 7.5pt;">末梢動脈疾患</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">, </span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">画像上プラーク狭窄が指摘など<span lang="EN-US">)<br /></span>・臓器障害を伴う糖尿病<span lang="EN-US">, </span>もしくは<span lang="EN-US">3</span>つ以上のリスクを有する糖尿病<span lang="EN-US">, 20</span>年を超える<span lang="EN-US">1</span>型糖尿病<span lang="EN-US"><br /></span>・重度の慢性腎臓病<span lang="EN-US">(</span>予測<span lang="EN-US">GFR <30mL/</span>分<span lang="EN-US">/1.73</span>m<sup><span lang="EN-US">2</span></sup><span lang="EN-US">)<br /></span>・<span lang="EN-US">10</span>年間致命的心血管疾患リスクスコア </span><span lang="EN-US" style="font-family: Helvetica; font-size: 7pt;">≥</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">10%<o:p></o:p></span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">・動脈硬化性疾患の既往や他のリスク因子を有する</span><span style="font-size: 8.5pt;">家族性高コレステロール血症</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 77.65pt;" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">LDL</span><span style="font-size: 8.5pt;">コレステロール</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">50%</span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">以上の減少<span lang="EN-US">, <55mg/dL</span>を目標<span lang="EN-US"> (</span>高強度スタチン<span lang="EN-US">)</span></span><span lang="EN-US"><o:p></o:p></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 56.45pt;" width="75"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">高リスク</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 290.6pt;" width="387"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">・次のいずれかが認められる<span lang="EN-US">: </span>総コレステロール<span class="apple-converted-space"> </span><span lang="EN-US">>310mg/dL, LDL</span>コレステロール<span lang="EN-US">>190mg/dL</span>または血圧</span><span lang="EN-US" style="font-family: Helvetica; font-size: 7pt;">≥</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">180/110mmHg<br /></span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">・家族性高コレステロール血症があり<span lang="EN-US">, </span>他のリスクは認められない<span lang="EN-US"><br /></span>・臓器障害が認められない糖尿病<span lang="EN-US">, 10</span>年以上の糖尿病罹患歴<span lang="EN-US">, </span>他のリスク因子を伴う糖尿病<span lang="EN-US"><br /></span>・中等度慢性腎臓病<span lang="EN-US">(</span>予測<span lang="EN-US">GFR 30-59mL/</span>分<span lang="EN-US">/1.73</span>m<sup><span lang="EN-US">2</span></sup><span lang="EN-US">)<br /></span>・<span lang="EN-US">10</span>年間致命的心血管疾患リスクスコア<span lang="EN-US"> 5-10%</span></span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 77.65pt;" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">LDL</span><span style="font-size: 8.5pt;">コレステロール</span><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">50%</span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">以上の減少<span lang="EN-US">, <70mg/dL</span>を目標<span lang="EN-US"> (</span>高強度スタチン<span lang="EN-US">)</span></span><span lang="EN-US"><o:p></o:p></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 56.45pt;" width="75"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">中リスク</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 290.6pt;" width="387"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">若年者<span lang="EN-US">(2</span>型糖尿病<span lang="EN-US"><50</span>歳<span lang="EN-US">, 1</span>型糖尿病<span lang="EN-US"><35</span>歳<span lang="EN-US">)</span>で<span lang="EN-US">, </span>糖尿病罹患歴が<span lang="EN-US">10</span>年未満<span lang="EN-US">, </span>他のリスク因子は認められない<span lang="EN-US"><br />10</span>年間致命的心血管疾患リスクスコア<span lang="EN-US"> 1</span>%<span lang="EN-US">-5%</span>未満</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 77.65pt;" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;"><100mg/dL</span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">を目標</span><span lang="EN-US"><o:p></o:p></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 56.45pt;" width="75"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">低リスク</span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 290.6pt;" width="387"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">10</span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">年間致命的心血管疾患リスクスコア<span lang="EN-US"> <1%</span></span><span lang="EN-US"><o:p></o:p></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 77.65pt;" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;"><116mg/dL</span><span style="font-family: "Hiragino Kaku Gothic ProN", sans-serif; font-size: 7pt;">を目標</span><span lang="EN-US"><o:p></o:p></span></p></td></tr></tbody></table><p align="right" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm; text-align: right;"><span lang="EN-US">Atherosclerosis. 2019 Nov;290:140-205<o:p></o:p></span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US"> </span></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;">動脈硬化疾患予防ガイドライン(<span lang="EN-US">2022</span>)におけるリスク分類と治療目標<span lang="EN-US"><o:p></o:p></span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; color: black;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0mm 5.4pt; width: 77.75pt;" valign="top" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">リスク<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 191.35pt;" valign="top" width="255"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">患者群<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0mm 5.4pt; width: 155.6pt;" valign="top" width="207"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">治療目標<span lang="EN-US">(LDL-C)<o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 77.75pt;" valign="top" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">二次予防<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 191.35pt;" valign="top" width="255"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">動脈硬化性疾患既往がある<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 155.6pt;" valign="top" width="207"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 9pt;"><100mg/dL<br /></span><span style="font-size: 9pt;">高リスク群<span lang="EN-US">*</span><sup>1</sup>では<span lang="EN-US"><70mg/dL<o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 77.75pt;" valign="top" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">高リスク<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 191.35pt;" valign="top" width="255"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">糖尿病<span lang="EN-US">, </span>慢性腎臓病<span lang="EN-US">, </span>末梢動脈疾患あり<span lang="EN-US"><br /></span>リスク評価<span lang="EN-US">(</span>図<span lang="EN-US">2)</span>にて≥<span lang="EN-US">10%<o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 155.6pt;" valign="top" width="207"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 9pt;"><120mg/dL<br /></span><span style="font-size: 9pt;">リスク因子あり<span lang="EN-US">*</span><sup>2</sup>では<span lang="EN-US"><100mg/dL<o:p></o:p></span></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 77.75pt;" valign="top" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">中リスク<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 191.35pt;" valign="top" width="255"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">リスク評価<span lang="EN-US">(</span>図<span lang="EN-US">2)</span>にて<span lang="EN-US">2</span>%<span lang="EN-US">-10%</span>未満<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 155.6pt;" valign="top" width="207"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 9pt;"><140mg/dL<o:p></o:p></span></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0mm 5.4pt; width: 77.75pt;" valign="top" width="104"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">低リスク<span lang="EN-US"><o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 191.35pt;" valign="top" width="255"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span style="font-size: 9pt;">リスク評価<span lang="EN-US">(</span>図<span lang="EN-US">2)</span>にて<span lang="EN-US"><2%<o:p></o:p></span></span></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0mm 5.4pt; width: 155.6pt;" valign="top" width="207"><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US" style="font-size: 9pt;"><160mg/dL<o:p></o:p></span></p></td></tr></tbody></table><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US">*</span>1冠動脈疾患<span lang="EN-US">, </span>家族性高コレステロール血症<span lang="EN-US">, </span>糖尿病<span lang="EN-US">, </span>アテローム血栓性脳梗塞<span lang="EN-US"><br />*</span>2糖尿病で末梢動脈疾患<span lang="EN-US">, </span>微小血管障害を合併した症例や喫煙者.<i><span lang="EN-US"><o:p></o:p></span></i></p><p align="right" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm; text-align: right;"><i>日本動脈硬化学会.動脈硬化性疾患予防ガイドライン<span lang="EN-US">2022</span></i></p><p align="left" class="MsoNormal" style="font-family: 游明朝, serif; font-size: 10.5pt; margin: 0mm;"><span lang="EN-US"> </span></p><p>ちなみに, 強度とは</p><p>LDLコレステロールを>50%減少させる量を高強度</p><p>30-50%減少させる量を中強度</p><p><30%減少させる量を低強度と定義し, 以下のような投与量となる.</p><p>国内保険適応ではほぼ中強度となり, 高強度はロスバスタチンのみという問題がある.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8voVZ0PMcu6bJUMBa2BkYNoKv4qu9HCLLdbQjus0INkpNgibCXKwcTaudaxczitiNqAmgFQgjyZ04RgbaJz-OGA_3ioI3X1_-9oVkh8HYZslLe1o0ZF-1qM2hY6Z6z9jwbMTsGFuCDMhy5QZ-Ho5Ub9IYtBBYok36AQ-p7X2TdzHvDf0oZNWeKXoqeQ/s425/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="159" data-original-width="425" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8voVZ0PMcu6bJUMBa2BkYNoKv4qu9HCLLdbQjus0INkpNgibCXKwcTaudaxczitiNqAmgFQgjyZ04RgbaJz-OGA_3ioI3X1_-9oVkh8HYZslLe1o0ZF-1qM2hY6Z6z9jwbMTsGFuCDMhy5QZ-Ho5Ub9IYtBBYok36AQ-p7X2TdzHvDf0oZNWeKXoqeQ/w400-h150/1.png" width="400" /></a></div><div><br /></div><div><br /></div>強度を基本としたスタチン投与方法と, LDLコレステロールの目標値を設定した方法はどちらが良いのかはこれまで直接的に比較されたものはなかった.<br /><p>そんななか, 韓国より非劣性試験が発表された.</p><p><br /></p><p>JAMA. 2023;329(13):1078-1087. </p><p><b><span style="color: red;">LODESTAR: 冠動脈既往患者を対象とし. High-intensity群と, Treat-to-target群に割り付け, 臨床アウトカムを比較した非劣性RCT @韓国</span></b></p><p>・Treat-to-target群はLDL-Cを50-70mg/dLを目標に投与
</p><p> 未使用例では中強度より開始, 使用例では目標達成まで増量.
<50mg/dLでは減量する.</p><p>・
High-intensityはロスバスタチン20mg/日, アトルバスタチン 40mg/日を使用</p><p>・3年間における死亡, 冠動脈疾患, Strokeを比較.
非劣性マージンは3.0% </p><p><br /></p><p><span style="color: #800180;">母集団</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpxvEb3IN_SQIH46QNdW9UNNMerHtmwrIuyl8PWqBy--fwEYus6z5LgAFsvoT3Ikisze_xzIauJSnU-msFGTVCT1f7LnSfEBK3b6NTh7HGZFiqnhgzYFQi_0fDsvNfNgnV5kyf0NEXxKTmoiFimbaaP5F1iA4vb-UeWI0j_svG8O5lHL0olLF3_cdHKQ/s535/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="535" data-original-width="520" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpxvEb3IN_SQIH46QNdW9UNNMerHtmwrIuyl8PWqBy--fwEYus6z5LgAFsvoT3Ikisze_xzIauJSnU-msFGTVCT1f7LnSfEBK3b6NTh7HGZFiqnhgzYFQi_0fDsvNfNgnV5kyf0NEXxKTmoiFimbaaP5F1iA4vb-UeWI0j_svG8O5lHL0olLF3_cdHKQ/w622-h640/1.png" width="622" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p><span style="color: #800180;">両群のスタチンの使用量</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlcIVBpq2UDalEQmFwF9mKe8Yp95VCMHvyLFNAazF2ZDumX6_NMHmVutHphuIhQ3FF2XPXSOOUxyy01gKvXxH5L1jxAmknsz6O9RmyeZLVZ1UoNdc4wLnliIRgkQK2fWYQVpR4d7kGYaau0z7KvulfnpjpCiie-fZSDgltmFU4r8JYKzD3E73B0jNtZQ/s479/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="466" data-original-width="479" height="622" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlcIVBpq2UDalEQmFwF9mKe8Yp95VCMHvyLFNAazF2ZDumX6_NMHmVutHphuIhQ3FF2XPXSOOUxyy01gKvXxH5L1jxAmknsz6O9RmyeZLVZ1UoNdc4wLnliIRgkQK2fWYQVpR4d7kGYaau0z7KvulfnpjpCiie-fZSDgltmFU4r8JYKzD3E73B0jNtZQ/w640-h622/1.png" width="640" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・Treat-to-target群では中強度例が4-5割を占め, Ezetimibe併用も
多い</p><p><br /></p><p><span style="color: red;"><b>LDL-Cの値とPrimary end point</b></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: red;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWcMX6oNZrvfqMklqaoHLStKUBFgXob_pmx4Fy410EUiMW9A2u0Rt98DysbFDiyBc2k2U6Aq-88xrnkYeDPyjE28D5XKuvTTLb_b2o7Yl60Yv2yU4BTc8Kzpws-qqdRZ051T4aOlJiGB618fcB9uo0bGVv6cHHjaWpOWWXgePmdvjAkXISjvNs4PDlDQ/s610/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="390" data-original-width="610" height="410" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWcMX6oNZrvfqMklqaoHLStKUBFgXob_pmx4Fy410EUiMW9A2u0Rt98DysbFDiyBc2k2U6Aq-88xrnkYeDPyjE28D5XKuvTTLb_b2o7Yl60Yv2yU4BTc8Kzpws-qqdRZ051T4aOlJiGB618fcB9uo0bGVv6cHHjaWpOWWXgePmdvjAkXISjvNs4PDlDQ/w640-h410/1.png" width="640" /></a></b></span></div><p></p><p>・LDL-Cは両群で<70mg/dLを達成しており,
</p><p> Primary end point(死亡, 冠動脈疾患, Stroke)も同等.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRD4sDfFPsXcjwanrnZxyb1MtLxXTRduHfsv_kh8WY761LchVui5Fv0wGGYFS-3JExHGRSK5S3T8IlDqsdoGliOvgfGsUHXvfk8kUBCw-oNj4oShqynaxkYIqXJrwN6erf-4mHhbf1OjXoq1OQFRuc2ObILutybHw0k4BH7FWhp-2muYo5ULkmV7x0FQ/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="471" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRD4sDfFPsXcjwanrnZxyb1MtLxXTRduHfsv_kh8WY761LchVui5Fv0wGGYFS-3JExHGRSK5S3T8IlDqsdoGliOvgfGsUHXvfk8kUBCw-oNj4oShqynaxkYIqXJrwN6erf-4mHhbf1OjXoq1OQFRuc2ObILutybHw0k4BH7FWhp-2muYo5ULkmV7x0FQ/w558-h640/1.png" width="558" /></a></div><p></p><p>・個別に見たアウトカムも両者で差は認めず.</p><p>・臨床的有意な差かどうかは不明であるが, 末期腎不全リスクはHigh-intensity群でやや多い.</p><p><br /></p><p>-------------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(255, 0, 0);">スタチンの使用可能量の国別の差により, 日本では海外で行われるような高強度スタチンの使用が難しい問題があった.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(255, 0, 0);">それでもエゼチミブなど併用しつつやっていたものの, 今回の報告からはそれで目標LDLコレステロールを達成できれば少なくとも3年間のアウトカムには差は認めないという結果.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(255, 0, 0);">長期フォロー結果も待ちたいところではあるが, 結局は低強度〜中強度で開始/投与しつつ, 目標値を意識しつつ管理, という方法はアリ.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-90862860598470114012023-04-01T10:58:00.006+09:002023-04-01T10:58:59.695+09:00MDS/MPNに伴うリウマチ性疾患や腸炎にJAK阻害薬はどうか?<p> 自分が総合診療/リウマチ膠原病の守備範囲の中でも, 比較的好んで診療しているMDS/MPN(特にCMML)に伴う自己炎症性の病態(あとは好酸球性疾患が好きです).</p><p>参考: </p><h3 class="post-title entry-title" itemprop="name" style="caret-color: rgb(51, 51, 51); color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 18px; font-stretch: normal; font-weight: normal; line-height: normal; margin: 0px; position: relative;"><a href="http://hospitalist-gim.blogspot.com/2016/04/mds.html" target="_blank">MDSには自己免疫性疾患が合併することがある</a></h3><div><h3 class="post-title entry-title" itemprop="name" style="caret-color: rgb(51, 51, 51); color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 18px; font-stretch: normal; font-weight: normal; line-height: normal; margin: 0px; position: relative;"><a href="http://hospitalist-gim.blogspot.com/2014/01/mds.html" target="_blank">MDSに合併する関節炎</a></h3></div><div><h3 class="post-title entry-title" itemprop="name" style="caret-color: rgb(51, 51, 51); color: #333333; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 18px; font-stretch: normal; font-weight: normal; line-height: normal; margin: 0px; position: relative;"><a href="http://hospitalist-gim.blogspot.com/2019/10/mds.html" target="_blank">ベーチェット病と悪性腫瘍(特に血液腫瘍, MDS)</a></h3></div><p>治療は原疾患の治療(アザシチジン)だが, その適応が難しい場合はステロイドやTNFα阻害薬が試されるものの, ステロイドは減量で再発しやすく, TNF-α阻害薬も長期間の使用で不応となる例がある.</p><p><br /></p><p>そこで, ふとMPN, 特に骨髄線維症や真性多血症で使用されるRuxolitinib(JAK1/2阻害薬)がこのような病態に効果が期待できるのでは。。。?と思ったが, そもそも上記のような疾患群は数が少なく, また狭間疾患ということもあり, ほぼ研究が進んでいない.</p><p><br /></p><p>とりあえず手当たり次第に読んでみた.</p><p><b><span style="color: red;">CMMLとJAK阻害薬</span></b></p><p><span style="color: red;">CMMLでは, 異常クローンよりCFU-GM(colony-forming units granulocyte/macrophage)が形成される.</span></p><p>・GFU-GMはin vitroにおいてGM-CSFより分化増殖し, 顆粒球やマクロファージから成るコロニーを形成する造血細胞群.</p><p>・JAK1/2はGM-CSFシグナル伝達経路のセンチネルキナーゼであり, CMMLにおけるJAK1/2阻害は疾患の治療に有用な可能性がある(Eur J Haematol . 2016 Dec;97(6):562-567.)</p><p><br /></p><p><span style="color: red;">CMML-1と診断された患者群20例において
Ruxolitinibを投与した報告(JAK1/2阻害薬)</span></p><p>(Clin Cancer Res . 2016 Aug 1;22(15):3746-54.)</p><p>・好中球数<250/µL, PLT<35000/µL,
Cr >2.0mg/dL, T-bil ≥1.5ULNの症例は除外</p><p>
また過去の治療歴とその内容は問わず.</p><p>・Ruxolitinibは1回5-20mg, 1日2回投与で評価.
</p><p> Cohort 1が5mg bid 6例
Cohort 2が10mg bid 4例
Cohort 3が15mg bid 5例
Cohort 4が20mg bid 5例</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGbeHqSEdJbr4gviBI24Ev0AgpyaQFG3iC2ZCqnzNXJnDOZ2QOzsm68FN0AcCM-RL7xrULlEdWXVCTjEbuDTBjMHgf8QJ8aEdvIU3gqk0oy2QB6LINZYCrvMghBs5YCoPVUeUeI1ZQQi1KOEkrDfUF6NoKb1V-JjNO8NVgZkkbcNT1vSkHIYWGn_nt-w/s311/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="309" data-original-width="311" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGbeHqSEdJbr4gviBI24Ev0AgpyaQFG3iC2ZCqnzNXJnDOZ2QOzsm68FN0AcCM-RL7xrULlEdWXVCTjEbuDTBjMHgf8QJ8aEdvIU3gqk0oy2QB6LINZYCrvMghBs5YCoPVUeUeI1ZQQi1KOEkrDfUF6NoKb1V-JjNO8NVgZkkbcNT1vSkHIYWGn_nt-w/s1600/1.png" width="311" /></a></div><p></p><p><span style="color: #800180;">各患者の経過. 平均投与期間は122日[範囲28-409]</span></p><p>・血液所見の改善が4例. 1例はPRを達成.</p><p>
脾腫を認めた5/9で脾臓サイズの改善
</p><p> 疾患に関連する症状を認めた10/11で臨床症状の改善を認めた</p><p>・疾患の改善を認めた症例全てでJAK2変異は認められなかった(JAK2変異陽性は4/20)</p><p><br /></p><p><span style="color: red;">CMMLと診断された50例の患者を対象とし, Ruxolitinib 20mg bidを投与.</span></p><p>(Clin Cancer Res. 2021 Nov 15;27(22):6095-6105.)</p><p>・好中球数<250/µL, PLT<35000/µL, Cr >2.0mg/dL, T-bil ≥1.5ULNの症例は除外</p><p>・Phase 1において10mg/dで開始され, 最大40mg/dまで増量. 20例を導入</p><p>
Phase 2では40mg/dで投与(20mg bid). さらに30例を導入</p><p>・投薬は疾患の増悪や許容できない副作用が出現まで継続</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdVncL5cpySMR6e-0DIPsHGIszcQMR-EH7PpGdeCVVxKtVvPUquYevI5Y8Y5_Om-PkgjyX7Vr7sFcZwAxlKdHGe_4c1Z0wGC8qYJrL2jjmCaanxnbHnE0TVMVg0DhlDn9exRFTmCj5fI8r1ksfVgu-W6PFAxik3PSVLKudSt-KGlAWQ5N-sSHXwJOwJg/s798/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="513" data-original-width="798" height="412" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdVncL5cpySMR6e-0DIPsHGIszcQMR-EH7PpGdeCVVxKtVvPUquYevI5Y8Y5_Om-PkgjyX7Vr7sFcZwAxlKdHGe_4c1Z0wGC8qYJrL2jjmCaanxnbHnE0TVMVg0DhlDn9exRFTmCj5fI8r1ksfVgu-W6PFAxik3PSVLKudSt-KGlAWQ5N-sSHXwJOwJg/w640-h412/1.png" width="640" /></a></div><br /><p></p><p><span style="color: #800180;">治療反応性</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib91sWlTioaMx2olCYmFJ4uNjh5QhY2jhqpGjy8sXjt208ojg34WVVcN0MQ8MrlLaFQV67Y6_3MtJFWT5FWer3b2Lu-9mnRjkYH7_JmjhzfDQrdvHcrEAhcHvG59dywm6eDAOdxY0PR17scmewq2ozv5lLEBx3SDNzWw8D-9_vGq8_RV1sLbWNmFKJHA/s466/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="466" data-original-width="418" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib91sWlTioaMx2olCYmFJ4uNjh5QhY2jhqpGjy8sXjt208ojg34WVVcN0MQ8MrlLaFQV67Y6_3MtJFWT5FWer3b2Lu-9mnRjkYH7_JmjhzfDQrdvHcrEAhcHvG59dywm6eDAOdxY0PR17scmewq2ozv5lLEBx3SDNzWw8D-9_vGq8_RV1sLbWNmFKJHA/w359-h400/1.png" width="359" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・CRやPRは少ないながら認められる.
</p><p> 脾腫のサイズの縮小は43.5%で認められた.</p><p>・全体的な反応率は38%</p><p><br /></p><p><b><span style="color: red;">JAK阻害薬: MDS症例に対してはどうか?</span></b></p><p>・いくつかの研究により, NF-κβ活性化を特徴とする自然免疫, 炎症シグナルの調節がMDSの病態に重要な役割を示すことが示唆されている</p><p>・NF-κβ経路とJAK-STAT経路には相互関係が認められ,
RuxolitinibはNF-κβを抑制する効果が認められるため,
MDSにおいてJAK1/2阻害薬は病勢のコントロールに有用な可能性がある.</p><p>(Leuk Res. 2018 Oct;73:78-85.)</p><p><br /></p><p><span style="color: red;">治療歴のあるLow, Int-1のMDS症例で,
且つNF-κβまたはJAK-STATの活性化が認められる症例において, Ruxolitinibを投与した報告.</span></p><p>(Leuk Res. 2018 Oct;73:78-85.)</p><p>・NF-κβ活性はphosphorylated p65を認めることで定義
</p><p> JAK-STAT活性はJAK2変異を認めることで定義</p><p>
(陽性細胞が骨髄細胞中≥5%を満たすことで定義)</p><p>・またβ2-microglobulin >2ULNを満たす患者群も導入された</p><p>・肝障害, 腎障害を認める患者群は除外</p><p>・患者数は20例.
Ruxilitinibは5mg bid, 10mg bid, 15mg bid, 20mg bidの4群に分けて投与</p><p><span style="color: #800180;">母集団では</span></p><p>・CMMLが42%(8例)
JAK2陽性例が42%(8例)</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNLr8x6cLJAbhMmLrjZmSruCr-9lE4mikGJnCJjZSKBn6ps7NSxR3Isa4BosPnxuk55UAbcI_EDf0zGFnSQ4rzVToDUcJA4I__vwT2gRPDLGQAEUAsUvToMJMJlIVG7-LpOqG-eTbuXrUaq3z1zXWbf8QqNDJq0xJ6TjrqdrfsqYtZMALSfUyV0_ilOg/s757/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="757" data-original-width="389" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNLr8x6cLJAbhMmLrjZmSruCr-9lE4mikGJnCJjZSKBn6ps7NSxR3Isa4BosPnxuk55UAbcI_EDf0zGFnSQ4rzVToDUcJA4I__vwT2gRPDLGQAEUAsUvToMJMJlIVG7-LpOqG-eTbuXrUaq3z1zXWbf8QqNDJq0xJ6TjrqdrfsqYtZMALSfUyV0_ilOg/w328-h640/1.png" width="328" /></a></div><br /><p></p><p><span style="color: #800180;">治療反応性を認めたのは</span></p><p>・MDSの4/11例.
血小板改善が2, 貧血改善が1
, 細胞遺伝学的のPRが1例.
</p><p> CMMLでは反応性を認めた症例は無し.</p><p>・pp65発現例と治療反応性に関連を認めた.</p><p><br /></p><p><span style="color: red;">Ruxolitinib + Azacytidineの併用療法</span></p><p><span style="color: red;">MDS/MPN症例35例を対象(MDS/MPN-U 14例, CMML 17例, aCML 4)</span></p><p>(Am J Hematol. 2018;93:277–285.)</p><p>・Ruxolitinibを1サイクル28日とし, 3サイクル先行投与し,
4サイクル目からAzacytidine 25mg/m2(Day 1-5)を追加投与.</p><p>・Ruxolitinibは血小板数に基づき投与量を調節.
</p><p> Azacytidineは最大75mg/m2まで増量可.
また急速に細胞数が増加した症例や芽球が増加した症例では4サイクル待たずに開始可能とした.</p><p><br /></p><p><span style="color: #800180;">母集団</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLDNJMRLTn748dFpXwImQXQ9zYxg8sLk5gmyKFPwxC1SnCBp0bZbcpZ1rib9_avlyM_3Sy51sf5lgRbyCA_q5jSzM6-dz4ZmEH08jZZw5LeuJ8QHDp1LMRmSKF61H0IiAsDb5CabsyGBA9GYhVzLlhorH082tkbT58kF9oAEDnC75ON0dIANelndYd3A/s762/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="762" data-original-width="303" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLDNJMRLTn748dFpXwImQXQ9zYxg8sLk5gmyKFPwxC1SnCBp0bZbcpZ1rib9_avlyM_3Sy51sf5lgRbyCA_q5jSzM6-dz4ZmEH08jZZw5LeuJ8QHDp1LMRmSKF61H0IiAsDb5CabsyGBA9GYhVzLlhorH082tkbT58kF9oAEDnC75ON0dIANelndYd3A/w254-h640/1.png" width="254" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・JAK2変異は10例(29%)</p><p><br /></p><p><span style="color: #800180;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx8jZLvHkYF30D_ajEc0xj6QmQ7lucOWBsUF9izKmhgXx20FSlgANDY2yN4lXrQGL9U6DUp0-F7YiEXC51p9x_yxFz20IpY9ebClqoEHkZRimIt9ecX3SsqZSVnjIUOAaEegUYzahlFEHKyk-rLTgINF2Lr6V7tyTbYkC8RrVWXrtoUUaRfG1RghRhQw/s584/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="584" data-original-width="462" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx8jZLvHkYF30D_ajEc0xj6QmQ7lucOWBsUF9izKmhgXx20FSlgANDY2yN4lXrQGL9U6DUp0-F7YiEXC51p9x_yxFz20IpY9ebClqoEHkZRimIt9ecX3SsqZSVnjIUOAaEegUYzahlFEHKyk-rLTgINF2Lr6V7tyTbYkC8RrVWXrtoUUaRfG1RghRhQw/w506-h640/1.png" width="506" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・ORは57%で認められた.</p><p>・脾臓サイズの改善は9例(64%).
AZA併用前に4例, 併用後にさらに5例で改善</p><p>・臨床症状の改善効果も期待</p><p>・輸血依存が改善したのは1/11</p><p><br /></p><p>--------------------------</p><p><span style="color: #2b00fe;">JAK1/2阻害薬単独でのMDS/MPN, CMML治療はイマイチではあるが, 一部で反応性が認められる症例はある.</span></p><p><span style="color: #2b00fe;">具体的な臨床症状や, 自己炎症性の病態を評価している報告はないものの, MDS/MPN, CMMLに伴う臨床症状の改善効果も期待できる.</span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">原疾患の治療が難しい, 炎症性病態を有する患者群の選択肢として押さえていく価値はあるように思う.</span></span></p><p><span style="color: #2b00fe;">
JAK1/2双方を阻害するのはRuxolitinib以外にはTof, Bar, Pef, Upaあたりが選択肢.</span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-87070501778000001482023-03-30T10:23:00.001+09:002023-03-30T10:23:59.617+09:00静脈血栓症(VTE)一次予防目的のアスピリン<p> 骨折外傷や整形外科手術においては静脈血栓症(VTE)予防としてヘパリンの投与などが行われる. 海外は低分子ヘパリン(LWMH)が使用される.</p><p> 出血リスクが高い症例ではアスピリンも選択肢となるという報告.</p><p><br /></p><p><b><span style="color: red;">股関節置換, 膝関節置換術におけるVTE予防として
アスピリン vs 他の抗凝固薬を比較したTrialsのMeta</span></b></p><p>(JAMA Intern Med. 2020;180(3):376-384.)</p><p>・13 RCTs, N=6060例での解析</p><p>・LMWH(5), リバロキサバン(3)との比較が最も多い</p><p>・アスピリンは他の抗凝固薬と比較して,
VTE予防効果は同等, 出血リスクもかわらない結果.</p><p> VTEリスク: RR 1.12[0.78-1.62]
</p><p> DVTリスク: RR 1.04[0.72-1.51]
</p><p> PEリスク: RR 1.01[0.68-1.48]</p><p>・出血, 血腫形成リスクは両者で有意差なし</p><p>・Sub解析でも特に大きな差は認めない</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijebBc1f6NRepgCQAKokwc_tkPcXnTEh4yViWiFUqpLCvuMEa6zqHIDAdUEeZrz60QDCUig4nI64yxrU7umhUg0aB-l6baIwOTcCTd_e_UDAs-Z_GyfkW08-NumQ5tNxkIvMbiCEp9FIXx5ss6T2wnLhX6kh0MqbrXK4tL5pEMIB9HDtwP8_uxOiR1dg/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="437" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijebBc1f6NRepgCQAKokwc_tkPcXnTEh4yViWiFUqpLCvuMEa6zqHIDAdUEeZrz60QDCUig4nI64yxrU7umhUg0aB-l6baIwOTcCTd_e_UDAs-Z_GyfkW08-NumQ5tNxkIvMbiCEp9FIXx5ss6T2wnLhX6kh0MqbrXK4tL5pEMIB9HDtwP8_uxOiR1dg/w518-h640/1.png" width="518" /></a></div><br /><p></p><p><b><span style="color: red;">PREVENT CLOT: 骨折患者を対象とし, LWMHとASAによるVTE予防効果を比較した非劣性RCT.</span></b></p><p>(N Engl J Med. 2023 Jan 19;388(3):203-213.)</p><p>・手術治療が必要となる四肢の骨折, または臼蓋・骨盤骨折の成人症例12211例を対象.</p><p>・除外例: 受傷〜受診まで48時間以上, Study導入までに3回以上のVTE予防投与を受けている群, 6ヶ月以内のVTE既往, 治療的抗凝固療法を行っている群, 慢性の血液凝固疾患がある患者.</p><p>・入院中のVTE予防としてLWMH群(Enoxaparin 3000U, 1日2回)とアスピリン群(81mg 1日2回投与)に割り付け, 比較.</p><p>・退院後は各病院のプロトコールに則ってVTE予防を行なった.</p><p><span style="color: #800180;">母集団</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIsNJPhGCP7sgUQ-CURxjE6XD-yV5dQPeS3zB_SYUB3QQHxGJconCwg98q6ueajJJHob827lZ_J14yGwfabzT97YOjCwGpwFybrRG1UlF0IsHVcRQoFbLDC47d2JpleL38hP6emWgwNT0ynOVeZjjGro3Fpwug2PMdAhnILbtyzGrk0E1IDQXbwXMJxg/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="357" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIsNJPhGCP7sgUQ-CURxjE6XD-yV5dQPeS3zB_SYUB3QQHxGJconCwg98q6ueajJJHob827lZ_J14yGwfabzT97YOjCwGpwFybrRG1UlF0IsHVcRQoFbLDC47d2JpleL38hP6emWgwNT0ynOVeZjjGro3Fpwug2PMdAhnILbtyzGrk0E1IDQXbwXMJxg/w424-h640/1.png" width="424" /></a></span></div><p></p><p>・BMIは27.4[23.7-32.3]</p><p>・担癌患者は2.5%</p><p>・VTE既往は0.7%</p><p>・下肢骨折が87.5%</p><p><br /></p><p><span style="color: #800180;"><b>アウトカム</b></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdM9Pccy1DPIovOkQ-xSQ-uHPfvLxgYWHg2JO6HGSqNZy2UG658Yju_2Qfz5qSa79hXr_o9A0KXMZfFLhCsIuaKT0tGdrEkrAQVf3mykFCbjwj9cGZD0WwoKnT71VdJA4K77GJsEHCGYidOeDdJVnDP0lY25vFMk1mfwYDImJsRpV4gXKKdq8mrigA9w/s707/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="521" data-original-width="707" height="472" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdM9Pccy1DPIovOkQ-xSQ-uHPfvLxgYWHg2JO6HGSqNZy2UG658Yju_2Qfz5qSa79hXr_o9A0KXMZfFLhCsIuaKT0tGdrEkrAQVf3mykFCbjwj9cGZD0WwoKnT71VdJA4K77GJsEHCGYidOeDdJVnDP0lY25vFMk1mfwYDImJsRpV4gXKKdq8mrigA9w/w640-h472/1.png" width="640" /></a></b></span></div><p></p><p>・90日死亡リスクはASA群で0.78%, LWMH群で0.73%と有意差なし</p><p>・DVT発症率は2.5% vs 1.7%, AD 0.80[0.28-1.31]
</p><p> 遠位DVTが1.45% vs 0.86%, AD 0.58[0.20-0.96]と差があり
</p><p> 近位DVTは1.23% vs 0.98%, AD 0.25[-0.12~0.62]と差は認めず</p><p>・PE発症率は1.49% vs 1.49%と差は認めず.
</p><p> タイプ別でも差はない(症候性, 無症候性, Massiveなど)</p><p>・出血リスクも
有意差なし</p><p><br /></p><p>-------------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">四肢外傷や整形術後のVTE予防として、アスピリンも選択肢となりえる.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">遠位DVTは増加する可能性はあるが, 近位DVTや肺血栓塞栓症リスクは同等であり, 出血リスクが高い患者や抗凝固療法が行いにくい患者では選択肢として押さえておく価値はある.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-2098081082345076212023-03-29T10:51:00.002+09:002023-03-29T10:51:56.135+09:00ANCA関連血管炎の寛解維持療法: リツキシマブ vs アザチオプリン<p> (Ann Rheum Dis. 2023 Mar 23;ard-2022-223559. doi: 10.1136/ard-2022-223559.)</p><p><b><span style="color: red;">RITAZAREM: 再燃したAAV症例188例を対象としたRCT.</span></b></p><p><span style="color: red;">全例でRTX+GCにより寛解導入療法が行われ,
4ヶ月の時点で寛解を達成した症例を, </span></p><p><span style="color: red;">RTXによる維持療法群と, AZAによる維持群に割り付け, 比較したopen-label RCT.</span></p><p>・RTX群は1000mgを4ヶ月毎に投与.
</p><p> IgG<300mg/dLでは投与を延期し, >300を満たした際に投与</p><p>・AZA群は2mg/kg/日を投与し, 24ヶ月後より減量.
</p><p> AZAが継続困難な場合は腎機能良好群ではMTX, 不良群ではMMFを使用</p><p>・36ヶ月以上フォローし, 再燃率を比較した.</p><p><br /></p><p><span style="color: #800180;">母集団: 割り付けられたのは170例</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-zkytfNdWA-1NEvke4XJeyu130P6JmK0RIIWITZI9RF4ZRY_RVRidM2sUtgQkHbG0ity3NUUPtoc6lD76BiWe2hY0Ez2l6C-tBiV8UueCDkdQDwI-XMGpHr_HoOAMDGRw1KicRzCHY_1cM0bF8FwufuxcLjbbSHRfUQkSAUEmh_4VJpmop8Fsi1zi1Q/s648/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="648" data-original-width="516" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-zkytfNdWA-1NEvke4XJeyu130P6JmK0RIIWITZI9RF4ZRY_RVRidM2sUtgQkHbG0ity3NUUPtoc6lD76BiWe2hY0Ez2l6C-tBiV8UueCDkdQDwI-XMGpHr_HoOAMDGRw1KicRzCHY_1cM0bF8FwufuxcLjbbSHRfUQkSAUEmh_4VJpmop8Fsi1zi1Q/w510-h640/1.png" width="510" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・PR3-ANCA陽性例が7割</p><p>・再燃は重症例が6割</p><p><br /></p><p><span style="color: red;">アウトカム</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: red;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh4tnWKNmAIpU3qAzMZUpioZmUVbHEWQXkIaDQFS-fD4b0IogJx8vod3T67-CAg0qJO3gmpNwwVdBSFZlKo_zOB1NbB4udBDVQ9W-enTc1KFX3wZdJ6dCMkopg-HG7BvQSuPh_XiHq4er17NKX2BwOYPcYo-d3DqoqI9WhTRkSQi9WdMV0SJW_EBGl0w/s900/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="499" data-original-width="900" height="354" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh4tnWKNmAIpU3qAzMZUpioZmUVbHEWQXkIaDQFS-fD4b0IogJx8vod3T67-CAg0qJO3gmpNwwVdBSFZlKo_zOB1NbB4udBDVQ9W-enTc1KFX3wZdJ6dCMkopg-HG7BvQSuPh_XiHq4er17NKX2BwOYPcYo-d3DqoqI9WhTRkSQi9WdMV0SJW_EBGl0w/w640-h354/1.png" width="640" /></a></span></div><span style="color: red;"><br /></span><p></p><p>・再燃リスクは有意にRTX維持療法群で低い: HR 0.41[0.27-0.61]</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJokjS89OVfjIMR6DyX_Tknyx1s34-inL0uvR2qz0BnYTKPaatJmiqraEidcEocwQnNXjGJAFkMdV5v7R4c28Prr-ku5mcQAHUD9gNl2Hr-skwzehTUgN9YIzpzid073T0T4XEepr2nEAbFlC0HEXBQ-wMASMKDStV57bpifElxU0kSsTZC5J0h_wpOA/s858/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="394" data-original-width="858" height="294" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJokjS89OVfjIMR6DyX_Tknyx1s34-inL0uvR2qz0BnYTKPaatJmiqraEidcEocwQnNXjGJAFkMdV5v7R4c28Prr-ku5mcQAHUD9gNl2Hr-skwzehTUgN9YIzpzid073T0T4XEepr2nEAbFlC0HEXBQ-wMASMKDStV57bpifElxU0kSsTZC5J0h_wpOA/w640-h294/1.png" width="640" /></a></div><p>・寛解導入時のPSL量(1.0mg/kg vs 0.5mg/kg)や
ANCAタイプでは特に再燃リスクに差は認めず.</p><p>・再燃時に重症例の方が再燃リスクは低い.</p><p><br /></p><p><span style="color: #800180;">重大な合併症リスク</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1U-_rqsshQpuZkPPlikKrlMrTdRw5CbKG5kc9-8XzhiV9L6BEAZREo0Ae5jwEAbKLkO5-0KlWHt3XJCv0u3TbJkSLLWTQei17rl2dW7Y6UVV85IvE03RY89tpaHfMLN_VUfUkI5K-sUfbLR-5_zODSisirLGiPzSLoJ-H-PycHniPi6fAMne0YFxMLg/s1008/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="208" data-original-width="1008" height="132" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1U-_rqsshQpuZkPPlikKrlMrTdRw5CbKG5kc9-8XzhiV9L6BEAZREo0Ae5jwEAbKLkO5-0KlWHt3XJCv0u3TbJkSLLWTQei17rl2dW7Y6UVV85IvE03RY89tpaHfMLN_VUfUkI5K-sUfbLR-5_zODSisirLGiPzSLoJ-H-PycHniPi6fAMne0YFxMLg/w640-h132/1.png" width="640" /></a></span></div><p></p><p>・両群で感染症の頻度はほぼ同等.</p><p><br /></p><p>・低Igのリスク因子:
</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyHBge-8RWjVPGqab3awGJbUu-I3WbbrvHFv4aZiOOmAjS8hV2t_k9MKbVwCwWUBUWKkoTTbqrjjIQuhjtITKYlsB49emMn-sokFe9gsJmuUkdu4pSqsaUEoaPeKFS5vMLJid4tLdEJGHsFGDiI_LYJXUINubDMclCTFcLBvTuqb95X3WSEWlAWKyWlw/s449/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="383" data-original-width="449" height="341" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyHBge-8RWjVPGqab3awGJbUu-I3WbbrvHFv4aZiOOmAjS8hV2t_k9MKbVwCwWUBUWKkoTTbqrjjIQuhjtITKYlsB49emMn-sokFe9gsJmuUkdu4pSqsaUEoaPeKFS5vMLJid4tLdEJGHsFGDiI_LYJXUINubDMclCTFcLBvTuqb95X3WSEWlAWKyWlw/w400-h341/1.png" width="400" /></a></div><br /><p></p><p> RTXとAZAでリスクは同等だが, </p><p>
AZAは再燃時にさらに
RTXやGC増量で治療されるため結果的に低下する.</p><p>・再燃時のPSLが高用量群では
より低Igリスク</p><p><br /></p><p>--------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">AAVの寛解維持療法では, アザチオプリンよりもRTXの方が維持効果が良好という結果</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">ただし4ヶ月毎に1000mgとなかなかなスケジュール. コロナ禍ではどうか.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-45563505796873821192023-03-28T09:42:00.003+09:002023-03-28T09:42:33.269+09:00ICU管理となるような重症市中肺炎に対するステロイド投与<p> 市中肺炎に対するステロイド投与のStudyは2015年あたりより多く発表されている。</p><p>例えば:<a href="http://hospitalist-gim.blogspot.com/2015/02/blog-post_18.html" target="_blank"> http://hospitalist-gim.blogspot.com/2015/02/blog-post_18.html</a></p><p>他には 市中肺炎785例を対象としたRCT: Lancet 2015; 385: 1511–18 など.</p><p><span style="color: red;"><br /></span></p><p><span style="color: red;">9 RCTs, 6 cohortsのMeta-analysisでは </span>(CHEST 2016; 149(1):209-219)</p><p>・ステロイド投与量で多いのはmPSL 30mg/dを7日間</p><p>・市中肺炎に対するステロイド投与は, 死亡リスクを改善させない結果.
</p><p> 肺炎の死亡リスク RR 0.72[0.43-1.21]
重症肺炎の死亡リスク RR 0.72[0.43-1.21]</p><p>・ステロイド投与はARDSのリスクを軽減する効果はある
ARDSリスク RR 0.21[0.08-0.59]</p><p><br /></p><p><span style="color: red;">6 RCTsのMetaでは, </span>(Clinical Infectious Diseases® 2018;66(3):346–54)</p><p>・ステロイド投与により死亡リスクは変わらない(aOR 0.75[0.46-1.21])
</p><p>・状態安定化までの期間は1日短縮(-1.03[-1.62~-0.43])
</p><p>・入院期間も1日短縮(-1.15[-1.75~-0.55])</p><p>・高血糖リスクは上昇(aOR 2.15[1.60-2.90])</p><p>・
市中肺炎関連再入院率も上昇(aOR 1.85[1.03-3.32])</p><p><br /></p><p><br /></p><p><span style="color: #2b00fe;">といった結果があり, </span></p><p><span style="color: #2b00fe;">これまでは死亡リスクは低下させないものの, 重症化リスクを低下させたり,</span></p><p><span style="color: #2b00fe;">入院期間の短縮や挿管管理リスクの低下効果が期待できる, というような認識であった</span></p><p><br /></p><p>今回ICU管理となるような重症CAPにおけるステロイド投与のStudyが発表</p><p><span style="color: red;"><b>CRICS-TriGGERSep: ICU管理が必要なCAP症例を対象とし,
Hydrocortisone投与群 vs Placeboに割り付け比較したDB-RCT.</b></span></p><p>(N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145.)</p><p>・重症例の定義は以下の1つ以上を満たす:
</p><p> 人工呼吸器管理(PEEP ≥5cmH2O)
</p><p> HFNCによる酸素投与: FiO2 ≥50%, P/F <300
</p><p> マスクによる酸素投与: P/F <300
</p><p> PSI ≥130, Group Vに分類されたCAP</p><p>・除外項目: 気管挿管を希望しない患者, インフルエンザ肺炎, 敗血症性ショック症例.</p><p>・Hydrocortisoneは200mg/d, 4-8日継続し, その後減量.
</p><p> 投与期間は臨床的改善の有無で決められた.</p><p>
合計8-14日間投与.</p><p>・
28日間の死亡リスクを比較した</p><p><br /></p><p><span style="color: #800180;">StudyはN=800の時点で, 死亡リスクに差が認めたために中断.
</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnqrJgrRXjf_9Sy2bmIYomBUnWpq_1z2b7S2TU5ue13i9J2xTj0q3OoVC-0XIJXl56wJ3Uf_mtbYKodt3uMmanQYieMPRG0K0c6YBvtM1NuupHBTmE3OnJw-44MtHJpvmFgUUCfnty7fOHwR2jw0T9DMSQcbqa8CXl1xzVuRJSw1eKi-Q5nukdu-pvBw/s540/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="353" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnqrJgrRXjf_9Sy2bmIYomBUnWpq_1z2b7S2TU5ue13i9J2xTj0q3OoVC-0XIJXl56wJ3Uf_mtbYKodt3uMmanQYieMPRG0K0c6YBvtM1NuupHBTmE3OnJw-44MtHJpvmFgUUCfnty7fOHwR2jw0T9DMSQcbqa8CXl1xzVuRJSw1eKi-Q5nukdu-pvBw/w418-h640/1.png" width="418" /></a></div><br /><p><span style="color: #800180;">アウトカム:</span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiESNpBmhgTc_DWIAkhUnc1km7bWv_cO_9_joAVP048xJJSCjG-F6gcVLDk0kKTf8afihBol7xQoJlAZTpcywD8d0pQjRxr04rxNJTAQYCE3PVUBhIORsSMxTGep09ily7-f6nR096gYMkShom7BJBxj8a_aYtiU6wFBcC5DNyJO6qRXejnOaDdTLptQ/s495/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="495" data-original-width="481" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiESNpBmhgTc_DWIAkhUnc1km7bWv_cO_9_joAVP048xJJSCjG-F6gcVLDk0kKTf8afihBol7xQoJlAZTpcywD8d0pQjRxr04rxNJTAQYCE3PVUBhIORsSMxTGep09ily7-f6nR096gYMkShom7BJBxj8a_aYtiU6wFBcC5DNyJO6qRXejnOaDdTLptQ/w622-h640/1.png" width="622" /></a></span></div><span style="color: #800180;"><br /></span><p></p><p>・28日死亡率は, Hydrocortisone投与群では6.2%[3.9-8.6]
</p><p> Placebo群では11.9%[8.7-15.1], AD -5.6%[-9.6~-1.7]と有意にHydrocortisone群で低下する</p><p>・人工呼吸器管理がされていなかった患者群では,
</p><p> その後呼吸器管理となったのは18.0% vs 29.5%, HR 0.59[0.40-0.86]</p><p>・昇圧薬未使用群では, その後昇圧薬を使用したのは
15.3% vs 25%. HR 0.59[0.43-0.82]と, これらも有意にHydrocortisone群で重症化リスクの低下が期待できる.</p><p><br /></p><p>・消化管出血リスクや感染症リスクは両者で有意差なし</p><p>・インスリン使用量はステロイド投与群で増加する</p><p><br /></p><p>-------------------------------</p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">重症市中肺炎ではステロイドの投与により予後の改善が期待できる.</span></span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">これまでも臨床的な改善効果などは認められていたものの, どのような患者群で投与すべきかが明確ではない問題点があったが, これにより投与により利益が期待できる患者群がある程度わかってきたかもしれない.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-18942820506708615002023-03-06T18:49:00.003+09:002023-03-06T18:49:57.627+09:00心筋障害を伴う膠原病<p> ○○性の横紋筋融解症+心筋炎症例があったので</p><p>膠原病で心筋障害を伴うものはどのような疾患があるのか? を最近のレビューからまとめ</p><p>(Autoimmunity Reviews 21 (2022) 103037)</p><p><br /></p><table cellpadding="0" cellspacing="0" style="border-collapse: collapse; color: black;"><tbody><tr><td style="background-color: #ae0004; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 12px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><b>疾患</b></span></p></td><td style="background-color: #ae0004; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 12px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><b>頻度</b></span></p></td><td style="background-color: #ae0004; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 12px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><b>特徴</b></span></p></td><td style="background-color: #ae0004; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 12px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><b>診断に有用な所見</b></span></p></td><td style="background-color: #ae0004; border-color: rgb(255, 255, 255); border-style: solid; border-width: 1px 1px 3px; height: 12px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: white; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><b>予後への関連</b></span></p></td></tr><tr><td style="background-color: #eecaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心サルコイドーシス</span></p></td><td style="background-color: #eecaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">臨床診断</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 0.58-7.4%<br /></span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心臓</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">MR 13-45.7%<br /></span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">剖検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 24-45%</span></p></td><td style="background-color: #eecaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">見逃されている症例が多い可能性がある</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><br /></span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">様々な臨床パターン</span></p></td><td style="background-color: #eecaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, PET, AHA, AIDA</span></p></td><td style="background-color: #eecaca; border-color: rgb(255, 255, 255); border-style: solid; border-width: 3px 1px 1px; height: 53px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">予後悪への関連</span></p></td></tr><tr><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 48px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">SLE</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 48px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">臨床診断</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 3-11%<br /></span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">剖検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 15-50%</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 48px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">女性例が</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">90-100%<br />31%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">は心原性ショック</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 48px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">高活動性の</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Lupus</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">は心筋障害のリスク</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 48px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">重症度が低ければステロイドで心機能の改善んが期待</span></p></td></tr><tr><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">SSc</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検で</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"> 3%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">程度</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心臓</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">Raynaud</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">現象</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 53px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心臓</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">MR</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">でのびまん性の心筋線維化</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">. AHA, AIDA</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 53px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">SSc</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">関連死亡の</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">26%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">が心疾患</span></p></td></tr><tr><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 49px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">EGPA</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 49px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">8-38%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">で心筋炎の報告</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 49px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">好酸球性心筋炎</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;"><br /></span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">男女差は無し</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 49px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">ANCA</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">陰性例の方がより頻度が高い</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 49px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">若年診断例で高リスク</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">. </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心筋炎頻度が高いと予後悪と関連</span></p></td></tr><tr><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 51px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">抗リン脂質抗体症候群</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 51px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">稀に報告</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 51px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">致命的な症例の</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">14%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">が心臓障害を伴う</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">CAPS</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 51px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心筋</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">MR, </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">免疫グロブリン</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, C3</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">沈着所見</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 51px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">CAPS</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">で心筋障害を合併</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">. </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">予後が悪い</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">.</span></p></td></tr><tr><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 32px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">皮膚筋炎</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 32px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">38%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">で心筋障害</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 32px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心血管障害の合併は主な死因の</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">1</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">つとなる</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 32px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心筋</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">MR</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 32px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">死亡原因の</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">46.3%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">が心疾患による</span></p></td></tr><tr><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 43px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">高安病</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 43px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検で</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">50%</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 43px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">アジアの若年女性で多い疾患</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">.</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 43px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心内膜生検</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">, </span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心筋</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">MR, PET</span></p></td><td style="background-color: #eecaca; border: 1px solid rgb(255, 255, 255); height: 43px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">TA</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">活動性と相関して心筋障害を認める</span></p></td></tr><tr><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 72px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">炎症性腸疾患</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 72px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">全体の頻度</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">0.01%<br />UC</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">で</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">0.018%, <br />CD</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">で</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">0.009%<br />70%</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">が心外膜炎の報告</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 72px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">5-ASA</span><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">の薬剤性障害の関連もある</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">.</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 72px; padding: 4px; width: 126px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">心筋のリンパ球浸潤や巨細胞浸潤が認められる</span><span style="color: black; font-family: Arial; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">.</span></p></td><td style="background-color: #f7e6e6; border: 1px solid rgb(255, 255, 255); height: 72px; padding: 4px; width: 125px;" valign="middle"><p style="margin: 0px;"><span style="color: black; font-family: Hiragino Sans; font-size: 12px; font-stretch: normal; font-variant-ligatures: common-ligatures; line-height: normal;">巨細胞性心筋炎は予後不良と関連</span></p></td></tr></tbody></table><br /><div>サルコイドーシス, SLE, SSc, EGPA, APS, DM, TAK, IBDが代表的なところ.</div><div><br /></div>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.comtag:blogger.com,1999:blog-209997659381228251.post-10940620956580069662023-02-28T09:59:00.002+09:002023-02-28T09:59:22.326+09:00関節リウマチと線維筋痛症<p> 線維筋痛症(Fibromyalgia:FM)についてはこちらも参照</p><p><a href="http://hospitalist-gim.blogspot.com/2014/04/fibromyalgia.html" target="_blank">http://hospitalist-gim.blogspot.com/2014/04/fibromyalgia.html</a></p><p><br /></p><p>1年前に感染症を契機として, 全身の関節痛が出現した中年女性.</p><p>近医を受診し, 軽度のCRP上昇, ACPA弱陽性からRAと診断され, DMARDが開始.</p><p>しかしながらDMARD開始後も疼痛が改善せず薬剤はどんどん増量.... したが疼痛は持続.</p><p>転医を希望され, 紹介となった, という設定の症例.</p><p><br /></p><p><br /></p><p>診察すると腫脹関節は認めないが, 関節はかなり痛がる様子.</p><p>おかしいな? と思いエコーを行うが, 滑膜肥厚やPDの亢進所見は認めない.</p><p><br /></p><p>これは,「 RAだけではない or RAじゃない」のではないかと考えて全身の疼痛を評価すると,</p><p>頸部、肩、肘〜 手指はDIP、はたまた関節外の筋把握痛など... さまざまな部位に圧痛を認める</p><p><br /></p><p>これはFMぽい. 最初はRAだったのか? それは最初に見てないからわからない.</p><p>詳細は避けるが, 掘るとどんどん出る環境因子...</p><p><br /></p><p><br /></p><p>ところでRAでFMを合併するのはどの程度か, というのを調べてみた.</p><p><br /></p><p>-----------------------------</p><p><br /></p><p><b><span style="color: red;">RAとFM</span></b></p><p><span style="color: #800180;">RAとFMSは合併することがある</span></p><p>・報告では381例のRAのうち25.7%でFMの診断基準を満たすものや (Ann Saudi Med 41(4): 246-252. )</p><p>
13.4%で合併するとした前向きCohort
(Arthritis & Rheumatism (Arthritis Care & Research) Vol. 61, No. 6, June 15, 2009, pp 794–800)</p><p> 20.8%で合併していた報告など (Clinical Rheumatology (2022) 41:1235–1240)</p><p>・2019年のSystematic ReviewではRAの18-24%, axSpAの14-16%, PsAの18%で合併すると記載 (Best Practice & Research Clinical Rheumatology 33 (2019) 101423)</p><p><br /></p><p>・およそRAの5-10人に一人がFMを満たす.</p><p><br /></p><p><span style="color: #800180;">FMを合併したRA患者では, 非合併例と比較して,</span></p><p>・圧痛関節数が多く, PGAも有意に悪い.
</p><p> ESRやCRPといった炎症パラメータ, 腫脹関節数は有意差なし (Ann Saudi Med 41(4): 246-252. )</p><p>・ステロイドや他のDMARDの使用量も多くなる傾向がある. (rev bras reumatol. 2017;57(5):403–411)</p><p><br /></p><p><span style="color: #800180;">FM合併例と非合併例の比較 (</span>Clinical Rheumatology (2022) 41:1235–1240<span style="color: #800180;">)</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2G9DnqnB6QONvImgrwnL3PpDANiI8i0AhruY4lB1r33FgaIXGbJ6Ut0-PGnMstYzuvklah1WC7loo1DlOYvLKGSjWrHioj4DEt2IrgEjkgZ1-4AgD-5sKChTu7U2DGrGaIY4mno8KPgz-8Buv0HqiORgIQLxfn4CvxZAwTBni2kflRjabCHDan-Hidw/s1496/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1496" data-original-width="790" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2G9DnqnB6QONvImgrwnL3PpDANiI8i0AhruY4lB1r33FgaIXGbJ6Ut0-PGnMstYzuvklah1WC7loo1DlOYvLKGSjWrHioj4DEt2IrgEjkgZ1-4AgD-5sKChTu7U2DGrGaIY4mno8KPgz-8Buv0HqiORgIQLxfn4CvxZAwTBni2kflRjabCHDan-Hidw/w338-h640/1.jpg" width="338" /></a></div><p></p><p>・特に圧痛関節数に大きな差があり, その影響でVASやQOLの低下がある</p><p>・また, よくうつ症状や不安症状
倦怠感を訴える例も多い.</p><p><br /></p><p><span style="color: #800180;">同様に合併例と非合併例の比較 (</span>Arthritis & Rheumatism (Arthritis Care & Research) Vol. 61, No. 6, June 15, 2009, pp 794–800<span style="color: #800180;">)</span></p><p><span style="color: #800180;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="color: #800180;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjHpOcWgl8miu54vvSRuzlGV_UT03mqUquz8qURaSzYuOIh5NA3YWSYF7pc7AOFVhaiRe9tekwRPvGpEOAW6Ji6sE8s4V-47N_mbY0DQPPYrss1VGS4iL8P4pO4zExdF2Duz7vODMkpqBG_Gn5rPKOcg4t2JGHbTeBWeE9h9g88rWV0nxzr2Uk4pSPRQ/s1470/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1470" data-original-width="1088" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjHpOcWgl8miu54vvSRuzlGV_UT03mqUquz8qURaSzYuOIh5NA3YWSYF7pc7AOFVhaiRe9tekwRPvGpEOAW6Ji6sE8s4V-47N_mbY0DQPPYrss1VGS4iL8P4pO4zExdF2Duz7vODMkpqBG_Gn5rPKOcg4t2JGHbTeBWeE9h9g88rWV0nxzr2Uk4pSPRQ/w474-h640/1.jpg" width="474" /></a></span></div><p></p><p>・FMに関連する症状として,</p><p>
頭痛や倦怠感, 異常感覚,
口渇感やドライアイ
睡眠障害, 気分障害がある</p><p>・また, 全身の疼痛が目立つ
圧痛点の数も多い.</p><p><br /></p><p>--------------------------------</p><p><span style="color: #2b00fe;">・RAとFMはそれなりに合併があり得る.</span></p><p><span style="color: #2b00fe;">・FM合併例ではPGAやTJCが増加し, RAの活動性が高く見積もられるものの, それに対してDMARDを増量しても, 解決にはならない可能性がある. </span></p><p><span style="color: #2b00fe;"><span style="caret-color: rgb(43, 0, 254);">・しっかり関節所見の評価, エコーなども用いてFMを意識し, それに対するアプローチを行った方がよりよい疼痛管理, 適切なDMARDの使用ができるのでは.</span></span></p>GIMhttp://www.blogger.com/profile/18151682169201880846noreply@blogger.com