Therapeutic Research

2024 年6 月,『高齢者および高齢社会に関する検討ワ-キンググル-プ報告書2024』が刊行され,2017 年の報告書と同様,医学的な観点から高齢者の定義を「75 歳以上」とし,65 ~ 74 歳を「准高齢者」,90 歳以上を「超高齢者」とすることが提唱された.同時に日本老年医学会の『健康長寿達成を支える老年医学推進5か年計画2024』も公表された.第66 回日本老年医学会学術集会(2024 年6 月13 日/ 名古屋)で,前者の概要を荒井秀典氏(国立長寿医療研究センタ-理事長),後者については神﨑恒一氏(日本老年医学会理事長)が解説した.

遺伝性疾患である家族性高コレステロ-ル血症は,2022 年4 月の診療報酬改訂で遺伝学的検査が保険適用された.しかし,検査の実施体制整備やゲノム医療に関連する人材育成が十分とは言えない.本セミナ-では吉田雅幸氏がゲノム医療の現状や今後の課題などについて解説した.

6 月18 日にオンラインで開催された,第8 回報道関係者向け勉強会「NIBIOHN って何だ?Part8」で,「科学的に考える中年太りとフレイルの予防法・対処法」のテ-マで山田陽介氏(国立研究開発法人 医薬基盤・健康・栄養研究所 身体活動研究部 運動ガイドライン研究室長)が,中年太りになる理由とその解消法,および中年太りとフレイル,水の代謝等との関連について解説した.本稿では概要を紹介する.

Introduction: Severe aortic regurgitation(AR) often leads to left ventricular remodeling and functional mitral regurgitation(FMR), exacerbating heart failure. We present a case of successful management of severe heart failure secondary to FMR resulting from advanced AR through percutaneous mitral valve repair, along with a literature review. Method: An 81 –year–old male with symptoms of heart failure and a history of chronic AR was admitted with worsening heart failure. Despite conventional therapy, his condition deteriorated, prompting consideration of percutaneous mitral valve repair using Mitra-ClipTM. Result: Postoperative evaluation showed improvement in mitral regurgitation to mild–to –moderate, with a mean mitral valve pressure gradient of 5.4 mmHg. The patient’s symptoms improved significantly, and he was discharged without recurrent heart failure exacerbation. Discussion: Advanced AR often leads to FMR and worsens the prognosis. Surgical intervention is recommended for patients with symptomatic heart failure and reduced left ventricular function, but in this case, percutaneous mitral valve repair was chosen due to high surgical risk and patient preference. Despite the lack of established efficacy in severe AR, MitraClipTM resulted in improved hemodynamics and heart failure symptoms. This case highlights the potential of percutaneous mitral valve repair as an effective alternative for managing severe heart failure secondary to FMR in advanced AR. Further research is warranted to evaluate its efficacy in this population. Conclusion: Percutaneous mitral valve repair with MitraClipTM effectively managed severe heart failure secondary to FMR in advanced AR, demonstrating significant improvement in symptoms and hemodynamics.

心筋炎は心筋を主座とした炎症性疾患であり,その中でも血行動態の破綻を急激にきたし,致死的経過をとる急性心筋炎は劇症型心筋炎(fulminant myocarditis)と定義される.劇症型心筋炎の救命には補助循環が不可欠であるが,急性期を乗り切ればその後の予後は比較的良好とされる1).劇症型心筋炎の急性期管理において最も重要なことは,循環動態の破綻による臓器障害を回避し,自然回復に至るまでの時期をいかに橋渡しするかである.今回われわれは,両心不全をきたした劇症型心筋炎に対し長期的に両心補助管理を行った1 例を経験したので報告する.

Background:In the medical field, most of database studies in Japan utilize medical receipts and DPC data. In this study, we investigated the steroid reduction effects of the monoclonal antibodies, Rituximab and Belimumab, in patients with systemic lupus erythematosus( SLE)using data derived from electronic medical records. 　　Objective:To describe the clinical characteristics of patients treated with rituximab and belimumab for SLE. 　　Methods:This study utilized data from the Japanese electronic medical record database“ DATuM IDEA®”(TOPPAN Holdings Inc.). We included data from 64 patients treated with Rituximab(n=21)and Belimumab(n=43). Daily corticosteroid dose, clinical laboratory values of biomarkers, and rates of adverse events were evaluated. 　　Results:Mean daily corticosteroid dose in the Rituximab group was 24.7 mg/day before prescription and significantly decreased to 6.55 mg/day after prescription. In the Belimumab group, the dose significantly decreased from 10.0 mg/day to 8.14 mg/day. 　　The rates of hematotoxicity, hepatotoxicity and glycolipid metabolism disorder after Rituximab or Belimumab prescription were investigated. Compared to the previous reports of rituximab, the rates of the adverse events in this study were lower, except for thrombocytopenia. The rates with belimumab were similar to the previous reports. 　　Conclusion:In this study, we elucidated the steroid reduction effects of Rituximab and Belimumab for SLE using electronic medical record data. This study suggests the potential to understand more detailed treatment practices that were previously unavailable by utilizing electronic medical record data.