Title
Cerebral Glucose Metabolism in Patients with Chronic Mental
and Cognitive Sequelae after a Single Blunt Mild Traumatic Brain
Injury without Visible Brain Lesions( 内容と審査の要旨
(Summary) )
Author(s)
河村, 章史
Report No.(Doctoral
Degree)
博士(医学) 甲第1091号
Issue Date
2019-01-16
Type
博士論文
Version
none
URL
http://hdl.handle.net/20.500.12099/77430
※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。Ặ ྡ 㸦 ᮏ ⡠ 㸧 Ἑ ᮧ ❶ ྐ 㸦ᒱ㜧┴㸧 Ꮫ ࡢ ✀ 㢮 ༤ ኈ㸦་Ꮫ㸧
Ꮫ ᤵ ␒ ྕ ⏥➨ ྕ
Ꮫ ᤵ ᪥ ᖹᡂ ᖺ ᭶ ᪥ Ꮫ ᤵ せ ௳ Ꮫつ๎➨㸲᮲➨㸯㡯ヱᙜ
Ꮫ ㄽ ᩥ 㢟 ┠ &HUHEUDO *OXFRVH 0HWDEROLVP LQ 3DWLHQWV ZLWK &KURQLF 0HQWDO DQG &RJQLWLYH6HTXHODHDIWHUD6LQJOH%OXQW0LOG7UDXPDWLF%UDLQ,QMXU\ ZLWKRXW9LVLEOH%UDLQ/HVLRQV ᑂ ᰝ ጤ ဨ 㸦ᰝ㸧ᩍᤵ ሷධ ಇᶞ 㸦ᰝ㸧ᩍᤵ ᯇᑿ ᨻஅ ᩍᤵ ୗ⏿ ாⰋ ㄽ ᩥ ෆ ᐜ ࡢ せ ᪨ ࠙ࡣࡌࡵࠚ እയᛶ⬻ᦆയ㸦7%,㸸WUDXPDWLFEUDLQLQMXU\㸧ࡢ⣙ ࢆ༨ࡵࡿ㍍ᗘእയᛶ⬻ᦆയ㸦㸦PLOG7%,㸸 ศ௨ෆࡢព㆑႙ኻ㸪ᨾࡢ┤๓┤ᚋ࠾ࡅࡿグ᠈ࡢ႙ኻ㸪ᨾⓎ⏕ࡢ⢭⚄≧ែࡢኚ㸦ᨺᚰ㸪࿈ ↛㸪ΰ࡞㸧㸪୍ⓗࡲࡓࡣᜏஂⓗ࡞ᒁᡤ⚄⤒㞀ᐖࡢ࠸ࡎࢀࡢ≧ࢆ♧ࡋ㸪ཷയᚋ ศᚋࡢ *ODVJRZ&RPD6FDOH ࡢⅬᩘࡀ Ⅼ࡛ࡘᚰⓗእയᚋᛀࡀ 㛫௨ୖ࡞ࡽ࡞࠸ែࠋཎᅉ ࡋ࡚㢌㒊ᡴ᧞㸪㢌㒊ᑐ㇟≀㸦㢦㠃➼㸧ᡴᧁ㸪⬻ࡢຍ㏿㐠ືῶ㏿㐠ືࡼࡿࡶࡢ㸦ࡴࡕᡴࡕᦆയࡢ ࡼ࠺㢌㒊ࡢ┤᥋ࡢእയࡣ࡞࠸ࡶࡢࢆྵࡴࠋ㸧࡛ࡣ &7㸪05, ࡛⬻እയ㉳ᅉࡍࡿჾ㉁ⓗᦆയࢆㄆ ࡵ࡞࠸ࡶࢃࡽࡎ㸪៏ᛶᮇ⮳ࡗ࡚ࡶㄆ▱࣭⢭⚄≧ࡀᚋ㑇ࡋ་Ꮫⓗࡶ♫ⓗࡶࡁ࡞ၥ㢟 ࡞ࡿࡀ⛥࡞ࡽࡎࡳࡽࢀࡿࠋᮏ◊✲࡛ࡣࡇࡢࡼ࠺࡞ PLOG 7%, ᝈ⪅ )IOXRURGHR[\JOXFRVH SRVLWURQ HPLVVLRQ WRPRJUDSK\ )'*3(7ࢆ⾜ࡋ⬻⢾௦ㅰ␗ᖖศᕸࢆホ౯ࡍࡿࡇ࡛⬻ࡢᶵ⬟ⓗ ࡞␗ᖖࡢᒁᅾࢆ᫂ࡽࡋ㸪ࡇࡢែࡢⓎᶵᗎࢆ᥎ᐹࡍࡿࡇࢆ┠ⓗࡋࡓࠋ ࠙ᑐ㇟᪉ἲࠚ ㏻ᨾࡼࡿ PLOG7%, デ᩿ࡉࢀ៏ᛶᮇ㸦ཷയᚋᖹᆒ 㹼᭶㸧ㄆ▱࣭⢭⚄≧ 㸦グ᠈࣭グ㖭ຊ㞀ᐖ㸸㸪ὀព㞀ᐖ㸸㸪㐙⾜ᶵ⬟㞀ᐖ㸸㸪ឤᢚไ㞀ᐖ㸸㸪⾜ື 㞀ᐖ㸸㸧ࡀṧᏑࡋ㸪ᛴᛶᮇཬࡧ៏ᛶᮇ༢⣧ &7㸪៏ᛶᮇ 705,7 ᙉㄪ⏬ീ㸪7 ᙉㄪ⏬ീ㸪7 ᙉㄪ⏬ീ㸪ᣑᩓᙉㄪ⏬ീ㸪)/$,5 ⏬ീ㸪☢⋡ᙉㄪ⏬ീ࡛⬻እയ㉳ᅉࡍࡿჾ㉁ⓗᦆയࡀぢࡽࢀ࡞ ࠸ ྡ㸦ᝈ⪅⩌㸸⏨ᛶ ྡ㸪ᖹᆒ 㸦㹼㸧ṓ㸧 )'*3(7 ࢆ⾜㸦)'*㸸0%TNJ㸪LY㸹3(7 ⨨㸸ᓥὠ (PLQHQFH67$5*$7(㸧㸧ࡋ㸪6WDWLVWLFDO3DUDPHWULFDO0DSSLQJYHUVLRQ㸦630ࢆ⏝ ࠸ࡓ⤫ィ⏬ീゎᯒࡼࡾᖺ㱋ศᕸࡢ୍⮴ࡋࡓᖖᡂே㸦ᑐ㇟⩌㸸 ྡ㸪ᖹᆒ ṓ㸧ࡢ⬻⢾௦ㅰ ẚ㍑ࡋࡓࠋ⤖ᯝࡢ⢭ᗘホ౯ࢆ┠ⓗ⏬ീୖࡢ⤫ィᏛⓗ࡞ ᕪࡢࣆ࣮ࢡࢆ♧ࡋࡓ࣎ࢡࢭࣝ㛵ࡋ࡚ 5HFHLYHU2SHUDWLQJ&KDUDFWHULVWLF52&ゎᯒࢆ⾜ࡗࡓࠋࡲࡓ㸪:HFKVOHU$GXOW,QWHOOLJHQFH6FDOH YHUVLRQ ,,,㸦:$,6,,,㸧ࢆ⾜ࡋ㸪)'*3(7 :$,6,,, ࡢ⤖ᯝ㛫ࡢ┦㛵ࡘ࠸࡚ 630 ࢆ⏝࠸࡚ ᳨ウࡋࡓࠋ ࠙⤖ᯝࠚ ᝈ⪅⩌࡛ࡣ୧ഃ๓㢌๓㔝㒊ཬࡧෆഃ㒊ࡢᗈ⠊࡞㡿ᇦ࡛ᑐ㇟⩌ẚ㍑ࡋ᭷ព࡞⢾௦ㅰࡢపୗࡀ 㸦S㸧㸪ࡲࡓ୧ഃഃ㢌ⴥෆഃ㸪ୖ⬻ᖿ㸪どᗋୗ㒊㏆ഐ࡛᭷ព࡞⢾௦ㅰࡢቑຍࡀࡳࡽࢀࡓ㸦S㸧ࠋ ᝈ⪅⩌࡛ࡣᕥ๓㢌ⴥࡢ୍㒊࡛ :$,6,,, ⤖ᯝࡢ㛫᭷ព࡞ṇࡢ┦㛵㸦S㸧㸪ྑᾏ㤿ഐᅇࡢ୍㒊 ࡛ :$,6,,, ⤖ᯝࡢ㛫᭷ព࡞㈇ࡢ┦㛵㸦S㸧ࡀࡳࡽࢀࡓࠋᝈ⪅⩌ࡢ )'*3(7 ⤫ィᏛⓗ⏬ീࡣ
52& ゎᯒࡼࡾ㸪᭷ព࡞⢾௦ㅰపୗࢆ♧ࡋࡓ࣎ࢡࢭ࡛ࣝ≉␗ᗘࡼࡾឤᗘࡀ㧗ࡃ㸪᭷ព࡞⢾௦ㅰቑࢆ ♧ࡋࡓ࣎ࢡࢭ࡛ࣝឤᗘࡼࡾࡶ≉␗ᗘࡀ㧗࠸ഴྥࡀࡳࡽࢀࡓࠋ ࠙⪃ᐹࠚ ㄆ▱࣭⢭⚄≧ࢆᚋ㑇ࡍࡿ PLOG 7%, ᝈ⪅ᑐࡋ㸪እയ㉳ᅉࡍࡿ⬻ࡢჾ㉁ⓗኚࢆⓎぢࡍࡿࡓࡵ 05, ࡼࡿከࡃࡢ⮫ᗋ◊✲ࡀ⾜ࢃࢀ࡚ࡁࡓࠋࡶࡗࡶ㗦ᩄᚤ⣽࡞⬻ࡢᦆയࢆぢฟࡍᡭἲࡣᣑᩓᙉ ㄪ⏬ീࡼࡿ )$ ್ࡢ␗ᖖࢆⓎぢࡍࡿࡇ࡛࠶ࡾ㸪୍㒊ࡢᝈ⪅࡛ࡣ⬻ෆᚤ⣽࡞ᦆയࡢᏑᅾࡀᣦࡉ ࢀ࡚࠸ࡿࠋࡋࡋ㸪ࡇࡢࡼ࠺࡞ᙧែᏛⓗ⏬ീデ᩿ࢆ⏝࠸࡚ࡶᚤ⣽࡞⬻ᦆയࡀⓎぢࡉࢀ࡞࠸ᝈ⪅ࡶ࠸ࡲ ࡔከࡃᏑᅾࡍࡿࠋ୍᪉㸪PLOG 7%, ᝈ⪅ࢆᑐ㇟ࡋࡓᶵ⬟ⓗ⏬ീデ᩿ࡶ⢭ຊⓗ⾜ࢃࢀ࡚ࡁࡓࠋ)'* 3(7 ࢆ⏝࠸ࡓඛ⾜◊✲࡛ࡣ㸪ࡧࡲࢇᛶ㍈⣴ᦆയ㸦'$,㸸GLIIXVHD[RQDOLQMXU\㸧ᝈ⪅࡛ࡳࡽࢀࡿ៏ᛶ ᮇࡢㄆ▱࣭⢭⚄≧㸦㑄ᘏᛶព㆑㞀ᐖ㸪㧗ḟ⬻ᶵ⬟㞀ᐖࢆྵࡴ㸧࡛ࡣ⬻༙⌫῝㒊ⓑ㉁㸪⬻ᱱ㸪⬻ ᇶᗏ᰾㒊㸪ᑠ⬻⬮㸪⬻ᖿࢆ୰ᚰჾ㉁ⓗᦆയࡀࡳࡽࢀ㸪)'*3(7 ࡛ࡣࡑࡢ㔜ᗘࡣ↓㛵ಀඹ㏻ࡋ ࡚ᖖ⪅ẚ๓㢌๓㔝ෆഃ㒊㸪ᖏ≧ᅇ㸪๓㢌ⴥᗏ㒊㸪どᗋෆഃ㒊⢾௦ㅰࡢపୗࡀほᐹࡉࢀࡿࠋᮏ ◊✲࡛ࡣㄆ▱࣭⢭⚄≧ࢆᚋ㑇ࡋ㸪⏬ീୖ⬻ჾ㉁ⓗᦆയࢆㄆࡵ࡞࠸ PLOG 7%, ᝈ⪅࡛ࡣᑐ㇟⩌ẚ ㍑ࡋ୧ഃ๓㢌๓㔝㒊ཬࡧෆഃ㒊ࡢᗈ⠊࡞㡿ᇦ࡛᭷ព࡞⢾௦ㅰࡢపୗࡀ㸪⬻㎶⦕⣔ࡢ୰᰾ࢆ࡞ࡍ ୧ഃഃ㢌ⴥෆഃ㸪ୖ⬻ᖿ㸪どᗋୗ㒊㏆ഐ࡛᭷ព࡞⢾௦ㅰࡢቑຍࡀࡳࡽࢀࡓࠋࡇࡢ⢾௦ㅰ␗ᖖศᕸࡣ '$, ᝈ⪅ࡢࡑࢀࡣ᫂ࡽ␗࡞ࡗ࡚࠾ࡾ㸪࠺ࡘ࡞ࡢ⢭⚄ᝈ࡛ࡳࡽࢀࡿ⢾௦ㅰศᕸ㏆ఝࡋ ࡚࠸ࡿྍ⬟ᛶࡀఛࢃࢀࡓࠋࡇࢀࡽࡢ⤖ᯝࡼࡾ㸪៏ᛶᮇᙧែᏛⓗ⏬ീ࡛ኚࢆㄆࡵ࡞࠸ PLOG 7%, ᝈ ⪅ࡀ♧ࡍ⢭⚄ⓗ࣭ㄆ▱ⓗ≧ࢆᘬࡁ㉳ࡇࡍ⌮Ꮫⓗ࣓࢝ࢽࢬ࣒ࡣ '$, ᝈ⪅࠾ࡅࡿ୍ḟᛶࡢ㍈⣴㞀ᐖ ࡼࡿࡶࡢࡣ␗࡞ࡿࡶࡋࢀ࡞࠸ࡇࡀ♧၀ࡉࢀࡓࠋ ࠙⤖ㄽࠚ ㄆ▱࣭⢭⚄≧ࢆᚋ㑇ࡍࡿࡶ⬻ჾ㉁ⓗᦆയࢆㄆࡵ࡞࠸ PLOG 7%, ᝈ⪅࡛ࡣᑐ㇟⩌ẚ㍑ࡋ୧ഃ๓ 㢌๓㔝㒊ཬࡧෆഃ㒊ࡢᗈ⠊࡞㡿ᇦ࡛᭷ព࡞⢾௦ㅰࡢపୗࡀ㸪ࡲࡓ⬻㎶⦕⣔ࡢ୰᰾ࢆ࡞ࡍ୧ഃഃ 㢌ⴥෆഃ㸪ୖ⬻ᖿ㸪どᗋୗ㒊㏆ഐ࡛᭷ព࡞⢾௦ㅰࡢቑຍࡀࡳࡽࢀࡓࠋࡇࡢ⬻ෆࡢ⢾௦ㅰ␗ᖖศᕸࡣ '$, ᝈ⪅࠾ࡅࡿ⢾௦ㅰ␗ᖖศᕸࡣ␗࡞ࡾ㸪࠺ࡘ࡞ࡢ⢭⚄ᝈ࡛ࡳࡽࢀࡿ⢾௦ㅰ␗ᖖศᕸ ㏆ఝࡋ࡚࠸ࡿྍ⬟ᛶࡀఛࢃࢀࡓࠋࡇࡢ⤖ᯝࡣᮏ࡛ࡳࡽࢀࡿㄆ▱࣭⢭⚄≧ࡀ ' $, ࠾ࡅࡿ୍ḟᛶࡢ㍈⣴㞀ᐖࡣ␗࡞ࡿ⌮Ꮫⓗ⫼ᬒࢆ᭷ࡍࡿྍ⬟ᛶࢆ♧၀ࡋ࡚࠸ࡿࠋ ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ⏦ㄳ⪅ Ἑᮧ❶ྐࡣࠊࡇࢀࡲ࡛ࢇ᳨ウࡀ࡞ࡉࢀ࡚࠸࡞ࡗࡓࠊ05, ⏬ീୖ᫂ࡽ࡞␗ᖖࡢㄆ ࡵࡽ࡞࠸㏻ᨾᚋࡢ㍍ᗘእയᛶ⬻ᦆയᝈ⪅ࡢ⬻⢾௦ㅰ␗ᖖࡘ࠸࡚ࠊ)'*3(7 ࢆ⏝࠸࡚ୡ⏺࡛ึࡵ ࡚ከᩘ᳨࡛ウࢆຍ࠼ࠊྠᝈ⪅⩌ࡢ⬻ᶵ⬟㞀ᐖ㒊ࡘ࠸࡚ヲ⣽ሗ࿌ࡋࡓࠋᮏ◊✲ࡢᡂᯝࡣࠊ⬻⚄ ⤒እ⛉Ꮫ࡞ࡽࡧࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་Ꮫࡢ㐍Ṍᑡ࡞ࡽࡎᐤࡍࡿࡶࡢ⪃࠼ࡿࠋ 㹙ㄽᩥබ⾲ㄅ㹛
$NLIXPL .RPXUD 7RPRKLUR .DZDVDNL <XLFKL <DPDGD 6KLKR 8]X\DPD <RVKLWDND $VDQR -XQ 6KLQRGD&HUHEUDOJOXFRVHPHWDEROLVPLQSDWLHQWVZLWKFKURQLFPHQWDODQGFRJQLWLYHVHTXHODH DIWHUDVLQJOHEOXQWPLOGWUDXPDWLFEUDLQLQMXU\ZLWKRXWYLVLEOHEUDLQOHVLRQV