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Alpha-glucosidase inhibitor use is associated with decreased colorectal neoplasia risk in patients with type 2 diabetes mellitus receiving colonoscopy: a retrospective study

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Title

Alpha-glucosidase inhibitor use is associated with decreased

colorectal neoplasia risk in patients with type 2 diabetes mellitus

receiving colonoscopy: a retrospective study( 内容と審査の要旨

(Summary) )

Author(s)

堀部, 陽平

Report No.(Doctoral

Degree)

博士(医学) 乙第1496号

Issue Date

2018-09-12

Type

博士論文

Version

ETD

URL

http://hdl.handle.net/20.500.12099/77235

※この資料の著作権は、各資料の著者・学協会・出版社等に帰属します。

(2)

Ặ ྡ 㸦 ᮏ ⡠ 㸧 ᇼ 㒊 㝧 ᖹ 㸦ᒱ㜧┴㸧 Ꮫ ఩ ࡢ ✀ 㢮 ༤ ኈ㸦་Ꮫ㸧

Ꮫ ఩ ᤵ ୚ ␒ ྕ எ➨  ྕ

Ꮫ ఩ ᤵ ୚ ᪥ ௜ ᖹᡂ  ᖺ  ᭶  ᪥ Ꮫ ఩ ᤵ ୚ せ ௳ Ꮫ఩つ๎➨㸲᮲➨㸰㡯ヱᙜ

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(3)

᪉㸪Ș*, ෆ᭹ 25 㸪&, ̽㸪S  㸪/'$ ෆ᭹ 25 㸪&, ̽㸪S  ࡣ᭷ព࡟ప࠸ࣜࢫࢡ࡜㛵㐃ࡋ࡚࠸ࡓࠋ ࠙⪃ᐹࠚ  Ș*, ࡣ㣗┤ᚋࡢ㧗⾑⢾ࢆᢚไࡋ㸪㧗࢖ࣥࢫࣜࣥ⾑⑕ࡢᨵၿຠᯝࢆⓎ᥹ࡍࡿ⢾ᒀ⑓἞⒪⸆࡛࠶ࡿࠋ ᮏ◊✲⤖ᯝࡼࡾ㸪 ᆺ⢾ᒀ⑓ᝈ⪅࡟࠾࠸࡚㸪ྠ๣ࡢෆ᭹ࡀ኱⭠⭘⒆ᙧᡂ࡟ᑐࡋᢚไⓗ࡟ാࡃྍ⬟ᛶࡀ ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡇࢀࡲ࡛࡟㸪 ᆺ⢾ᒀ⑓࡟ࡼࡿ࢖ࣥࢫࣜࣥ᢬ᢠᛶࡢቑ኱࡟క࠺㧗࢖ࣥࢫࣜࣥ≧ែࡀ ኱⭠⭘⒆ᙧᡂࢆಁ㐍ࡍࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡀ㸪Ș*, ࡟ࡼࡿ኱⭠⭘⒆ᙧᡂᢚไᶵᗎࡢ୍ࡘ࡜ࡋ࡚㸪 㧗࢖ࣥࢫࣜࣥ⾑⑕ࡢᨵၿࡀ㔜せ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡓࠋࡲࡓ Ș*, ࡣ㸪౽ࡢ኱⭠㏻㐣᫬㛫ࢆ▷⦰ࡍࡿࡇ ࡜࡛኱⭠Ⓨ⒴ࡢࣜࢫࢡᅉᏊ࡛࠶ࡿ⭠⢓⭷ࡢ⫹Ồ㓟᭚㟢ࢆῶᑡࡉࡏࡿࡇ࡜ࡸ㸪Ⓨ⒴࡟ᢚไⓗ࡟ാࡃ⭠⟶ ෆࡢ㓗㓟ࣞ࣋ࣝࢆୖ᪼ࡉࡏࡿࡇ࡜ࡶሗ࿌ࡉࢀ࡚࠾ࡾ㸪」ྜⓗ࡞ᶵᗎ࡟ࡼࡗ࡚  ᆺ⢾ᒀ⑓ᝈ⪅ࡢ኱⭠⭘ ⒆ᙧᡂࢆᢚไࡍࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ  /'$ ࡛ࡣ㸪&2; 㜼ᐖస⏝࡟ࡼࡾ኱⭠⒴ᢚไస⏝ࢆⓎ᥹ࡍࡿ࡜࠸࠺ᇶ♏◊✲ࡢሗ࿌ࡸ㸪㐲㝸㌿⛣ࢆ᭷ ព࡟ᢚṆࡋࡓ࡜࠸࠺⮫ᗋ◊✲ࡢሗ࿌࡞࡝ࡀ࠶ࡾ㸪ᮏ◊✲࡛ࡶ᪤ሗ࡜ྠᵝ࡟ /'$ ෆ᭹ࡀ኱⭠⭘⒆ࣜࢫࢡ ࢆపୗࡉࡏࡿ⤖ᯝ࡛࠶ࡗࡓࠋࡲࡓᮏ◊✲࡛ࡣ㸪⏨ᛶ࠾ࡼࡧࢫࢱࢳࣥෆ᭹ࡀ኱⭠⭘⒆ࡢࣜࢫࢡᅉᏊ࡛࠶ ࡿࡇ࡜ࢆぢฟࡋࡓࡀ㸪ࢫࢱࢳࣥ࡟㛵ࡋ࡚ࡣ㸪⭘⒆ᢚไຠᯝࢆሗ࿌ࡍࡿㄽᩥࡢሗ࿌ࡀከ࠸ࠋࡇࡢ㐪࠸࡟ ࡣ⸆๣ࡢෆ᭹ᮇ㛫㸪ࢫࢱࢳࣥ౑⏝࡟క࠺⬡㉁್ࡢኚ໬㸪ࢫࢱࢳࣥࡢ✀㢮㸦⬡⁐ᛶ㸪Ỉ⁐ᛶ㸧ࡀホ౯ࡉ ࢀ࡚࠸࡞࠸࡞࡝ࡢ OLPLWDWLRQ ࡀ㛵ಀࡋ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋࡇࢀࡽࡢၥ㢟ࢆ⪃៖ࡋ㸪௒ᚋ㸪๓ྥࡁ ◊✲ࢆィ⏬ࡋ࡚࠸ࡃᚲせࡀ࠶ࡿࠋ ࠙⤖ㄽࠚ  㧗࢖ࣥࢫࣜࣥ⾑⑕ࡢᨵၿࡣ㸪⢾ᒀ⑓ࡢࢥࣥࢺ࣮ࣟࣝࡢࡳ࡞ࡽࡎ㸪኱⭠⭘⒆ᙧᡂࢆᢚไࡍࡿୖ࡛ࡶ㔜 せ࡞἞⒪┠ᶆ࡛࠶ࡿࠋ ᆺ⢾ᒀ⑓ᝈ⪅࡟࠾࠸࡚㸪Ș*, ࡸ /'$ ࡢෆ᭹ࡣ኱⭠⭘⒆ᙧᡂ࡟ᑐࡋᢚไⓗ࡟ ാࡃྍ⬟ᛶࡀ࠶ࡿࠋ≉࡟኱⭠⭘⒆ࣜࢫࢡࡢ㧗࠸⢾ᒀ⑓ᝈ⪅࡟ᑐࡍࡿ⾑⢾㝆ୗ๣࣭἞⒪⸆࡜ࡋ࡚㸪㧗࢖ ࣥࢫࣜࣥ⾑⑕ࢆᨵၿࡍࡿ Ș*, ࡣ㔜せ࡞㑅ᢥ⫥࡜࡞ࡾᚓࡿࠋࡲࡓࢫࢱࢳࣥࢆෆ᭹ࡋ࡚࠸ࡿ⏨ᛶ  ᆺ⢾ ᒀ⑓ᝈ⪅ࡣ㸪኱⭠⭘⒆ࡢ㧗ࣜࢫࢡ⩌࡛࠶ࡿྍ⬟ᛶࡀ࠶ࡿࡓࡵ㸪ៅ㔜࡞ IROORZXS ࡀᮃࡲࢀࡿࠋ  ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ⏦ㄳ⪅ ᇼ㒊 㝧ᖹࡣ㸪 ᆺ⢾ᒀ⑓ᝈ⪅࡟⏝࠸ࡽࢀࡿྛ✀ࡢ἞⒪⸆ࢆ୰ᚰ࡟኱⭠⭘⒆࡜ࡢ㛵㐃ᛶࢆ ホ౯ࡋࡓࠋࡑࡢ⤖ᯝ㸪Ș*,ࠊ/'$ ࡢෆ᭹ࡀ኱⭠⭘⒆ࣜࢫࢡࢆపୗࡉࡏ㸪ࢫࢱࢳࣥෆ᭹ࡣ኱⭠⭘⒆ࣜࢫ ࢡࢆୖ᪼ࡉࡏࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋࡇࢀࡽࡢ▱ぢࡣ᪂ࡋࡃ㸪௒ᚋࡢ◊✲ࢆಁࡍ㔜せ࡞ᡂᯝ࡜⪃࠼ࡽ ࢀ㸪ෆ⛉ᏛࡢⓎᒎ࡟ᑡ࡞࠿ࡽࡎᐤ୚ࡍࡿࡶࡢ࡜ㄆࡵࡿࠋ 㹙୺ㄽᩥබ⾲ㄅ㹛 <RKHL+RULEH6HLML$GDFKL7RPRKLNR2KQR1DRH*RWR0LWVXUX2NXQR0LGRUL,ZDPD2VDPX <DPDXFKL7DNDR.RMLPD.RVKLUR6DLWR7DNDVKL,EXND,FKLUR<DVXGD+LURVKL$UDNL +LVDWDND0RULZDNLDQG0DVDKLWR6KLPL]X$OSKDJOXFRVLGDVHLQKLELWRUXVHLVDVVRFLDWHG ZLWKGHFUHDVHGFRORUHFWDOQHRSODVLDULVNLQSDWLHQWVZLWKW\SHGLDEHWHVPHOOLWXV UHFHLYLQJFRORQRVFRS\DUHWURVSHFWLYHVWXG\ 2QFRWDUJHW㸪㸪9RO㸪 1R 㸪SS

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