ከⓎᛶ◳䞉ど⚄⤒⬨㧊⅖䛻䛚䛡䜛᪩ᮇデ᩿ᇶ‽䛸㔜ᗘศ㢮䛻᭷⏝䛺䝞䜲䜸䝬 䞊䜹䞊䛾☜❧䛻㛵䛩䜛◊✲
ศᢸ◊✲⪅䠖➉ෆ㻌 ⱥஅ
ᡤᒓタྡ䠖ᶓᕷ❧Ꮫ㝃ᒓ㝔㻌 ⚄⤒ෆ⛉䞉⬻༞୰⛉
◊✲せ᪨
㧊㠧⏤᮶䛾㍈⣴ఙ㛗㜼ᐖᅉᏊNogo䛿䚸ከⓎᛶ◳䛾ែᙧᡂ䛻䛝䛟㛵䛧䛶䛔䜛䛸⪃䛘䜙 䜜䛶䛔䜛䚹ᡃ䚻䛾ぢฟ䛧䛯ෆᅉᛶNogo㜼ᐖᅉᏊLOTUS䛾㧊ᾮ⃰ᗘ䛿䚸ከⓎᛶ◳䛾ໃ䛻
㏫┦㛵䛩䜛䛣䛸䛜᫂䜙䛛䛸䛺䜚䚸ከⓎᛶ◳䛾ໃ䝞䜲䜸䝬䞊䜹䞊䛸䛧䛶᭷⏝䛷䛒䜛䛸⪃䛘䜙䜜 䛯䚹
A. ◊✲┠ⓗ
㻌 㧊㠧⏤᮶䛾㍈⣴ఙ㛗㜼ᐖᅉᏊ䛷䛒䜛Nogo 䛿ከⓎᛶ◳䛾ែᙧᡂ䛻㔜せ䛷䛒䜛䛸⪃
䛘䜙䜜䛶䛔䜛䚹ᡃ䚻䛾ぢฟ䛧䛯ෆᅉᛶNogo㜼 ᐖᅉᏊLOTUS䛿䚸Nogoཷᐜయ䛾䜰䞁䝍䝂䝙 䝇䝖䛸䛧䛶ᶵ⬟䛩䜛䛣䛸䛷䚸㍈⣴ఙ㛗䜢ಁ㐍䛩 䜛䚹䛭䛣䛷䚸LOTUS䛾ከⓎᛶ◳䛾ໃ䝞 䜲䜸䝬䞊䜹䞊䛸䛧䛶䛾ྍ⬟ᛶ䜢᳨ウ䛧䛯䚹 B. ◊✲᪉ἲ
㻌 ᮏ◊✲䛿ᶓᕷ❧Ꮫ㝃ᒓ㝔⌮ጤဨ
䛾ᢎㄆ䛾ୗ䛻䚸䜲䞁䝣䜷䞊䝮䝗䝁䞁䝉䞁䝖䜢 ᚓ䛶⾜䜟䜜䛯䚹ᖖே䚸ከⓎᛶ◳䚸➽ⴎ
⦰ᛶഃ⣴◳䚸ከ⣔⤫ⴎ⦰䛾ᝈ⪅㧊ᾮ 䛛䜙Western blottingἲ䛻䜘䜚LOTUS⃰ᗘ䜢 ᐃ㔞 ᐃ䛧䛯䚹
C. ◊✲⤖ᯝ
㻌 ከⓎᛶ◳䛾Ⓨᮇ䞉ḟ㐍⾜ᮇ䛻䛚䛔 䛶䛾䜏䚸㧊ᾮ LOTUS ⃰ᗘῶᑡ䛜ㄆ䜑䜙䜜䚸 ᐶゎᮇ䛻䛿ᖖேྠᵝ䛾䝺䝧䝹䛻䛧䛯䚹
ᝈ䛷䛿ᖖேྠᵝ䛾䝺䝧䝹䛷䛒䛳䛯䚹 D. ⪃ᐹ
㻌 䛣䜜䜎䛷䛾◊✲䛷䚸ከⓎᛶ◳ᕢ䛷䛾 Nogo䛾Ⓨ⌧ቑຍ䛜ሗ࿌䛥䜜䛶䛔䜛䚹LOTUS 䛜ከⓎᛶ◳䛾ໃ䛻ᛂ䛨䛶Ⓨ⌧ῶᑡ䛧䛶 䛔䜛䛣䛸䛛䜙䚸Nogo䝅䜾䝘䝸䞁䜾䛻䜘䜛㍈⣴ኚ ᛶ䜢ຓ㛗䛧䛶䛔䜛ྍ⬟ᛶ䛜♧၀䛥䜜䛯䚹
LOTUS䛾Ⓨ⌧ไᚚ䛾ヲ⣽䛻䛴䛔䛶䛿ᚋ䛾
ㄢ㢟䛷䛒䜛䚹 E. ⤖ㄽ
㻌 LOTUS 䛾㧊ᾮ⃰ᗘ䛿䚸ከⓎᛶ◳䛾
ໃ䛻㏫┦㛵䛩䜛䛣䛸䛛䜙䚸ໃ䛾᪂つ䝞䜲䜸䝬
F. ◊✲Ⓨ⾲
䠄1䠅ᅜෆ
㻌 ཱྀ㢌Ⓨ⾲ 㻌 㻌 䠄2䠅௳
㻌 ཎⴭㄽᩥ䛻䜘䜛Ⓨ⾲ 㻌 㻌 䠄0䠅௳
㻌 䛭䜜௨እ䠄䝺䝡䝳䞊➼䠅䛻䜘䜛Ⓨ⾲㻌 䠄0䠅௳
䛭䛾䛖䛱䛺䜒䛾 㻌 Ⓨ⾲ㄽᩥ
䛺䛧 㻌 ᏛⓎ⾲
1. 㧗ᶫኴ䚸ᰩཎ⿱ྖ䚸➉ෆⱥஅ䚸➉ᒃ ග ኴ 㑻 䚸 ⏣ ୰ ❶ ᬒ 䠖 ⚄ ⤒ ᶵ ⬟ ศ Ꮚ
LOTUS 䛿ᐇ㦂ⓗ⮬ᕫචᛶ⬻⬨㧊⅖
䛾චែ䛻䜒㛵䛩䜛.➨ 28 ᅇ᪥ᮏ
⚄⤒චᏛᏛ⾡㞟䠈㛗ᓮ䠈2016
䠄2䠅ᾏእⓎ⾲
㻌 ཱྀ㢌Ⓨ⾲ 㻌 㻌 䠄0䠅௳
㻌 ཎⴭㄽᩥ䛻䜘䜛Ⓨ⾲ 㻌 㻌 䠄0䠅௳
㻌 䛭䜜௨እ䠄䝺䝡䝳䞊➼䠅䛻䜘䜛Ⓨ⾲㻌 䠄0䠅௳
G. ▱ⓗᡤ᭷ᶒ䛾ฟ㢪䞉ྲྀᚓ≧ἣ ヱᙜ䛩䜛䜒䛾䛺䛧
䞊䜹䞊䛸䛧䛶᭷⏝䛷䛒䜛䛸⪃䛘䜙䜜䛯䚹
චᛶࢽ࣮ࣗࣟࣃࢳ࣮ࡑࡢ㛵㐃ᝈࡢデ᩿㛵ࡍࡿ◊✲
ศᢸ◊✲⪅㸸 ᅬ⏕㞞ᘯ
ᡤᒓタྡ㸸 ᖇிᏛ⚄⤒ෆ⛉
◊✲せ᪨㸸චᛶࢽ࣮ࣗࣟࣃࢳ࣮ཬࡧࡑࡢ㛵㐃ᝈ࡛࠶ࡿBickerstaff⬻ᖿ⬻⅖㸦BBE㸧ࠊ
៏ᛶ⅖ᛶ⬺㧊ᛶከⓎࢽ࣮ࣗࣟࣃࢳ࣮㸦CIDP㸧ࠊGuillain-Barré ೃ⩌㸦GBS㸧ࡢデ᩿
ᡭἲࡢᨵⰋࠊデ᩿ᇶ‽㛵ࡍࡿ㸱ࡘࡢ◊✲ࢆ⾜ࡗࡓࠋBBE࠾࠸࡚ࡣࠊయᛶឤぬㄏⓎ
㟁㸦SEP㸧ࡀデ᩿᭷⏝࡛࠶ࡿࡇࢆ♧ࡋࡓࠋCIDP࠾࠸࡚ࠊ➽㉸㡢Ἴ᳨ᰝࡀ᭱㐲
ࡢఏᑟࣈࣟࢵࢡࡢホ౯࠼ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋGBSࡢ㍈⣴ᆺ⬺㧊ᆺࡢศ㢮࠾
࠸࡚ࠊデ᩿ᇶ‽ࡢᩥ㠃ࡢゎ㔘ࡢ㐪࠸ࡀศ㢮ࡢ⤖ᯝᙳ㡪ࢆ࠼ࡿࡇࡀ♧ࡉࢀࡓࠋ
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⤖ᯝࡣࡍࡄุ᫂ࡋ࡞࠸ሙྜࡀከ࠸ࠋయᛶឤぬ ㄏⓎ㟁㸦6(3㸧⫈ᛶ⬻ᖿᛂ㸦$%5㸧ࡢㄏⓎ
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$/6 ࢆ௦⾲ࡍࡿ㍈⣴㞀ᐖࢆࡁࡓࡍᝈ࡛ࡣ
⬺⚄⤒క࠸ 086 ࡢ➽ࡢ㍤ᗘ㸦(,㸧ࡢୖ᪼➽
ࡢཌࡳ㸦07㸧ࡢῶᑡࡀㄆࡵࡽࢀࡿࠋ୍᪉ &,'3 ࢆ ௦⾲ࡍࡿ⬺㧊ᛶࢽ࣮ࣗࣟࣃࢳ࣮࡛ࡣ㍈⣴ኚᛶ
ࢆకࢃ࡞࠸㝈ࡾ⬺⚄⤒ࡣㄆࡵࡽࢀ࡞࠸ࡉࢀࠊ 086 ࡛ࡢ␗ᖖࡣㄆࡵࡽࢀࡃ࠸ྍ⬟ᛶࡀ࠶ࡿࠋ
&,'3 ࡢ 086 ᡤぢࢆ $/6 ẚ㍑᳨ウࡋࡓࠋ 㸱㸧*%6 デ᩿ᇶ‽ࡢゎ㔘㛵ࡍࡿ◊✲
*%6 ࡢ㍈⣴ᆺ㸦$0$1㸧⬺㧊ᆺ㸦$,'3㸧ࡢศ㢮 ࡢᇶ‽ࡋ࡚ࡣࠊ ᖺࡢ +R ᇶ‽ࡀ᭱ࡶᗈࡃ⏝
࠸ࡽࢀ࡚࠸ࡿࠋࡇࡢ +R ᇶ‽ࡢ $0$1 ࡢᐃ⩏ࡘ࠸
࡚ࡣࠊ㸰㏻ࡾࡢゎ㔘ࡀ⪃࠼ࡽࢀࡿࠋᮏ◊✲࡛ࡣࡇ ࡢ㸰㏻ࡾࡢゎ㔘ࡢ㐪࠸ࡀࠊ*%6 ᆺศ㢮ཬࡰࡍ ᙳ㡪ࡘ࠸᳨࡚ウࡋࡓࠋ
㹀.◊✲᪉ἲ
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㸰㸧&,'3 ࡢ 086 㛵ࡍࡿ◊✲
()16 ᇶ‽ࡢ GHILQLWH ࢆ‶ࡓࡍ &,'3 ࠊ UHYLVHG (O (VFRULDO ᇶ ‽ ࡢ FOLQLFDOO\
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$/6 ࢆᑐ㇟ࡋࠊ▷ẕᣦእ㌿➽㸦$3%㸧ࠊ➨
୍⫼ഃ㦵㛫➽㸦)',㸧ࠊᑠᣦእ㌿➽㸦$'0㸧ࢆ⿕᳨
➽ࡋࡓࠋ086 ࡢ (,࣭07 ࠊ㐠ື⚄⤒ఏᑟ᳨ᰝ
࡛ࡢ㐲」ྜ➽άື㟁㸦&0$3㸧ᖜࢆホ౯ࡋ ࡓࠋ
㸱㸧*%6 デ᩿ᇶ‽ࡢゎ㔘㛵ࡍࡿ◊✲
+R ᇶ ‽ ࡢ $0$1 ࡢ 㡯 ┠ 1R HYLGHQFH RI GHP\HOLQDWLRQDVGHILQHGDERYH͇ࡢᩥ❶ࡣ௨
ୗࡢ㸰㏻ࡾࡢゎ㔘ࡀ⪃࠼ࡽࢀࡿࠋ$๓グLࠥ
LY࡛ᐃ⩏ࡉࢀࡿࡼ࠺࡞⬺㧊ࡢドᣐࡀࠊ㸦࠸ࡎࢀࡢ
⚄⤒࡛ࡶ㸧ㄆࡵࡽࢀ࡞࠸ࠋ%ࠕ ᮏ௨ୖࡢ⚄⤒
࡛ୗグࡢ࠸ࡎࢀ ࡘࢆ‶ࡓࡍࠖᐃ⩏ࡉࢀࡿࡼ
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ᚓࠊ๓ྥࡁ◊✲࠾࠸࡚ࡣᝈ⪅ࡽ᭩㠃ࡼࡿྠ
ពࢆᚓࡓࠋ
－ 59 －
㹁.◊✲⤖ᯝ
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ࠊ3UREDEOH㸱࡛࠶ࡗࡓࠋ6(3 ࡣᘏ㧊⏤᮶ࡢ 3R ࡲ࡛ࡣṇᖖ࡛࠶ࡗࡓࡀࠊ㸶୰㸵
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ẚ᭷ព࡞ (, ࡢୖ᪼ࠊ07 పୗࢆㄆࡵࡓࠋࡲࡓ
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㛵ࢆㄆࡵࡓࡀࠊ&,'3 ⩌࡛ࡣࡇࡢ┦㛵ࡣㄆࡵࡽࢀ
࡞ࡗࡓࠋ
㸱㸧*%6 デ᩿ᇶ‽ࡢゎ㔘㛵ࡍࡿ◊✲
ᝈ⪅࣮࣋ࢫࠊ᳨ᰝ࣮࣋ࢫ࠸ࡎࢀ࠾࠸࡚ࡶࠊゎ 㔘 $ ࡣゎ㔘 % ẚ࡚ $0$1 ࡀᑡ࡞ࡃࠊHTXLYRFDO ࡀቑ࠼ࡓࡀࠊࡑࡢᕪࡣⓎ㸯ࠊ㸰㐌ࡢ᪩ᮇ࠾࠸
࡚ࡼࡾ㢧ⴭ࡛࠶ࡗࡓࠋ
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ࣃࢱ࣮ࣥࡀ᭷⏝࡛࠶ࡿྍ⬟ᛶࡀ࠶ࡿࠋ 㸰㸧&,'3 ࡢ 086 㛵ࡍࡿ◊✲
&,'3 ⩌࡛ࡢ⤖ᯝࡣ⬺⚄⤒ࡀஈࡋ࠸ࡇࢆ♧
၀ࡋࠊࡃ &,'3 ࡛ &0$3 ࡀపୗࡋ࡚࠸ࡿࡀ 086
ࣃ࣓࣮ࣛࢱࡀṇᖖ࡞࠾࠸࡚ࡣ᭱㐲࠾
ࡅࡿఏᑟࣈࣟࢵࢡࡢᶵᗎࡀᐃࡉࢀࡓࠋࡇࢀ
ࡣ 1&6 ࡛ࡢド᫂ࡀ㞴ࡋ࠸⌧㇟࡛࠶ࡾࠊࡇࡢ
Ⅼ࡛ࡢ 086 ࡢ᭷⏝ᛶࡀ♧၀ࡉࢀࡿࠋ 㸱㸧*%6 デ᩿ᇶ‽ࡢゎ㔘㛵ࡍࡿ◊✲
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ࡇࢀࡽࡢ◊✲ࡼࡾࠊྛᝈࡢ᪩ᮇデ᩿ࠊែ
ணᚋホ౯ࠊᆺศ㢮ࡢ㐍Ṍᐤࡍࡿࡇࡀᮇᚅࡉ
ࢀࡿࠋ
㹄.◊✲Ⓨ⾲
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ࡑࢀ௨እ(ࣞࣅ࣮ࣗ➼)ࡼࡿⓎ⾲㸦2㸧௳
ࡑࡢ࠺ࡕ࡞ࡶࡢ ᏛⓎ⾲
1) ᅬ⏕㞞ᘯ: 100ᖺ┠ࡢࢠ࣭ࣛࣥࣂ࣮ࣞೃ
⩌㸸ࡇࢀࡲ࡛ࢃࡗࡓࡇ㸪ࡇࢀࡽࡢᒎᮃ Guillain-Barréೃ⩌100ᖺ㸪⚄⤒ఏᑟ᳨ᰝ50 ᖺ. ➨57ᅇ᪥ᮏ⚄⤒ᏛᏛ⾡, ⚄ᡞ, 5, 2016.
ᅧᆂ୍ᒣᮏ῟ᖹ༓ⴥ㝯ྖ▼▱⍞
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ࡑࡢ࠺ࡕ࡞ࡶࡢ Ⓨ⾲ㄽᩥ
1) Kadoya A, Ogawa G, Kawakami S, et al.
The correlation between the change of distal motor latency of the median nerve and the abundant A-waves in Guillain-Barré syndrome.
－ 60 －
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ࡑࡢ࠺ࡕ࡞ࡶࡢ ᏛⓎ⾲
1) ᅬ⏕㞞ᘯ: 100ᖺ┠ࡢࢠ࣭ࣛࣥࣂ࣮ࣞೃ
⩌㸸ࡇࢀࡲ࡛ࢃࡗࡓࡇ㸪ࡇࢀࡽࡢᒎᮃ Guillain-Barréೃ⩌100ᖺ㸪⚄⤒ఏᑟ᳨ᰝ50 ᖺ. ➨57ᅇ᪥ᮏ⚄⤒ᏛᏛ⾡, ⚄ᡞ, 5, 2016.
ᅧᆂ୍ᒣᮏ῟ᖹ༓ⴥ㝯ྖ▼▱⍞
Ꮚሯᮏᾈ⏿୰⿱ᕫᅬ⏕㞞ᘯ&,'3㸪$/6 ࡢ
➽㉸㡢Ἴᡤぢ㸸➽㉸㡢Ἴࡣ᭱㐲ఏᑟࣈࣟࢵࢡࢆ
᳨ฟ࡛ࡁࡿ➨ ᅇ᪥ᮏ⚄⤒ᏛᏛ⾡⚄
ᡞ 㸦㸰㸧ᾏእⓎ⾲
ཱྀ㢌Ⓨ⾲ 㸦3㸧௳
ཎⴭㄽᩥࡼࡿⓎ⾲ 㸦3㸧௳
ࡑࢀ௨እ(ࣞࣅ࣮ࣗ➼)ࡼࡿⓎ⾲㸦0㸧௳
ࡑࡢ࠺ࡕ࡞ࡶࡢ Ⓨ⾲ㄽᩥ
1) Kadoya A, Ogawa G, Kawakami S, et al.
The correlation between the change of distal motor latency of the median nerve and the abundant A-waves in Guillain-Barré syndrome.
J Neurol Neurosurg Psychiatry 2016; 87: 444-6.
ᏛⓎ⾲
1) Ogawa G, Kadoya A, Kawakami S, Yokota I, Hatanaka Y, Uchibori A, Chiba A, Sonoo M:
The correlation between the change of distal motor latency of the median nerve and
abundant A-waves in Guillain-Barre syndrome.
62nd annual scientific meeting of American association of neuromuscular and
electrodiagnostic medicine, Honolulu, 10, 2015.
2) Chiba T, Hokkoku K, Yamamoto J,
Kuwabara M, Kawamura Y, Ito T, Hatanaka Y, Sonoo M: Utility of needle electromyogrophy for differentiation between Guillain-Barre
syndrome and conversion disorder. 63rd Annual
Meeting of American Association of
Neuromuscular and Electrodiagnostic Medicine, New Orleans, 9, 2016.
3) Hokkoku K, Sonoo S, Chiba T, Oishi C, Tsukamoto H, Hatanaka Y: Comparison of muscle ultrasound findings between chronic inflammatory demyelinating
polyradiculoneuropathy and amyotrophic lateral sclerosis. 63rd Annual Meeting of American Association of Neuromuscular and Electrodiagnostic Medicine, New Orleans, 9, 2016.
㹅.▱ⓗᡤ᭷ᶒࡢฟ㢪࣭ྲྀᚓ≧ἣ ヱᙜࡍࡿࡶࡢ࡞ࡋ
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