Therapeutic Research

国民病である花粉症は重症化により仕事や勉強の能率，およびQOLを低下させる。政府でも花粉症に関する関係閣僚会議が開催され対策を進めている。日本耳鼻咽喉科頭頸部外科学会は2030年までに花粉症の重症化ゼロを目指し，2024年春の花粉症シーズンに向けて「花粉症重症化ゼロ作戦」を推進していくとして，セミナーで花粉症治療の情報発信を行った。本稿ではその概要を紹介する。

Five years have passed since our municipality introduced population–based endoscopic screening for gastric cancer. This screening is conducted as an individual examination at a certified medical institution, rather than in a group format using specific examination facilities or examination vehicles. As with many other municipalities, this screening project has been introduced, involving many issues such as securing medical examiners and secondary image interpreters, standard procedures for endoscopy, cleaning and disinfection of endoscopic equipment, and construction of accuracy control system, and handling of accidents. From the beginning of its introduction, it was difficult to set up a complete system based on “checklists for management evaluation” and “process indicators”. Although some contents were given to forms that suit down to conditions of our municipality at the beginning, we are continuously discussing to ensure in management committee that the implementation is in accordance with the guidelines provided by the Ministry of Health, Labor and Welfare and the Tokyo Metropolitan Government, and the “Population –based endoscopic screening for gastric cancer Manual 2017 Edition”. Therefore, we described the efforts, current status, assignment, and future outlook for the implementation of population –based endoscopic screening for gastric cancer in our municipality over the past five years.

目的：高血圧治療補助アプリ（以下，本アプリ）は2022 年9 月に保険適用となった本態性高血圧症に対する治療アプリである。本研究では臨床現場での本アプリの処方実態を評価する。　方法：2022 年9 月から2023 年4 月までに本アプリを処方された症例を対象に，多施設共同後ろ向き観察研究を行った。診療録情報とアプリデータを収集し，患者背景，血圧および降圧薬の処方状況の推移を検討した。　結果：国内11 施設の83 名が対象となり，平均年齢は56.8 歳（範囲：30～80 歳），男性が46名（55％），BMI の平均値は25.1 kg/m2であった。本アプリ使用開始時点では41 名（49％）が降圧薬を使用していた。合併症としては，糖尿病が14 名（17％），脂質異常症が41 名（49％），持続陽圧呼吸療法（CPAP）使用が11 名（13％）であった。本アプリの使用開始後24週における血圧は診察室血圧，起床時血圧，就寝前血圧いずれにおいてもベースラインから有意に低下していた。使用開始時点で降圧薬が使用された41名のうち14 名（34％）の症例で降圧薬が減量もしくは1 剤中止となっていた。　結論：高血圧治療補助アプリは実臨床における血圧管理の重要なアプローチの一つであり，降圧薬の減薬につながる可能性が示唆された。

Efficacy and safety of switch from GLP‒1 receptor agonist to GIP/GLP‒1 receptor agonist, tirzepatide were examined in Japanese out‒patients with type 2 diabetes. Switch to tirzepatide significantly decreased HbA1c by 1.04±0.83％ in poorly controlled Japanese out‒patients with type 2 diabetes. In addition, body weight and systolic blood pressure were significantly reduced by switch to tirzepatide. In the patients with HbA1c over 8.0％, the effects of tirzepatide on glycemic control were significantly higher than those in the patients with HbA1c 8.0％ or below. Treatment by tirzepatide for 4 months also significantly improved the degree of proteinuria. Efficacy and safety of switch from GLP‒1 receptor agonist to GIP/GLP‒1 receptor agonist, tirzepatide were confirmed in Japanese out‒patients with type 2 diabetes. The reduction of HbA1c by tirzepatide was significantly higher in the patients with HbA1c over 8.0％.