Therapeutic Research

5年ごとに改訂される「動脈硬化性疾患予防ガイドライン」の2022年版が7月4日に発行された。日本動脈硬化学会は翌5日にプセスセミナーを開催し，2022年版のガイドライン委員長である岡村 智教氏（慶應義塾大学衛生学公衆衛生学 教授）が今回の改訂点を中心に解説した。（編集部取材）

J – CLEAR 特別座談会では，高血圧領域で2021 年に発表された論文を中心に，NC – RisCによる世界の高血圧の状況，中国の代用塩の大規模試験，オンライン診療による家庭血圧のHOME BP 研究が紹介された。降圧薬はQUARTET 試験，ミネラルコルチコイド受容体拮抗薬，降圧目標はSPRINT 試験最終レポート，STEP 試験，BPLTTC のメタ解析，年齢による区別をしていないWHO 高血圧治療ガイドライン2021 が解説された。さらに，RAS 阻害薬とCOVID – 19 の関係，腎デナベーションなど多岐にわたる最新情報が取り上げられた。　（2022年2月2日収録，CareNet.comで3 月29日に公開された内容を基に編集部で作成）

Background: Heart failure（HF） pandemic is expected to be evident in Kanagawa. A seamless approach is critical for patient care of HF. Methods: Between November 2018 and April 2021, 138 patients（80 men, mean age 79 years） with HF were registered to the clinical pathway to coordinate with local clinics（cardiologist 23％, general practitioner 77％）. Information was provided to a clinic including optimal body weight and exacerbating factors. All patients were supplied a textbook for self–monitoring and self –management of HF. Patients were prescribed with medicine by a clinic doctor, filled in the check sheet for health condition, and followed by a cardiologist in our hospital every 6 months. Results: The incidence of cardiac death or HF requiring hospitalization was 16％ during an average of 216 days follow–up. Patients with above HF events（n＝22） were older（84 vs 78 years）, and had higher rates of prior history of HF hospitalization ≧3 times（27 vs 8％）, anemia（68 vs 41％）, chronic kidney disease（95 vs 73％）, and certification for long – term care or support need（59 vs 26％）（p＜0.05, respectively）, compared those without （n ＝ 116）, with no difference in the percentage of cardiology clinics（18 vs 23％）. Multiple logistic regression analysis identified certification for long –term care or support need as the independent predictor of HF events. Conclusion: We started applying a clinical pathway for patients with chronic HF in Fujisawa. Strong multidisciplinary teams embracing both hospital and community healthcare professionals, should be developed to improve patient outcomes.

メカニカルサポート下での心室頻拍アブレーションはいまだに報告例が少なく，その成績や術後経過などに関して不明確な点が多い。　頻脈誘発性心筋症は，頻脈性不整脈を解除し，心機能改善が得られることで診断に至る。つまり，長期間の経過をフォローすることにより診断されるものであり，急性期にはその他心筋症との鑑別に難渋することは臨床上しばしば経験される。　今回，われわれは若年男性の心室頻拍および頻脈誘発性心筋症に対して，IMPELLA CP®補助下にカテーテルアブレーションを行い奏効した1例を経験したため報告する。

僧帽弁閉鎖不全症（mitral regurgitation：MR）に対する治療選択が広がる中で，心機能や重症度とともに逆流の原因や形態を正確に評価することが重要である。MRの原因には僧帽弁尖や腱索の構造異常で生じる器質性（一次性）と，左室や左房拡大による機能不全に伴う機能性（二次性）に分類される。機能性MR（functionalMR：FMR）は左室拡大や収縮機能低下に起因する僧帽弁尖のテザリングによる心室性FMR（ventricular FMR：VFMR）と，左房拡大によって生じる心房性FMR（atrial FMR：AFMR）とに分類され，AFMRは新しい概念として注目されている。症候性AFMRの治療戦略は心不全に対する十分な薬物治療が重要であり，改善が乏しい場合には心房細動に対するカテーテルアブレーションや外科的手術が推奨される1）。しかし，洞調律維持が困難である症例や手術リスクが高い症例に対する追加治療に関しては明確な基準が存在しない。今回，AFMRを伴う心不全に対してMitraClipTMが奏効した症例を経験したため，文献的考察を含めて報告する。

Fabry病はライソゾームに存在する酵素の欠損により，細胞内にグロボトリアオシルセラミドという糖脂質が蓄積することで臓器障害が生じるX染色体劣性遺伝子病である。小児期から多臓器器官症状を呈する古典型Fabr y病は，欧米では男性の4 万～ 11 万人に1 人の割合といわれている。1995 年に鹿児島大学のグループが左室肥大を有する成人男性230 例中7 例にα – ガラクトシダーゼ活性低下を認め1），心障害を主とする心Fabr y病が注目されるようになった。近年，酵素補充療法が病状の進行を抑制することが報告され，早期診断，治療開始の重要性が認識された。今回われわれは僧帽弁閉鎖不全症を合併した初回心不全患者において，ろ紙血法により心Fabr y病と診断し，早期治療を導入できた症例を経験したので報告する。

Objectives：This investigation was conducted to evaluate the long‒term safety and effectiveness of vilanterol/fluticasone furoate dry powder inhaler（FF/VI）in patients with chronic obstructive pulmonary disease（COPD）in routine clinical practice. 　　Methods：The subjects were patients diagnosed with COPD and previously untreated with FF/VI, and the observation period per patient was one year from the start of treatment with FF/VI. The safety was evaluated based on the incidences of adverse drug reaction （ADRs）, and the effectiveness was evaluated based on the investigator’s global assessment according to the courses of patient‒reported symptoms and of clinical symptoms, COPD exacerbations, and the time courses of respiratory function test values and the COPD Assessment Test（CAT）score and such. 　　Results：ADRs were reported in 43（4.4％）of 968 patients in the safety analysis set of this investigation. The most common ADRs were pneumonia in 9 patients（0.9％）, dysphonia in 9（0.9％）, COPD in 8（0.8％）, and oral candidiasis in 4（0.4％）. 　　Among 889 patients in the effectiveness analysis set, the proportion of responders based on the global assessment was 89.3％（794/889）；decreases in the number of COPD exacerbations and increases in respiratory function test values（FEV1, FVC）were observed. 　　Conclusion：The results of this investigation revealed no new safety issues, suggesting the safety and effectiveness of long‒term FF/VI treatment in routine clinical practice.

Purpose：Our previous study in 2021＊ found that there were safety hazards for health foods promoted for pregnancy purposes, as well as related problems between sellers and consumers. Therefore, the purpose of this study was to clarify the characteristics of catchphrases included on the enterprise homepages viewed by persons trying to conceive. 　　Methods：A keyword search of Yahoo! internet search engines, which have many Japanese consumers, was conducted from April 22, 2022 to April 29, 2022. The keywords were“ conception”,“ supplement”, and“ ranking”, and the top five advertising information sites（organizing the ranking of supplements）were adopted. Catchphrases（CFs：key phrases used for public relations）about the concepts of company products in each ranking were extracted. If there were similar phrases, they were combined. After data cleaning the phrases, quantitative text analysis was performed. The decomposition from text data into words was performed by computer programs, which decomposed the CFs into meaningful minimum units and determined parts of speech. 　　In addition, co‒occurrence network analysis was performed on the high ranking, frequently spoken words. This analysis method groups and illustrates a group of words from their simultaneous appearance（co‒happening）in relation to the extracted word. Furthermore, categorization was performed based on the groups identified by co‒occurrence network analysis, and a category was interpreted and named while checking the CF itself and centering on the co‒occurrence words. The Jaccard coefficient（setting over 0.2）was performed to determine the relevance of each occurrence pattern of the word. The KH Coder 3 was used for analysis. Results：Thirty‒four products were extracted from 33 companies. The number of sentences contained in the text data used in the analysis was 487, and the total number of extracted words was 4,957, of which 1,127 were different types of words“. Pregnancy” was the most frequent word（72 occurrences）, followed by“ folic acid”（54 occurrences）. Six categories were obtained from the co‒occurrence network analysis and named as follows：“ Folic acid is rich in other ingredients”,“ Support for women who wish to become pregnant or are pregnant”,“ Health of babies and moms”,“ Recommended by the Ministry of Health, Labor and Welfare”,“ Effectiveness of monoglutamic acid type”, and “Commitment to safety”. In public relations, the words in each CF are message‒oriented, and if six or more categories are included, pregnant women see it as compelling and attractive information, which encourages them to imagine a bright future. Additionally, it can mislead them into thinking they can get pregnant. 　　Conclusion：Consumer education is needed to enable consumers to accurately understand and interpret CF in order to prevent the misconception that supplements can lead to pregnancy. ＊Kamioka H, Wada Y, et al. Health problems and conflicts related to claimed“Health Foods”for individuals trying to conceive in Japan. Therapeutic Research 2021；42：559‒571