Volume 42,
Issue 12,
2021
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Topics
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Source:
Therapeutic Research 42巻12号, 821-829 (2021);
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2021年10月15 ~ 17日に第43回日本高血圧学会総会が開催され,2022年1月14日に第3回Digital Hypertension Conference,2022年10月12 ~ 16日には国際高血圧学会の開催が予定されている。現在,高血圧領域では新たな診療形態や治療法に関する多くの研究が活性化している。自治医科大学の苅尾七臣氏に,大規模臨床試験の結果,新薬,デジタル治療や腎デナベーションの実用化へ向けたアプローチ,高血圧ワクチンの開発,ウエアラブルデバイスやIoTの活用など,診療に直結した最新の話題について解説していただいた。
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総説
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Source:
Therapeutic Research 42巻12号, 833-838 (2021);
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慢性閉塞性肺疾患(COPD)は気流閉塞を伴う慢性疾患であり,他の生活習慣病と同様,発症・重症化の予防が重要である。しかし,COPDは診断されても治療が開始されない患者が多い。その背景には,患者の疾患理解度が低く,症状が進行し日常生活に支障をきたさないかぎり,治療開始の意欲があがらないことが想定される。COPD は適切に管理しなければ,QOL を著しく損なうとともにフレイルへと移行し,やがて要介護状態から死に至る可能性が高い。よって治療開始への動機付けを行うことがきわめて重要であり,そのためには患者と医療者の双方が,将来の健康リスクについて十分なコミュニケーションをとることが大切である。
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Source:
Therapeutic Research 42巻12号, 839-845 (2021);
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COPD治療においては,一部の患者で適切なコントロールができていないことが大きな課題の一つである。本稿では,COPD治療の服薬アドヒアランスに関する報告を整理するとともに適切に管理するためのポイントについて概説した。 本稿が服薬アドヒアランスの向上,ひいてはCOPD管理目標の達成につながることを期待する。
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原著
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Source:
Therapeutic Research 42巻12号, 847-855 (2021);
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Background:Clinical characteristics in severe asthma patients have been studied well. Few studies have examined patient perception for asthma treatment and asthma disease in severe asthma patients. Object:To descriptively investigate patient satisfaction for current asthma treatment, perception for asthma treatment and subjective disease burden for asthma between severe asthma patients with biologics treatment(BIO treated patients)and severe asthma patients with biologics recommendation(BIO recommended patients). Method:This study was a cross‒sectional web survey of severe asthma patients aged≧20 years with, asthma diagnosis and one of three criteria for severe asthma(1:high dose inhaled corticosteroid and additional asthma treatment, 2:continuous oral corticosteroid use, 3:biologics use). Patient perception for asthma treatment and asthma disease was evaluated with original questionnaires. Results:Among 1247 severe asthma patients, 144 BIO treated patients and 48 BIO recommended patients were included. Proportion of patients with satisfaction for asthma treatment in BIO treated patients(65.3%)was higher than in BIO recommended patients(52.1%). Patient perception for current treatment with 10% or more difference between two groups is“good treatment”,“ continuous high efficacy”and“latest treatment”(higher in BIO treated patients)and“intention to continue current treatment to consider cost”(higher in BIO recommended patients). Conclusion:This is the first study to clarify patient satisfaction for current asthma treatment in BIO treated patients and BIO recommended patients. Improvements for severe asthma treatment are expected by consideration of patient perception of asthma treatment and asthma disease shown in this study.
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Source:
Therapeutic Research 42巻12号, 857-866 (2021);
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Background:Biologics for severe asthma patients showed clinical efficacy. However, some severe asthma patients never accept initiation of biologics. Although insufficient understanding by patients for efficacy of biologics and self‒payment for biologics may be related, the fact remains to be elucidated. Object:To descriptively investigate patient expectation for biologics and process of biologics recommendation between severe asthma patients with biologics treatment (BIO treated patients)and severe asthma patients with biologics recommendation(BIO recommended patients). Method:Cross‒sectional web survey of severe asthma patients aged≧20 years with, asthma diagnosis and one of three criteria for severe asthma(1:high dose inhaled corticosteroid and additional asthma treatment, 2:continuous oral corticosteroid use, 3:biologics use)was conducted. Patient expectation for biologics and process of biologics recommendation were evaluated with original questionnaires. Results:Among 1247 severe asthma patients, 144 BIO treated patients and 48 BIO recommended patients were included. In both groups, approximately half of patients received explanation about efficacy of biologics including improvements of respiratory function and asthma symptoms. On the other hands, proportion of patients without explanation for biologics cost by physician was higher in BIO recommended patients (50.0%)than in BIO treated patients(21.5%). Conclusion:This is the first study to investigate explanation of biologics and process of biologics recommendation in BIO treated patients and BIO recommended patients. Severe asthma patients in need of biologics will be treated with biologics in future by utilizing the information about explanation and recommendation process for biologics shown in this study.
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Source:
Therapeutic Research 42巻12号, 867-876 (2021);
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背景:P 波加算平均心電図(P–SAECG)は,わずかな心房伝導異常を検出でき,P–SAECGによる心房遅延電位(ALP)の検出は,心房細動の発症リスクなどの評価が可能である。また,心機能の測定の一つとして,二次元スペックルトラッキングエコー(2D–STE)を用いて,左室容積曲線とその時間微分曲線から心機能評価が可能である。左房機能は,左室拡張能と関連することがよく知られている。本研究の目的は,P–SAECGと2D–STEを用いて,心房伝導と左室拡張能の関係を調べることである。 方法:対象は左室収縮能が正常で,同日にP–SAECGと2D–STEを実施した男性110名(年齢48.0±13.2歳)である。P–SAECG波形のフィルター化P波持続時間(FPD,msec)とP波終末部20 msec の電位の二乗の平均値の平方根(RMS20,μV)を測定した。ALP陽性はFPD>120 msecかつRMS20<3.5μVと定義した。2D–STEを用いて左室拡張末期容積(EDV)にて補正した左室急速充満期最大速度(PRFR,/sec),心房収縮期最大充満速度(PAFR,/sec)を算出した。 結果:FPDは134.1±11.7 msec,RMS20は4.46± 2.10μVであった。PRFRは2.22 ± 0.58/sec,PAFR は1.49 ± 0.64/sec であった。FPD とPRFRの間には有意な関係がなかった(r=- 0.16,p = 0.096)が,FPDとPAFRには正の相関が認められた(r = 0.24,p = 0.013)。一方,RMS20はPRFRと正の相関を示した(r=0.22,p=0.022)が,RMS20 はPAFRとは有意な関係を示さなかった(r =- 0.07,p = 0.48)。多変量ロジスティック解析では,PRFRはALP陽性の独立因子であった。 結語:本検討から,心房伝導と左室拡張能は密接に関連している可能性があると考えられた。
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症例
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Source:
Therapeutic Research 42巻12号, 877-884 (2021);
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Background:Hyperglycemia has been reported to be a risk factor for frailty and sarcopenia in older patients with type 2 diabetes mellitus. However, the effects of correcting glycemic control on frailty or sarcopenia have not been fully elucidated. Objective:The purpose of this study was to evaluate the effect of correcting hyperglycemia on the progression of sarcopenia in older diabetic patients with prefrailty. Method:The participants were given either a fixed‒dose combination of glinide and alpha‒glucosidase inhibitor(intervention group)or a small dose of sulphonylurea (control group)for 6 months. The effects on muscle mass, muscle strength, and gait speed as well as the changes in glycemic control, the markers of inflammation, oxidative stress, and advanced glycation endproducts were examined. Results:Five patients(mean age:75.0 years)were enrolled in this study, three in the intervention group and two in the control group. There was no difference in clinical background at baseline between both groups. HbA1c improved in both groups, however, the daily mean of blood glucose tended to improve more in the intervention group. There was no dif ference in muscle mass or gait speed between both groups. Grip strength increased in the intervention group, however, decreased in the control group. Blood IL‒6 and urine pentosidine levels decreased in the inter vention group but increased in the control group. Conclusion:Hypoglycemic treatment of older preflail diabetic patients with hyperglycemia with glycemic variability may contribute to the improvement of muscle strength. Further studies in a sufficient number of subjects must be needed.
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INFORMATION
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Source:
Therapeutic Research 42巻12号, 886-887 (2021);
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Source:
Therapeutic Research 42巻12号, 888-889 (2021);
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