日本における犬の不安行動に影響する要因の研究

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Title

日本における犬の不安行動に影響する要因の研究( 本文

_{(Fulltext) )}

Author(s)

倉地, 卓将

Report No.(Doctoral

Degree)

博士(獣医学) 甲第499号

Issue Date

2018-03-13

Type

博士論文

Version

ETD

URL

http://hdl.handle.net/20.500.12099/75222

※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。

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᪥ᮏ࡟࠾ࡅࡿ≟ࡢ୙Ᏻ⾜ື࡟ᙳ㡪ࡍࡿせᅉࡢ

◊✲

2017 ᖺ

ᒱ㜧኱Ꮫ኱Ꮫ㝔

㐃ྜ⋇་Ꮫ◊✲⛉

㸦ᮾி㎰ᕤ኱Ꮫ㸧

಴ᆅ༟ᑗ

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┠ḟ

ᗎㄽ ---

1

➨

1 ❶ ᪥ᮏ࡟࠾ࡅࡿ୙Ᏻ㞀ᐖࡢ⣲ᅉࢆᣢࡘ≟ࡢᐇែㄪᰝ ---

4 ⥴ゝ --- 4 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ --- 6 ⤖ᯝ --- 8 ⪃ᐹ --- 18 ⤖ㄒ --- 22

➨

2 ❶ ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ᑐࡍࡿ⤒㦂ⓗ࣭⎔ቃⓗ࡞せᅉࡢᙳ㡪 ---

23 ⥴ゝ --- 23 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ --- 25 ⤖ᯝ --- 27 ⪃ᐹ --- 31 ⤖ㄒ --- 33

➨

3 ❶ ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ᑐࡍࡿࢺ࣮ࣞࢽࣥࢢᩍᐊཧຍࡢᙳ㡪 ---

34 ⥴ゝ --- 34 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ --- 36 ⤖ᯝ --- 38

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⪃ᐹ --- 42 ⤖ㄒ --- 45

⤖ㄽ ---

46

ㅰ㎡ ---

49

ཧ⪃ᩥ⊩ ---

50 Supplement --- 59

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1 ᗎㄽ ㏆ᖺࠊ≟ࡢၥ㢟⾜ືࡀ㔜せどࡉࢀࡿࡼ࠺࡟࡞ࡗ࡚ࡁ࡚࠸ࡿࠋື≀ࠊ≉࡟క౶ື≀ࡢၥ 㢟⾜ືࡣࠊࠕே㛫♫఍࡜༠ㄪ࡛ࡁ࡞࠸⾜ືࠖࡶࡋࡃࡣࠕே㛫ࡀၥ㢟࡜ឤࡌࡿ⾜ືࠖ࡜ᐃ ⩏ࡉࢀࡿ㸦31㸧ࠋၥ㢟⾜ືࡀὀ┠ࡉࢀࡿࡼ࠺࡟࡞ࡗࡓ⌮⏤࡜ࡋ࡚ࠊ࢔࣓ࣜ࢝࡟࠾࠸࡚≟ ࡢṚᅉࡢ➨1 ఩ࡣᏳᴦṚ࡛࠶ࡾࠊᏳᴦṚࡢ⌮⏤ࡢ➨ 1 ఩ࡀၥ㢟⾜ື࡛࠶ࡿࡇ࡜ࡀ⪃࠼ࡽ ࢀࡿ㸦31㸧ࠋࡲࡓ᪥ᮏ࡟࠾࠸࡚ࡶࠊᮾி㒔ࡀ 2006 ᖺ࡟ሗ࿌ࡋࡓࢹ࣮ࢱ࡛ࡣಖ೺ᡤ࡟࠾ ࡅࡿ≟ࡢᘬࡁྲྀࡾࡢ⌮⏤ࡢ࠺ࡕ14㸣ࡀၥ㢟⾜ື࡛࠶ࡾ㸦41㸧ࠊ඲ᅜࡢಖ೺ᡤࢆᑐ㇟࡜ࡋ ࡓ2013 ᖺ࡟Ⓨ⾲ࡉࢀࡓࢹ࣮ࢱ࡛ࡣ 20.8㸣ࡀၥ㢟⾜ື࡛࠶ࡗࡓ㸦32㸧ࠋࡇࢀࡽࡢࡇ࡜࠿ ࡽࠊ᪥ᮏ࡛ࡶ≟ࡢၥ㢟⾜ືࡣ௒ᚋ᪩ᛴ࡞ᑐᛂࡀồࡵࡽࢀࡿ㔜せ࡞ၥ㢟࡜࡞ࡾࡘࡘ࠶ࡿࠋ ၥ㢟⾜ືࡢ୰࡛ࡶࠊ㐣๫࡞୙Ᏻࡀཎᅉ࡜࡞ࡗ࡚ᘬࡁ㉳ࡇࡉࢀࡿ୙Ᏻ㞀ᐖࢆ♧ࡍ≟ࡣከ ࠸ࠋ୙Ᏻ㞀ᐖࡣࠊ≟ࡀ୙Ᏻࡸᜍᛧࢆឤࡌࡓ㝿࡟ぢࡽࢀࡿṇᖖ࡞⾜ື࡛࠶ࡿ୙Ᏻ⾜ືࡀⓎ ᒎࡋࠊ㣫࠸୺ࡀၥ㢟࡜ឤࡌࡿࡼ࠺࡟࡞ࡿࡇ࡜࡛⏕ࡌࡿࠋ≟ࡢ୙Ᏻ㞀ᐖ࡟ࡣࠊศ㞳୙Ᏻ⑕ࠊ 㞾ᜍᛧ⑕ࠊ㡢࡟ᑐࡍࡿᜍᛧ⑕ࠊேࡸ≀࡟ᑐࡍࡿᜍᛧ⑕ࠊ඲⯡ᛶ୙Ᏻ㞀ᐖ࡞࡝ࡀ࠶ࡿࠋ୙ Ᏻ㞀ᐖࢆ♧ࡍ≟ࡣࠊ≉ᐃࡢ᮲௳ୗ࡟࠾࠸࡚㐣๫࡞࿯ေࠊ୙㐺ษ࡞᤼ἥࠊ◚ቯ⾜ືࠊ⮬യ ⾜Ⅽ࡞࡝ࢆ♧ࡍ㸦26㸧ࠋࡇࡢࡼ࠺࡞⾜ືࢆ࡜ࡿ≟ࢆ㣫࠸⥆ࡅࡿࡇ࡜ࡣ㣫࠸୺࡟࡜ࡗ࡚኱ ࡁ࡞㈇ᢸ࡜࡞ࡾࠊࡑࢀ࡟ࡼࡾᏳᴦṚࡸ㣫⫱ᨺᲠࢆ㑅ᢥࡍࡿ㣫࠸୺ࡀ⌧ࢀ࡚࠸ࡿ࡜⪃࠼ࡽ ࢀࡿࠋ ຍ࠼࡚ࠊ୙Ᏻ㞀ᐖࢆᢪ࠼ࡓ≟ࡣᙉ࠸ࢫࢺࣞࢫࢆឤࡌ࡚࠸ࡿࡇ࡜ࡀඛ⾜◊✲࠿ࡽ♧ࡉࢀ

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2 ࡚࠸ࡿࠋ㞾ᜍᛧ⑕ࡢ≟ࡣ㞾ࡀ㬆ࡗ࡚࠸ࡿ᫬࡟ࠊࢫࢺࣞࢫ࡟ࡼࡾศἪࡀ㧗ࡲࡿࢥࣝࢳࢰ࣮ ್ࣝࡀ2 ಸ௨ୖ࡟࡞ࡿ࡜࠸࠺ඛ⾜◊✲ࡀ࠶ࡿ㸦11㸧ࠋࡉࡽ࡟ࠊ≟ࡢẟ㧥୰ࡢࢥࣝࢳࢰ࣮ ್ࣝ࡜㞾ࡀ㬆ࡗ࡚࠸ࡿ᫬ࡢ཯ᛂ࡟᭷ព࡞ṇࡢ┦㛵ࡀ࠶ࡿࡇ࡜ࢆ♧ࡋࡓ◊✲ࡶ࠶ࡿ㸦37㸧ࠋ ࡲࡓࠊ୙Ᏻ㞀ᐖࢆ♧ࡍ≟ࡣ୙Ᏻ㞀ᐖࡢ࡞࠸≟࡟ẚ࡭࡚ᖹᆒᑑ࿨ࡀ▷࠸࡜࠸࠺ඛ⾜◊✲ࡶ ࠶ࡿ㸦10㸧ࠋࡇࡢࡼ࠺࡟ࠊ୙Ᏻ㞀ᐖࡣ≟࡟ᙉ࠸ࢫࢺࣞࢫࢆ୚࠼ࡿࡓࡵࠊື≀ឡㆤࡢほⅬ ࠿ࡽࡶ㔜せ࡞ၥ㢟࡛࠶ࡿࠋ ࡋ࠿ࡋࠊ᪥ᮏ࡟࠾࠸࡚ࡣၥ㢟⾜ື࡟ᑐࡍࡿ⌮ゎࡣ㐍ࢇ࡛࠸࡞࠸ࡢࡀ⌧≧࡛࠶ࡿࠋ㏆ᖺ ࡟࡞ࡗ࡚⋇་Ꮫᩍ⫱ࡢࢥ࢔࣭࣒࢝ࣜ࢟ࣗࣛ࡟ື≀⾜ືᏛ࣭⮫ᗋ⾜ືᏛࡀຍ࠼ࡽࢀࠊၥ㢟⾜ືࡢデ᩿ࡸ἞⒪࡟⯆࿡ࢆᣢࡘ⋇་ᖌࡣቑ࠼ࡘࡘ࠶ࡿࡀࠊ௚ࡢデ⒪ศ㔝࡟ẚ࡭ࡿ࡜ᅽಽ ⓗ࡟ᑡ࡞࠸ࠋࡑࡢࡓࡵࠊ᪥ᮏ࡟࠾ࡅࡿၥ㢟⾜ືࡢ⌮ゎࢆ㐍ࡵࡿࡓࡵ࡟ࡶࠊၥ㢟⾜ືࢆ♧ ࡍ≟ࡀ࡝ࡢ⛬ᗘ࠸ࡿࡢ࠿ࠊၥ㢟⾜ືࡢⓎ⌧࡟ᙳ㡪ࡍࡿせᅉࡣఱ࠿ࠊ࡝ࡢࡼ࠺࡟ࡍࢀࡤண 㜵࡛ࡁࡿࡢ࠿࡞࡝ࢆ▱ࡿᚲせࡀ࠶ࡿࠋ ௒ᅇࡢㄪᰝ࡛ࡣࠊ௨ୗࡢ3 ❶࡟Ώࡿ◊✲ࢆ≟ࡢ㣫࠸୺࡟ᑐࡍࡿ࢔ࣥࢣ࣮ࢺ࡟ࡼࡾ⾜ࡗ ࡓࠋ࢔ࣥࢣ࣮ࢺࡣࠊ≟ࡢ⾜ືࢆホ౯ࡍࡿ᪉ἲ࡜ࡋ࡚ᗈࡃ⏝࠸ࡽࢀ࡚࠾ࡾࠊ㣫࠸୺࡟ᑐࡍ ࡿ࢔ࣥࢣ࣮ࢺࡣ≟ࡢ⾜ືࢆṇ☜࡟ホ౯ࡍࡿࡓࡵࡢ᪉ἲ࡜ࡋ࡚㧗ࡃホ౯ࡉࢀ࡚࠸ࡿ㸦21ࠊ 24ࠊ27ࠊ28ࠊ36ࠊ40ࠊ42㸧ࠋඛ㏙ࡢࡼ࠺࡟ࠊ୙Ᏻ㞀ᐖࢆ♧ࡍ≟ࡣ≉ᐃࡢ≧ἣୗ࡛ࡢࡳ ≉ᚩⓗ࡞୙Ᏻ⾜ືࢆ♧ࡍࡇ࡜࠿ࡽ㣫࠸୺ࡀㄆ㆑ࡋࡸࡍࡃࠊ࢔ࣥࢣ࣮ࢺ࡟ࡼࡿㄪᰝࢆ⾜࠸ ࡸࡍ࠸ࠋࡲࡓࠊ᪥ᮏ࡟࠾ࡅࡿ≟ࡢၥ㢟⾜ືࡣᇶ♏᝟ሗࡀᑡ࡞࠸ࡓࡵࠊ࡛ࡁࡿࡔࡅ⡆᫆࡞

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3 ᪉ἲ࡛ከࡃࡢ㣫࠸୺࡟᝟ሗࢆᥦ౪ࡋ࡚ࡶࡽ࠺ࡇ࡜ࡀᚲせ࡜࡞ࡿࠋ࢔ࣥࢣ࣮ࢺㄪᰝࡣࡑࡢ Ⅼ࡛ࡶඃࢀ࡚࠾ࡾࠊ௒ᅇࡢ◊✲࡟᭱ࡶ㐺ࡋࡓ᪉ἲ࡛࠶ࡿ࡜ゝ࠼ࡿࠋ ➨1 ❶࡛ࡣࠊᚋ࡟୙Ᏻ㞀ᐖ࡟Ⓨᒎࡍࡿྍ⬟ᛶࡀ࠶ࡿ≟ࡢ୙Ᏻ⾜ື࡟ࡘ࠸࡚᪥ᮏ࡛ࡢⓎ ⏕≧ἣࡢᐇែࢆㄪᰝࡋࠊ࡝ࡢ⛬ᗘࡢ≟ࡀ୙Ᏻ㞀ᐖࡢ⣲ᅉࢆᣢࡘࡢ࠿ࠊ࡝ࡢ⛬ᗘࡢ㣫࠸୺ ࡀᐇ㝿࡟≟ࡢ୙Ᏻ⾜ື࡟ࡼࡾᅔࡗ࡚࠸ࡿࡢ࠿ࠊၥ㢟⾜ືࡢデ᩿࣭἞⒪ࢆ⾜ࡗ࡚࠸ࡿ⋇་ ᖌࡢᏑᅾࡀ࡝ࡢ⛬ᗘ▱ࡽࢀ࡚࠸ࡿࡢ࠿ࠊࡑࡢࡼ࠺࡞⋇་ᖌࡀ࡝ࡢ⛬ᗘᚲせ࡜ࡉࢀ࡚࠸ࡿ ࡢ࠿ࠊྛ୙Ᏻ⾜ືࡢⓎ⌧࡟ᙳ㡪ࡍࡿせᅉࡣఱ࠿ࠊྛ୙Ᏻ⾜ືࡢ㛫࡟㛵㐃ࡣ࠶ࡿࡢ࠿ࢆㄪ ࡭ࠊᆅᇦ㛫࡛ࡢᕪࡸྛせᅉࡢࢢ࣮ࣝࣉ㛫࡛ࡢᕪࢆẚ㍑ࡋࡓࠋ➨2 ❶࡛ࡣࠊ≟ࡢ୙Ᏻ⾜ື ࡢⓎ⌧࡟ᑐࡍࡿ⤒㦂ⓗ࣭⎔ቃⓗ࡞せᅉ࡜ࡋ࡚ࠊࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍࠊࢺ࣮ࣞࢽࣥࢢᩍ ᐊ࡬ࡢཧຍࠊྠᒃ≟࠾ࡼࡧྠᒃࡍࡿᏊ౪ࡢᙳ㡪ࢆㄪ࡭ࠊ≟࡟࡝ࡢࡼ࠺࡞⤒㦂ࢆࡉࡏࡿࡇ ࡜ࡀ୙Ᏻ⾜ືࢆண㜵ࡍࡿୖ࡛㔜せ࡛࠶ࡿ࠿᳨ウࡋࡓࠋ➨3 ❶࡛ࡣࠊ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧ ࡟ᑐࡍࡿࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡢᙳ㡪ࢆ᫂ࡽ࠿࡟ࡍࡿࡓࡵࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢ ཧຍᮇ㛫ࠊཧຍ㢖ᗘࠊཧຍᅇᩘࠊཧຍ᫬ࡢ≟ࡢᖺ㱋ࠊ᚟⩦ࡢ᭷↓࡞࡝ࡢᙳ㡪ࢆㄪ࡭ࠊࢺ ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻࠺᭱㐺࡞ࢫࢣࢪ࣮ࣗࣝ࡟ࡘ࠸᳨࡚ウࡋࡓࠋ

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4 ➨1 ❶

᪥ᮏ࡟࠾ࡅࡿ୙Ᏻ㞀ᐖࡢ⣲ᅉࢆᣢࡘ≟ࡢᐇែㄪᰝ

⥴ゝ ၥ㢟⾜ືࡢⓎ⌧࡟㛵ࢃࡿせᅉࢆㄪᰝࡋࡓඛ⾜◊✲࡟ࡣࠊ⑓㝔ࡢ⾜ືデ⒪⛉ࢆཷデࡋၥ 㢟⾜ື࡜デ᩿ࢆཷࡅࡓ≟ࢆᑐ㇟࡜ࡋࡓࡶࡢ㸦13ࠊ33ࠊ38㸧ࡸࠊಖ೺ᡤࡢ≟ࢆᑐ㇟࡜ࡋ ࡚ㄪᰝࢆ⾜ࡗࡓࡶࡢࡀ࠶ࡿ㸦45㸧ࠋࡇࢀࡽࡢ◊✲࡛ࡣࠊ≟✀ࡸᛶูࠊᖺ㱋࡜ࡢ㛵㐃ࡀ♧ ࡉࢀ࡚࠸ࡿࡀࠊ೺ᖖ࡞≟࡜ࡢẚ㍑ࢆ⾜ࡗ࡚࠾ࡽࡎࠊࡇࢀࡽࡢせᅉࡀᐇ㝿࡟ၥ㢟⾜ືࡢ᭷ ↓࡟ᙳ㡪ࡋ࡚࠸ࡿ࠿ࡣ୙࡛᫂࠶ࡿࠋࡑࡢࡓࡵࠊၥ㢟⾜ືࡢⓎ⌧࡟ᙳ㡪ࡍࡿせᅉࢆㄪ࡭ࡿ ࡓࡵ࡟ࡣࠊ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋ࡚ၥ㢟⾜ືࢆ♧ࡍ≟࡜♧ࡉ࡞࠸≟ࢆẚ㍑ࡍࡿࡇ࡜ࡀ㔜せ ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋ ୍᪉࡛ࠊ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋ࡚୙Ᏻ⾜ືࢆ♧ࡍ≟࡜♧ࡉ࡞࠸≟ࢆẚ㍑ࡋࡓඛ⾜◊✲ࡶ Ꮡᅾࡍࡿ㸦3ࠊ28ࠊ44㸧ࠋࡇࢀࡽࡢ◊✲࡟࠾࠸࡚ࡶࠊ≟✀ࡸᛶูࠊᖺ㱋ࠊධᡭ⤒㊰࡞࡝ ࡜ࡢ㛵㐃ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋࡋ࠿ࡋࠊࡇࢀࡽࡢ◊✲࡟࠾࠸࡚ࡣ㣫࠸୺ࡀ≟ࡢ⾜ືࢆၥ㢟 ࡜ឤࡌ࡚࠸ࡿ࠿ࠊࡍ࡞ࢃࡕ≟ࡢၥ㢟⾜ືࡢ⨯ᝈ⋡࡟ࡘ࠸࡚ࡣㄪ࡭ࡽࢀ࡚࠸࡞࠸ࠋࡲࡓࠊ ≟ࡢၥ㢟⾜ື࡟ࡘ࠸࡚⌮ゎࡍࡿࡓࡵ࡟ࡣ࡝ࡢ⛬ᗘࡢ≟ࡀၥ㢟⾜ືࢆⓎ⌧ࡋ࡚࠸ࡿࡢ࠿ ࡟ࡘ࠸࡚ࡢᇶ♏ⓗ࡞ࢹ࣮ࢱࢆᚓࡿࡇ࡜ࡀᚲせ୙ྍḞ࡛࠶ࡿ࡟ࡶ㛵ࢃࡽࡎࠊࡑࡢࡼ࠺࡞ࢹ ࣮ࢱࡣⓙ↓࡛࠶ࡿࠋ ࡉࡽ࡟ࠊၥ㢟⾜ືࡢデ᩿࣭἞⒪ࢆ⾜ࡗ࡚࠸ࡿ⋇་ᖌࡀ࠸ࡿ࡜࠸࠺ࡇ࡜ࡀ࡝ࡢ⛬ᗘ▱ࡽ

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5 ࢀ࡚࠸ࡿ࠿ࡣ㔜せ࡞ព࿡ࢆᣢࡘࠋ㣫࠸≟ࡀၥ㢟⾜ືࢆ♧ࡍࡼ࠺࡟࡞ࡗࡓ㝿࡟ࠊࡑࡢࡼ࠺ ࡞⋇་ᖌࢆ▱ࡗ࡚࠸ࢀࡤࡍࡄ࡟┦ㄯ࣭἞⒪ࢆࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋࡑࡢࡓࡵࠊၥ㢟⾜ືࡢ デ᩿࣭἞⒪ࢆ⾜࠼ࡿ⋇་ᖌࢆ▱ࡗ࡚࠸ࢀࡤࠊᏳᴦṚࡸ㣫⫱ᨺᲠࢆ㑅ᢥࡍࡿ㣫࠸୺ࡀῶࡿ ࡛࠶ࢁ࠺ࡇ࡜ࡀᮇᚅ࡛ࡁࡿࠋࡋ࠿ࡋࠊඛ㏙ࡢࡼ࠺࡟᪥ᮏ࡛ࡣ≟ࡢၥ㢟⾜ືࡣⓎᒎ㏵ୖࡢ ศ㔝࡛࠶ࡿࡓࡵࠊ࡯࡜ࢇ࡝ࡢ㣫࠸୺ࡀࡑࡢࡼ࠺࡞⋇་ᖌࡢᏑᅾࢆ▱ࡽ࡞࠸ࡢ࡛ࡣ࡞࠸࠿ ࡜⪃࠼ࡽࢀࡿࠋ ࡲࡓࠊඛ㏙ࡢࡼ࠺࡟ࠊၥ㢟⾜ືࡣࠕே㛫♫఍࡜༠ㄪ࡛ࡁ࡞࠸⾜ືࠖࡶࡋࡃࡣࠕே㛫ࡀ ၥ㢟࡜ឤࡌࡿ⾜ືࠖ࡜ᐃ⩏ࡉࢀࡿࡇ࡜࠿ࡽ㸦31㸧ࠊ≟࡜ேࡀࡼࡾ῝ࡃ㛵ࢃࡗ࡚࠸ࡿ♫఍ ࡟࠾࠸࡚ࡼࡾ῝้࡟࡞ࡿ࡜⪃࠼ࡽࢀࡿࠋᐇ㝿ࠊ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋࡓඛ⾜◊✲࡟࠾࠸࡚ ࡶ୺࡟㒔ᕷ㒊࡟࠾࠸࡚ㄪᰝࡀ⾜ࢃࢀ࡚࠸ࡿ㸦3ࠊ28ࠊ44㸧ࠋࡑࡢࡓࡵࠊ≟࡜ேࡀᐦ᥋࡞ 㛵ಀࢆ⠏࠸࡚࠸ࡿ㒔ᕷ㒊࡟࠾࠸࡚ࡢ≧ἣࢆ⌮ゎࡍࡿࡇ࡜ࡀ㔜せ࡛࠶ࡿࠋຍ࠼࡚ࠊ㒔ᕷ㒊 ࡛࠶ࢀࡤ≟ࡢ㣫⫱᪉ἲ࡟኱ࡁ࡞㐪࠸ࡣ⏕ࡌ࡞࠸࡜⪃࠼ࡽࢀࡿࡓࡵࠊ㣫࠸୺ഃࡢせᅉ࡟ࡼ ࡿᙳ㡪ࢆᑠࡉࡃࡍࡿࡇ࡜ࡶᮇᚅ࡛ࡁࡿࠋ ௨ୖࡢࡇ࡜࠿ࡽࠊ୙Ᏻ⾜ືࢆ♧ࡍ≟ࡢ๭ྜࠊࡑࢀ࡟ࡼࡾᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࠊၥ 㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌࡀ࡝ࡢ⛬ᗘ▱ࡽࢀ࡚࠸ࡿ࠿ࠊ୙Ᏻ⾜ືࡢⓎ⌧࡟ᙳ㡪ࡍࡿせᅉ ࡣఱ࠿ࢆㄪᰝࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡋ࡚◊✲ࢆ⾜ࡗࡓࠋ

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6 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ

ᮏ◊✲ࡣࠊᮾி㎰ᕤ኱Ꮫ◊✲೔⌮ጤဨ఍ࡢᢎㄆࢆᚓ࡚⾜ࡗࡓ㸦⏦ㄳ␒ྕ No.26-21㸧ࠋ ㄪᰝࡣྛ㣫࠸୺ࡢྠពࢆᚓࡓୖ࡛⾜ࡗࡓࠋ

ㄪᰝࡢࡓࡵࡢ࢔ࣥࢣ࣮ࢺࢆసᡂࡋࡓ㸦supplement 1㸧ࠋ࢔ࣥࢣ࣮ࢺࡣྛ≟ࡢᇶ♏᝟ሗ ࢆ☜ㄆࡍࡿ㡯┠࡜୙Ᏻ࡟ࡘ࠸࡚ࡢ㡯┠࡟ศࡅࡽࢀࡓࠋᇶ♏᝟ሗࡢ㡯┠࡟ࡣࠊ≟✀ࠊᛶูࠊ ᖺ㱋ࠊධᡭ᫬ࡢᖺ㱋ࠊධᡭ⤒㊰ࠊዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓㸦࣓ࢫࡢࡳ㸧ࠊ᪤ Ṕࡀྵࡲ ࢀࡓࠋ୙Ᏻ࡟ࡘ࠸࡚ࡢ㡯┠࡟ࡣࠊ௨ୗࡢ≧ἣ࡛≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ࠿㸹”ศ㞳୙Ᏻ”㸦␃ Ᏺ␒୰ࡸ㣫࠸୺ࡢጼࡀぢ࠼࡞࠸᫬㸧ࠊ”ᔒ”㸦ᔒࡢ᫬㸧ࠊ”ⰼⅆ”㸦ⰼⅆࡢ㡢ࡀࡍࡿ᫬㸧ࠊ”㡢” 㸦኱ࡁ࡞㡢ࡀࡍࡿ᫬㸧ࠊ”≉ᐃࡢᑐ㇟≀”㸦≉ᐃࡢேࡸ≀ࢆぢࡓ᫬㸧ࠊ”඲⯡ᛶ୙Ᏻ”㸦ᖖ࡟ ࣜࣛࢵࢡࢫ࡛ࡁ࡞࠸㸧㸹ヱᙜࡍࡿࡶࡢࡀ࠶ࡿሙྜࡣࡑࢀࡒࢀࡢ୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ࠺ ࡟࡞ࡗࡓ᫬ᮇࠊ≟ࡀᛧࡀࡾ࡛࠶ࡿ࠿㸦≟ࡀ୙Ᏻ⾜ືࢆ♧ࡋࡸࡍ࠸࠿ྰ࠿ࡢᣦᶆ㸧ࠊᛧࡀ ࡾ࡞≟ࡢ⾜ື࡟ࡼࡾ㣫࠸୺ࡀᅔࡗ࡚࠸ࡿ࠿ࠊᛧࡀࡾ࡞≟ࡢ⾜ື࡟ࡘ࠸࡚ㄡ࠿࡟┦ㄯࡋࡓ ࡶࡋࡃࡣ┦ㄯࡋࡓ࠸࡜ᛮ࠺࠿ࠊၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌࡀ࠸ࡿࡇ࡜ࢆ▱ࡗ࡚࠸ࡿ࠿ࠊ ᚲせ࡛࠶ࢀࡤࡑࡢࡼ࠺࡞⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜ᛮ࠺࠿ࡀྵࡲࢀࡓࠋ୙Ᏻ࡟ࡘ࠸࡚ࡢ㡯┠ ࡣࠊ୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ࠺࡟࡞ࡗࡓ᫬ᮇࢆ㝖ࡁࠊ඲࡚”ࡣ࠸”/ “࠸࠸࠼” ࡛ᅇ⟅ࡉࡏࡿ ࡼ࠺࡟ࡋࡓࠋ

᪥ᮏࡢ㒔ᕷ㒊࡜ࡋ࡚೫ࡾࡀ⏕ࡌࡿྍ⬟ᛶࢆ⪃៖ࡋࠊㄪᰝࡣ㛵ᮾࠊ㛵すࠊᮾ໭ᆅ᪉ࡢ㒔 ᕷ㒊࡛࠶ࡿᮾிࠊ኱㜰ࠊ௝ྎࡢ3 㒔ᕷࡢ࣌ࢵࢺࢩࣙࢵࣉ࡛⾜ࡗࡓࠋ࣌ࢵࢺࢩࣙࢵࣉࢆゼ

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7 ࢀࡓ≟ࡢ㣫࠸୺࡟ᑐࡋࠊࡑࡢሙ࡛࢔ࣥࢣ࣮ࢺ࡬ࡢグධࢆ౫㢗ࡋࡓࠋ

ᚓࡽࢀࡓࢹ࣮ࢱ࡟ᑐࡋ⤫ィゎᯒࢆ⾜ࡗࡓࠋᛧࡀࡾ࡛࠶ࡿ≟ࡢ๭ྜࠊᛧࡀࡾ࡞≟ࡢ⾜ື ࡟ࡼࡾᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࠊᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ࠺ࡕ≟ࡢᛶ᱁࣭⾜ື࡟ࡘ࠸࡚┦ㄯ ࡋࡓࡶࡋࡃࡣ┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࠊၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌࡀ࠸ ࡿࡇ࡜ࢆ▱ࡗ࡚࠸ࡓ㣫࠸୺ࡢ๭ྜࠊᚲせࡀ࠶ࢀࡤࡑࡢࡼ࠺࡞⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜ᛮࡗ ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜ࡟㛵ࡋ࡚ࡣࠊȮ2_{᳨ᐃࢆ⏝࠸࡚ᆅᇦ࡟ࡼࡿᕪࡀ࠶ࡿ࠿ࢆゎᯒࡋࡓࠋ}

୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ㛫ࡢ㛵㐃ࢆㄪ࡭ࡿࡓࡵ࡟ࠊ࢜ࢵࢬẚࢆ⟬ฟࡋࡓࠋ∦᪉ࡢ≧ἣࡢᅇ ⟅ࢆᛂ⟅ኚᩘࠊࡶ࠺∦᪉ࡢ≧ἣࡢᅇ⟅ࢆㄝ᫂ኚᩘ࡜ࡋ࡚ࠊ஧㡯ศᕸ࡟ࡼࡿ୍⯡໬⥺ᙧࣔ ࢹࣝࢆ⏝࠸ࡓࠋ࢜ࢵࢬẚࡢ⟬ฟ࡟ࡣࠊ⤌ࡳྜࢃࡏࡓ2 ࡘࡢ≧ἣࡢᅇ⟅ࢆࡑࢀࡒࢀ༢ᅇᖐ ࡋࡓ㝿ࡢಀᩘࢆ⏝࠸ࡓࠋࡲࡓࠊ༢ᅇᖐࡋࡓ㝿ࡢp್࠿ࡽࠊ⤌ࡳྜࢃࡏࡓ2 ࡘࡢ≧ἣࡢ㛵

㐃ࡀ᭷ព࡛࠶ࡿ࠿ࢆุᐃࡋࡓࠋࡇࡢゎᯒ࡟ࡣࠊR software (ver. 3.2.1)ࡢ lmer function ࢆ⏝࠸ࡓࠋ

≟ࡀᛧࡀࡾ࡛࠶ࡿ࠿ࠊ࠾ࡼࡧྛ≧ἣ࡛୙Ᏻ⾜ືࢆ♧ࡍ࠿ࢆᛂ⟅ኚᩘࠊ≟✀ࠊᛶูࠊᖺ 㱋ࠊධᡭ᫬ࡢᖺ㱋ࠊධᡭ⤒㊰ࠊᆅᇦࢆㄝ᫂ኚᩘ࡜ࡋ࡚ࠊ஧㡯ศᕸ࡟ࡼࡿ୍⯡໬⥺ᙧࣔࢹ ࣝࢆ⏝࠸࡚ྛㄝ᫂ኚᩘࡀᛂ⟅ኚᩘ࡟ᙳ㡪ࢆཬࡰࡋ࡚࠸ࡿ࠿ࢆ☜ㄆࡋࡓࠋ᭷ព࡛࠶ࡗࡓㄝ ᫂ኚᩘ࡟㛵ࡋ࡚ࡣࠊྛ㡯┠㛫ࡢ᭷ពᕪࢆ☜ㄆࡍࡿࡓࡵ࡟ࠊከ㔜ẚ㍑ࢆ⾜ࡗࡓࠋ⟬ฟࡉࢀ ࡓp್࡟ࡣࠊHolm ἲ࡟ࡼࡿ⿵ṇࢆ࠿ࡅࡓࠋ᭷ព࡛࠶ࡿ࠿ࢆホ౯ࡍࡿ᪉ἲ࡜ࡋ࡚ࡣࠊᑬ

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8 ⤖ᯝ ྜィ࡛262 㢌ศ㸦ᮾி 69 㢌ࠊ኱㜰 99 㢌ࠊ௝ྎ 94 㢌㸧ࡢࢹ࣮ࢱࡀᚓࡽࢀࡓࠋࡇࢀࡽ ࡢ≟ࡣ࡯ࡰ඲࡚㸦247 㢌㸧ࡀᐊෆ࡛㣫⫱ࡉࢀ࡚࠸ࡓࠋ≟✀ࡣ⣧⾑✀ 33 ≟✀࡟㞧✀ࡀྵ ࡲࢀࡓࠋ5 㢌௨ୗࡔࡗࡓ≟✀ࡣ”ࡑࡢ௚”࡜ࡋ࡚ 1 ࡘࡢࢢ࣮ࣝࣉ࡟ࡲ࡜ࡵࠊࡑࡢ⤖ᯝ 14 ࡢࢢ࣮ࣝࣉ࡟ศࡅࡽࢀࡓ㸦supplement 2㸧ࠋᖹᆒ᭶㱋ࡣ 59.5ࠊධᡭ᫬ࡢᖹᆒ᭶㱋ࡣ 5.0 ࡛࠶ࡗࡓࠋᖺ㱋ࡣඛ⾜◊✲㸦27㸧ࢆཧ⪃࡟ࠊ᭶㱋࡟ࡼࡾ”ᗂ㱋”㸦23 ࣨ᭶㱋௨ୗ㸧ࠊ”ⱝ㱋” 㸦24 ࣨ᭶㱋௨ୖ 59 ࣨ᭶㱋௨ୗ㸧ࠊ”ᡂ㱋”㸦60 ࣨ᭶㱋௨ୖ 95 ࣨ᭶㱋௨ୗ㸧ࠊ”⪁㱋”㸦96 ࣨ᭶㱋௨ୖ㸧ࡢ4 ࡘࡢࢢ࣮ࣝࣉ࡟ศࡅࡓࠋධᡭ᫬ࡢᖺ㱋ࡶ Houpt ࡟ࡼࡿศ㢮 (19㸧ࢆ ཧ⪃࡟ࠊ᭶㱋࡟ࡼࡾ”ࣃࣆ࣮1”㸦1 ࣨ᭶㱋௨ୗ㸧ࠊ”ࣃࣆ࣮2”㸦1 ࣨ᭶㱋< ࠊ2 ࣨ᭶㱋௨ୗ㸧ࠊ” ࣃࣆ࣮3”㸦2 ࣨ᭶㱋< ࠊ3 ࣨ᭶㱋௨ୗ㸧ࠊ”ࣃࣆ࣮4”㸦3 ࣨ᭶㱋<㸧ࡢ 4 ࡘࡢࢢ࣮ࣝࣉ࡟ศ ࡅࡓࠋᛶูࡣࠊ࢜ࢫ75 㢌ࠊཤໃ࢜ࢫ 64 㢌ࠊ࣓ࢫ 61 㢌ࠊ㑊ዷ࣓ࢫ 57 㢌ࠊ↓ᅇ⟅ 5 㢌 ࡛࠶ࡗࡓࠋධᡭ⤒㊰ࡣࠊ”࣌ࢵࢺࢩࣙࢵࣉ”㸦࣌ࢵࢺࢩࣙࢵࣉ࠿ࡽ㉎ධ㸧 176 㢌ࠊ”ࣈࣜ ࣮ࢲ࣮” 㸦ࣈ࣮ࣜࢲ࣮࠿ࡽ㉎ධ㸧47 㢌ࠊ”▱ே”㸦▱ே࠿ࡽࡢㆡΏ㸧 25 㢌ࠊ”ࢩ࢙ࣝࢱ ࣮” 㸦ಖ೺ᡤ࠿ࡽᘬࡁྲྀࡾ㸧5 㢌ࠊ”ࡑࡢ௚” 㸦⮬Ꮿ࡛⦾Ṫ࡞࡝㸧8 㢌ࠊ↓ᅇ⟅ 1 㢌࡛࠶ ࡗࡓࠋዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓࠾ࡼࡧ᪤ Ṕ࡜୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ࠺࡟࡞ࡗࡓ᫬ᮇ࠿ ࡽࠊゎᯒ࠿ࡽ㝖እࡍࡿᚲせࡀ࠶ࡿ࡜ุ᩿ࡋࡓሙྜࡣゎᯒ࡟ࡣ⏝࠸࡞࠸ணᐃ࡛࠶ࡗࡓࡀࠊ ࡑࡢࡼ࠺࡞ࢹ࣮ࢱࡣ࡞࠿ࡗࡓࠋ”ࢩ࢙ࣝࢱ࣮”࠾ࡼࡧ ”ࡑࡢ௚”ࡣᩘࡀᑡ࡞࠿ࡗࡓࡓࡵࠊࢢ࣮ࣝࣉ㛫࡛ࡢከ㔜ẚ㍑࠿ࡽࡣ㝖እࡋࡓࠋ

(13)

9 ≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ࡟ࡘ࠸࡚ࡣ௨ୗࡢࡼ࠺࡟࡞ࡗࡓ㸹”ศ㞳୙Ᏻ” 59 㢌㸦ᮾி 17 㢌ࠊ኱㜰 20 㢌ࠊ௝ྎ 22㸧ࠊ”ᔒ” 105 㢌㸦ᮾி 35 㢌ࠊ኱㜰 29 㢌ࠊ௝ྎ 41 㢌㸧ࠊ”ⰼⅆ” 68 㢌㸦ᮾி 18 㢌ࠊ኱㜰 16 㢌ࠊ௝ྎ 34 㢌㸧ࠊ”㡢” 150 㢌㸦ᮾி 41 㢌ࠊ኱㜰 61 㢌ࠊ௝ྎ 48 㢌㸧ࠊ”≉ᐃࡢᑐ㇟≀” 27 㢌㸦ᮾி 10 㢌ࠊ኱㜰 7 㢌ࠊ௝ྎ10 㢌㸧ࠊ”඲⯡ᛶ୙Ᏻ” 4 㢌㸦ᮾி 2 㢌ࠊ኱㜰 1 㢌ࠊ௝ྎ 1 㢌)ࠋ”඲⯡ᛶ୙ Ᏻ”࡟㛵ࡋ࡚ࡣᩘࡀᑡ࡞࠿ࡗࡓࡓࡵࠊ௨㝆ࡢゎᯒ࠿ࡽࡣ㝖እࡋࡓࠋ ᛧࡀࡾ࡞≟ࡢ๭ྜࡣࠊᮾி 55.1%ࠊ኱㜰 51.5%ࠊ௝ྎ 56.4%㸦඲య࡛ࡣ 54.2%㸧࡛ ࠶ࡗࡓࠋᛧࡀࡾ࡞≟ࡢ⾜ື࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡣࠊᮾி 47.4%ࠊ኱㜰 41.2%ࠊ ௝ྎ 43.4%㸦඲య࡛ࡣ 43.7%㸧࡛࠶ࡗࡓࠋᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ࠺ࡕ≟ࡢ୙Ᏻ⾜ື࡟ࡘ ࠸࡚┦ㄯࡋࡓࡶࡋࡃࡣ┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡣࠊᮾி 44.5%ࠊ኱㜰 61.9%ࠊ௝ྎ 60.9%㸦඲య࡛ࡣ 56.5%㸧࡛࠶ࡗࡓࠋၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌࡀ࠸ࡿ ࡇ࡜ࢆ▱ࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡣࠊᮾி 21.7%ࠊ኱㜰 19.2%ࠊ௝ྎ 23.4%㸦඲య࡛ࡣ 21.4%㸧࡛࠶ࡗࡓࠋᚲせࡀ࠶ࢀࡤࡑࡢࡼ࠺࡞⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚࠸ࡿ㣫࠸୺ࡢ ๭ྜࡣࠊᮾி 52.2%ࠊ኱㜰 59.6%ࠊ௝ྎ 55.3%㸦඲య࡛ࡣ 56.1%㸧࡛࠶ࡗࡓࠋࡑࢀࡒ ࢀࡢ๭ྜ࡟㛵ࡋ࡚ࠊᆅᇦ࡟ࡼࡿ᭷ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓ㸦ࡑࢀࡒࢀ߯ଶ_=0.489,_p =0.783; ߯ଶ_=2.061,_p_{=0.724; ߯}ଶ_=1.492,_p_{=0.474; ߯}ଶ_=0.517,_p_{=0.772; ߯}ଶ_=5.021,_p =0.285; ᅗ 1a-e㸧ࠋ

ྛ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ㛫ࡢ࢜ࢵࢬẚࢆ⾲1 ࡟♧ࡋࡓࠋ”ศ㞳୙Ᏻ”࡜”≉ᐃࡢᑐ㇟≀”ࠊ

(14)

10 ”ᔒ”࡜”ⰼⅆ”ࠊ”ᔒ”࡜”㡢”ࠊ”ⰼⅆ”࡜”㡢”ࡢ㛫࡟᭷ព࡞㛵㐃ࡀぢࡽࢀࡓ㸦⾲ 1㸧ࠋ

ከ㔜ẚ㍑ࡢ⤖ᯝࠊ୙Ᏻ⾜ືࡀぢࡽࢀࡿ≧ἣ࡜ྛせᅉࡢ㛫࡟᭷ព࡞㛵㐃ࡀぢࡽࢀࡓ 㸦supplement 3㸧ࠋ”ศ㞳୙Ᏻ”ࡣධᡭ⤒㊰ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࡀࠊࢢ࣮ࣝࣉ㛫࡛ ࡢ᭷ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓ㸦ᅗ2㸧ࠋ”ᔒ”ࡣᖺ㱋ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋຍ࠼࡚ࠊ ᖺ㱋ࢆࢢ࣮ࣝࣉ㛫࡛ẚ㍑ࡍࡿ࡜ࠊ”⪁㱋”ࡣ”ᗂ㱋”ࡼࡾࡶ”ᔒ”࡛୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ ព࡟㧗࠿ࡗࡓ㸦ᅗ3㸧ࠋ”ⰼⅆ”ࡣᖺ㱋࠾ࡼࡧᆅᇦࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋຍ࠼࡚ࠊᖺ 㱋ࢆࢢ࣮ࣝࣉ㛫࡛ẚ㍑ࡍࡿ࡜ࠊ”ⱝ㱋”ࠊ”ᡂ㱋”ࠊ࠾ࡼࡧ”⪁㱋”ࡣ”ᗂ㱋”ࡼࡾࡶ”ⰼⅆ”࡛୙ Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ព࡟㧗࠿ࡗࡓ㸦ᅗ4a㸧ࠋࡋ࠿ࡋࠊᆅᇦࢆࢢ࣮ࣝࣉ㛫࡛ẚ㍑ࡍࡿ࡜ ᭷ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓ㸦ᅗ4b㸧ࠋ”㡢”ࡣᛶู࠾ࡼࡧᖺ㱋ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓ ࡀࠊ࠸ࡎࢀ࡟࠾࠸࡚ࡶࢢ࣮ࣝࣉ㛫࡛ࡢ᭷ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓ㸦ᅗ5a-b㸧ࠋ”≉ᐃࡢᑐ ㇟≀”ࡣᛶู࠾ࡼࡧධᡭ⤒㊰ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࡀࠊ࠸ࡎࢀ࡟࠾࠸࡚ࡶࢢ࣮ࣝࣉ 㛫࡛ࡢ᭷ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓ㸦ᅗ6a-b㸧ࠋ

(15)

11 ᅗ 1㸸ᛧࡀࡾ࡞≟ࡢ๭ྜ(a)ࠊᛧࡀࡾ࡞≟ࡢ⾜ື࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜ(b)ࠊ≟ࡢ⾜ ື࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ࠺ࡕࠊ≟ࡢ⾜ື࡟ࡘ࠸࡚┦ㄯࡋࡓࡶࡋࡃࡣ┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚ ࠸ࡿ㣫࠸୺ࡢ๭ྜ (c)ࠊၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌࡀ࠸ࡿࡇ࡜ࢆ▱ࡗ࡚࠸ࡿ㣫࠸୺ࡢ ๭ྜ (d)ࠊᚲせࡀ࠶ࢀࡤၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜⪃࠼࡚࠸ࡿ㣫࠸୺ ࡢ๭ྜ (e).

a㻌

b㻌

c㻌

_d㻌

e㻌

(16)

12 ⾲1㸸୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ㛫ࡢ࢜ࢵࢬẚ ᭷ព࡞㛵㐃ࡀぢࡽࢀࡓࡶࡢࡣ࢔ࢫࢱࣜࢫࢡ࡛♧ࡋࡓ㸦*p < 0.05ࠊ***p < 0.001㸧ࠋ

*

㻌

***

㻌

***

㻌

***

㻌

(17)

13 ᅗ2㸸”ศ㞳୙Ᏻ”࡜ධᡭ⤒㊰ࡢ㛵㐃 ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚࠋ

0%

20%

40%

60%

80%

100%

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(38/176)

_(8/47)

(7/25)

(18)

14 ᅗ3㸸”ᔒ”࡜ᖺ㱋ࡢ㛵㐃 ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚࠋ᭷ពᕪࡀぢࡽ ࢀࡓࡶࡢࡣ࢔ࢫࢱࣜࢫࢡ࡛♧ࡋࡓ㸦**p < 0.01㸧ࠋ

0%

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100%

ᗂ㱋

ⱝ㱋

ᡂ㱋

⪁㱋

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(22/88)

(25/49)

(27/62)

(31/60)

**

(19)

15 ᅗ4㸸”ⰼⅆ”࡜ᖺ㱋ࡢ㛵㐃 (a)࠾ࡼࡧ”ⰼⅆ”࡜ᆅᇦࡢ㛵㐃(b) ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚࠋ᭷ពᕪࡀぢࡽ ࢀࡓࡶࡢࡣ࢔ࢫࢱࣜࢫࢡ࡛♧ࡋࡓ㸦**p < 0.01, ***p < 0.001㸧ࠋ

0%

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60%

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100%

ᗂ㱋

ⱝ㱋

ᡂ㱋

⪁㱋

୙

Ᏻ

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ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(11/88)

(17/49)

(19/62)

(21/60)

**

***

0%

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40%

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ᮾி

኱㜰

௝ྎ

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(18/69)

(16/99)

(34/94)

a

b

(20)

16 ᅗ5㸸”㡢”࡜ᖺ㱋ࡢ㛵㐃(a)࠾ࡼࡧ”㡢”࡜ᛶูࡢ㛵㐃(b) ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚࠋ

0%

20%

40%

60%

80%

100%

ᗂ㱋

ⱝ㱋

ᡂ㱋

⪁㱋

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(55/88)

(26/49)

(42/62)

(26/60)

0%

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40%

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࢜ࢫ

ཤໃ࢜ࢫ

࣓ࢫ

㑊ዷ࣓ࢫ

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(45/75)

(41/64)

(27/61)

(35/57)

a

b

(21)

17 ᅗ6㸸”≉ᐃࡢᑐ㇟≀”࡜ධᡭ⤒㊰ࡢ㛵㐃(a)࠾ࡼࡧ”≉ᐃࡢᑐ㇟≀”࡜ᛶูࡢ㛵㐃(b). ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚࠋ

0%

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୙

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ື

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ྜ

(15/176)

_(2/47)

(4/25)

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࢜ࢫ

ཤໃ࢜ࢫ

࣓ࢫ

㑊ዷ࣓ࢫ

୙

Ᏻ

⾜

ື

ࡀ

ぢ

ࡽ

ࢀ

ࡓ

๭

ྜ

(5/75)

(8/64)

_(4/61)

(7/57)

a

b

(22)

18 ⪃ᐹ

௒ᅇࠊ3 ࡘࡢ㒔ᕷ㒊࡟࠾࠸࡚ㄪᰝࢆ⾜ࡗࡓࡀࠊ࠸ࡎࢀࡢゎᯒ࡟࠾࠸࡚ࡶᆅᇦ㛫࡛ࡢ᭷ ព࡞ᕪࡣぢࡽࢀ࡞࠿ࡗࡓࠋࡑࡢࡓࡵࠊ262 㢌ศࡢࢹ࣮ࢱࢆࡲ࡜ࡵ࡚ศᯒࡍࡿࡇ࡜࡟ၥ㢟 ࡣ࡞࠸࡜⪃࠼ࡽࢀࡓࠋ ௒ᅇࡢ⤖ᯝ࠿ࡽࠊ50㸣௨ୖࡢ≟ࡀᛧࡀࡾ࡛࠶ࡾࠊ୙Ᏻ⾜ືࢆ♧ࡋࡸࡍ࠸ࡇ࡜ࡀ᫂ࡽ࠿ ࡜࡞ࡗࡓࠋຍ࠼࡚ࠊᛧࡀࡾ࡞≟ࡢ㣫࠸୺ࡢ࠺ࡕࠊ40㸣௨ୖࡢ㣫࠸୺ࡀᛧࡀࡾ࡞≟ࡢ⾜ື ࡛ᅔࡗ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡇࢀࡽࡢ๭ྜࡣ௨๓࡟⾜ࢃࢀ࡚࠸ࡓㄪᰝ⤖ᯝ㸦32ࠊ 41㸧ࡼࡾࡶ㧗࠸ࡶࡢ࡜࡞ࡗࡓࠋࡋ࠿ࡋࠊ௨๓࡟⾜ࢃࢀࡓㄪᰝࡣ༢࡟ಖ೺ᡤ࡟ᘬࡁྲྀࡽࢀ ࡿ㝿ࡢ⌮⏤ࢆ♧ࡋࡓࡔࡅ࡛࠶ࡾࠊࡑࢀ࡟ᑐࡋ࡚௒ᅇࡢㄪᰝࡣ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋࡓࡶࡢ ࡛࠶ࡿࠋ௒ᅇࡢ⤖ᯝࡣࠊၥ㢟⾜ືࢆ♧ࡍ≟ࡢ๭ྜࢆホ౯ࡍࡿࡓࡵ࡟ࡣࠊ୍⯡ࡢ≟ࢆᑐ㇟ ࡜ࡋ࡚ㄪᰝࢆ⾜࠺ࡇ࡜ࡀ㔜せ࡛࠶ࡿࡇ࡜ࢆ♧၀ࡍࡿࠋࡲࡓࠊ௒ᅇࡢ◊✲ࡣ୙Ᏻ㞀ᐖࡢ⣲ ᅉࢆᣢࡘ≟ࡢ๭ྜࢆ♧ࡋࡓึࡢ◊✲࡛࠶ࡿࠋᨷᧁ⾜ືࢆྵࡴ௚ࡢၥ㢟⾜ື࡟㛵ࡋ࡚ࡶྠ ᵝࡢㄪᰝࢆ⾜࠸ࠊࡑࢀࡽࢆ♧ࡍ≟ࡀ࡝ࡢ⛬ᗘ࠸ࡿࡢ࠿ࢆㄪ࡭ࡿࡇ࡜ࡶ௒ᚋᚲせ࡟࡞ࡿ࡛ ࠶ࢁ࠺ࠋ ຍ࠼࡚ࠊ≟ࡢ୙Ᏻ⾜ື࡟ࡘ࠸࡚┦ㄯࡋࡓࡶࡋࡃࡣ┦ㄯࡋࡓ࠸࡜ᛮࡗࡓࡇ࡜ࡀ࠶ࡿ㣫࠸ ୺ࡣࠊᛧࡀࡾ࡞≟ࡢ⾜ື࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ࠺ࡕ⣙ 56㸣࡛࠶ࡗࡓࠋࡋ࠿ࡋࠊၥ㢟⾜ ືࢆᑓ㛛࡜ࡋ࡚࠸ࡿ⋇་ᖌࡀ࠸ࡿࡇ࡜ࢆ▱ࡗ࡚࠸ࡿ㣫࠸୺ࡣࠊ඲య࡜ࡋ࡚⣙ 21㸣࡛࠶ ࡗࡓࠋࡇࢀࡽࡢ⤖ᯝ࠿ࡽࠊၥ㢟⾜ືࡢ἞⒪ࢆ⾜࠼ࡿ⋇་ᖌࡀ࠸ࡿࡇ࡜ࢆ▱ࡽࡎ࡟ࠊ┦ㄯ

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19 ࡋࡓࡃ࡚ࡶ࡛ࡁࡎ࡟࠸ࡿ㣫࠸୺ࡀከࡃ࠸ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋࡇࡢࡇ࡜ࡣࠊᚲせࡀ࠶ ࢀࡤၥ㢟⾜ືࢆᑓ㛛࡜ࡍࡿ⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚࠸ࡿ㣫࠸୺ࡀ⣙ 56㸣࠸ࡿࡇ࡜ ࠿ࡽࡶᨭᣢࡉࢀࡿࠋࡑࡢࡓࡵࠊၥ㢟⾜ືࢆᑓ㛛࡜ࡋ࡞࠸⋇་ᖌ࡛࠶ࡗ࡚ࡶࠊ┦ㄯࢆཷࡅ ࡽࢀࡿࡼ࠺࡟ࡍࡿࡇ࡜ࡀᮃࡲࡋ࠸ࠋᖾ࠸࡟ࡶࠊከࡃࡢඛ⾜◊✲࡟ࡼࡾ㣫࠸୺࡟ᅇ⟅ࡋ࡚ ࡶࡽ࠺࢔ࣥࢣ࣮ࢺࡀసᡂࡉࢀ࡚࠾ࡾࠊ≟ࡢᛶ᱁ࡸ⾜ືࡀホ౯ࡉࢀ࡚࠸ࡿ㸦21ࠊ24ࠊ27ࠊ 28ࠊ36ࠊ40ࠊ42㸧ࠋࡇࢀࡽࡢ࢔ࣥࢣ࣮ࢺࢆ౑⏝ࡍࡿࡇ࡜࡛ࠊ୍⯡ࡢ⋇་ᖌ࡛ࡶ≟ࡢ⾜ື ࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢᡭຓࡅࡀ࡛ࡁࡿ࠿ࡶࡋࢀ࡞࠸ࠋ ࢜ࢵࢬẚࢆ⟬ฟࡋࡓ⤖ᯝࠊ”ศ㞳୙Ᏻ”࡜”≉ᐃࡢᑐ㇟≀”ࠊ”ᔒ”࡜”ⰼⅆ”ࠊ”ᔒ”࡜”㡢”࠾ ࡼࡧ”ⰼⅆ”࡜”㡢”࡟᭷ព࡞㛵㐃ࡀぢࡽࢀࡓࠋ”ᔒ”࡜”㡢”࡟㛵ࡍࡿ⤖ᯝࡣࠊOverall et al. 㸦33㸧ࡢ◊✲࡟࠾࠸࡚♧ࡉࢀ࡚࠸ࡿ㧗࠸ඹ᭷☜❧࡜▩┪ࡋ࡞࠸ࠋࡋ࠿ࡋࠊྠ◊✲࡟࠾ࡅ ࡿศ㞳୙Ᏻ⑕ࢆ♧ࡍ≟ࡣ㧗࠸☜⋡࡛㞾ᜍᛧ⑕࠾ࡼࡧ㦁㡢ᜍᛧ⑕ࢆ♧ࡍ࡜࠸࠺⤖ᯝ࡜ࡣ ୍⮴ࡋ࡞࠸ࠋࡲࡓࠊ௚ࡢ◊✲࡛ࡣ㞾࡜ⰼⅆ࡟ᑐࡍࡿᜍᛧࡣྠ᫬࡟㉳ࡇࡾࡸࡍ࠸࡜ሗ࿌ࡉ ࢀ࡚࠸ࡿ㸦3㸧ࠋࡇࡢඛ⾜◊✲࡛ࡣࠊศ㞳㛵㐃⾜ື࡜㞾ࡸⰼⅆ࡟ᑐࡍࡿᜍᛧࡣྠ᫬࡟ࡣ㉳ ࡇࡗ࡚࠸࡞࠿ࡗࡓࠋࡇࢀࡽࡢ⤖ᯝࡣ௒ᅇࡢ⤖ᯝ࡜୍⮴ࡋ࡚࠸ࡿࠋ๓⪅ࡣ⑓㝔࡛デ᩿ࢆୗ ࡋࡓ≟ࡢࡳࢆᑐ㇟࡜ࡋ࡚࠾ࡾࠊᚋ⪅ࡣ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋ࡚࠸ࡿࠋࡇࢀࡽࡢࡇ࡜ࡣࠊᑐ ㇟ࡢᇶ‽ࡀྠ୍࡛࠶ࢀࡤ୍㈏ࡋࡓ⤖ᯝࡀᚓࡽࢀࡿࡇ࡜ࢆ♧၀ࡍࡿࠋຍ࠼࡚ࠊ”ศ㞳୙Ᏻ” ࡜”≉ᐃࡢᑐ㇟≀”࡟㛵ࡋ࡚ࡣࠊ㞳ࢀࡿ࠿㏆࡙ࡃ࠿࡜࠸࠺㐪࠸ࡣ࠶ࡿࡀࠊ࠸ࡎࢀࡶ≉ᐃࡢ ᑐ㇟≀ࡀ㛵ࢃࡿ୙Ᏻ㞀ᐖ࡜࠸࠺Ⅼ࡛ඹ㏻ࡋ࡚࠸ࡿࠋࡲࡓ”ᔒ”࡜”ⰼⅆ”ࠊ”ᔒ”࡜”㡢”࠾ࡼࡧ”

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20 ⰼⅆ”࡜”㡢”࡟㛵ࡋ࡚ࡣࠊ࠸ࡎࢀࡶ㡢ࡀ㛵ࢃࡿ୙Ᏻ㞀ᐖ࡜࠸࠺Ⅼ࡛ඹ㏻ࡋ࡚࠸ࡿࠋྠᵝ ࡢឤぬ࡛Ⓨ⏕ࡍࡿ୙Ᏻ㞀ᐖࡣ஫࠸࡟㔜」ࡋ࡚Ⓨ⏕ࡋࡸࡍ࠸࡜࠸࠺ࡇ࡜ࡀ♧၀ࡉࢀࡿࠋ ከ㔜ẚ㍑ࡢ⤖ᯝ࠿ࡽࠊ࠸ࡃࡘ࠿ࡢ୙Ᏻ⾜ືࡀぢࡽࢀࡿ≧ἣ࡜㛵㐃ࡢ࠶ࡿせᅉ࠾ࡼࡧせ ᅉࡢࢢ࣮ࣝࣉ㛫࡛ࡢ᭷ព࡞ᕪࡀぢࡘ࠿ࡗࡓࠋ”ศ㞳୙Ᏻ”࠾ࡼࡧ”≉ᐃࡢᑐ㇟≀”ࡣධᡭ⤒ ㊰࡜ࡢ㛵㐃ࡀ♧ࡉࢀࡓࡀࠊࢢ࣮ࣝࣉ㛫࡛ࡢ᭷ពᕪࡣ࡞࠿ࡗࡓࠋࡇࡢ⤖ᯝࡣࠊ࢜ࢵࢬẚ࡟ ࠾࠸࡚ぢࡽࢀࡓ᭷ព࡞㛵㐃࡜ࡶ▩┪ࡋ࡞࠸㸦⾲ 1㸧ࠋ౛ᩘࡀᑡ࡞࠿ࡗࡓࡓࡵከ㔜ẚ㍑ࡣ ⾜ࢃ࡞࠿ࡗࡓࡀࠊ”ࢩ࢙ࣝࢱ࣮”⏤᮶ࡢ≟ࡣࡇࢀࡽࡢ≧ἣୗ࡟࠾࠸࡚୙Ᏻ⾜ືࢆ♧ࡍ๭ྜ ࡀ㧗࠿ࡗࡓ㸦”ศ㞳୙Ᏻ”ࠊ”≉ᐃࡢᑐ㇟≀”࡜ࡶ 5 ౛୰ 3 ౛㸧ࠋFlannigan et al.㸦13㸧ࡢ ◊✲࡟࠾࠸࡚ࠊࢩ࢙ࣝࢱ࣮⏤᮶ࡢ≟ࡣศ㞳୙Ᏻ⑕࡟࡞ࡾࡸࡍ࠸࡜࠸࠺⤖ᯝࡀᚓࡽࢀ࡚࠸ ࡿࠋࡲࡓࠊ௚ࡢඛ⾜◊✲࡛ࡣࢩ࢙ࣝࢱ࣮⏤᮶ࡢ≟ࡣၥ㢟⾜ືࢆ♧ࡍྍ⬟ᛶࡀ㧗࠸࡜ሗ࿌ ࡉࢀ࡚࠸ࡿ㸦45㸧ࠋ௨ୖࡢⅬ࠿ࡽࠊ௒ᚋࢩ࢙ࣝࢱ࣮⏤᮶ࡢ≟ࡢ౛ᩘࢆቑࡸࡋࠊ୍ᗘ㣫࠸ ୺࠿ࡽ㞳ࡉࢀࡿ࡜࠸࠺⤒㦂ࡀࠊ≉ᐃࡢᑐ㇟≀࡟ᑐࡍࡿ୙Ᏻ⾜ືࢆ♧ࡍࡇࡢࢱ࢖ࣉࡢ୙Ᏻ 㞀ᐖ࡟୚࠼ࡿᙳ㡪ࢆ᳨ドࡍࡿᚲせࡀ࠶ࡿࠋᛶูࡸ≟✀࡜ศ㞳୙Ᏻ⑕ࡢ㛵㐃ࢆ♧ࡋࡓඛ⾜ ◊✲ࡶ࠶ࡿࡀࠊ௒ᅇࡢ◊✲࡛ࡣᛶู࠾ࡼࡧ≟✀࡜”ศ㞳୙Ᏻ”ࡢ㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓ 㸦13㸧ࠋࡇࡢ㐪࠸ࡣࠊၥ㢟⾜ືࡢཎᅉࢆㄪ࡭ࡿ㝿࡟ࡣၥ㢟⾜ືࢆ♧ࡍ≟࡜♧ࡉ࡞࠸≟ࢆ ẚ㍑ࡍࡿࡇ࡜ࡀ㔜せ࡛࠶ࡿࡇ࡜ࢆ♧၀ࡍࡿࠋ “ᔒ”ࡣᖺ㱋࡜ࡢ㛵㐃ࡀ♧ࡉࢀࠊ”⪁㱋”ࡣ”ᗂ㱋”ࡼࡾࡶ”ᔒ”࡟ᑐࡋ࡚୙Ᏻ⾜ືࢆ♧ࡍ๭ྜ ࡀ᭷ព࡟㧗࠿ࡗࡓࠋ㸦ᅗ3㸧ࠋ”ⰼⅆ”࡟࠾࠸࡚ࡶࠊ”ⱝ㱋”ࠊ”ᡂ㱋”࠾ࡼࡧ”⪁㱋”ࡣ”ᗂ㱋”ࡼ

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21 ࡾࡶ”ⰼⅆ”࡟ᑐࡋ࡚୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ព࡟㧗࠿ࡗࡓ㸦ᅗ 4a㸧ࠋࡇࢀࡽࡢ⤖ᯝࡣ࢜ ࢵࢬẚ࡟࠾࠸࡚ぢࡽࢀࡓ᭷ព࡞㛵㐃࡜ࡶ▩┪ࡋ࡞࠸㸦⾲ 1㸧ࠋຍ࠼࡚ࠊࡇࢀࡽࡢ⤖ᯝࡣ ຍ㱋ࡀ㡢࡟ᑐࡍࡿᜍᛧ⑕ࡢࣜࢫࢡࢆ㧗ࡵࡿ࡜࠸࠺ඛ⾜◊✲࡜୍⮴ࡋ࡚࠸ࡿ㸦3㸧ࠋ௨ୖࡢ Ⅼ࠿ࡽࠊ2 ṓ௨ୖࡢ≟ࡣ”ᔒ”࡜”ⰼⅆ”࡟ᑐࡋ୙Ᏻ⾜ືࢆ♧ࡍྍ⬟ᛶࡀ㧗࠸ࡇ࡜ࡀ♧၀ࡉ ࢀࡿࠋ௒ᅇࡢ◊✲࡛ࡣࠊ”ᔒ”ࠊ”ⰼⅆ”ࠊ”㡢”࡟࠾࠸࡚ධᡭ⤒㊰ࡢᙳ㡪ࡣぢࡽࢀ࡞࠿ࡗࡓࠋ ࡋ࠿ࡋࠊࣈ࣮ࣜࢲ࣮⏤᮶ࡢ≟ࡀ௚ࡢධᡭ⤒㊰⏤᮶ࡢ≟ࡼࡾ㡢࡟㛵ࢃࡿᜍᛧࢆ♧ࡋ࡟ࡃ࠸ ࡇ࡜ࢆሗ࿌ࡋࡓඛ⾜◊✲ࡀ࠶ࡿ㸦44㸧ࠋࡇࡢඛ⾜◊✲࡛ࡣࠊ୍⯡ࡢ≟ࢆᑐ㇟࡜ࡋ࡚࠸ࡿ Ⅼ࡛ࡣᮏ◊✲࡜ඹ㏻࡛࠶ࡿࡀࠊධᡭ⤒㊰ࢆࣈ࣮ࣜࢲ࣮࡜ࡑࢀ௨እࡢධᡭ⤒㊰ࠊ౛࠼ࡤࢩ ࢙ࣝࢱ࣮ࡸ▱ே࠿ࡽࡢㆡΏ࡞࡝ࠊ࡟ศ㢮ࡋ࡚࠸ࡓࠋࡇࡢࡇ࡜ࡣࠊᑐ㇟ࡢᇶ‽ࡢࡳ࡛࡞ࡃ ྛせᅉࡢࢢ࣮ࣝࣉศࡅࡶ⤫୍ࡋ࡚ㄪᰝࢆ⾜࠺ࡇ࡜ࡢ㔜せᛶࢆ♧၀ࡍࡿࠋ

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22 ⤖ㄒ

௒ᅇࡢ◊✲ࡣࠊ᪥ᮏ࡟࠾࠸࡚≟ࡢ୙Ᏻ⾜ື࡛ᅔࡗ࡚࠸ࡿ㣫࠸୺࠾ࡼࡧ≟ࡢ୙Ᏻ⾜ື࡟ ᙳ㡪ࡍࡿせᅉ࡟↔Ⅼࢆᙜ࡚ࡓึࡢ◊✲࡛࠶ࡿࠋᮏ◊✲ࡢ⤖ᯝࠊᛧࡀࡾ࡞≟ࡢ๭ྜࠊᛧࡀ ࡾ࡞≟ࡢ⾜ື࡛ᐇ㝿࡟ᅔࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࠊᐇ㝿࡟ᛧࡀࡾ࡞≟ࡢ⾜ື࡟ࡘ࠸࡚┦ㄯ ࡉࢀ࡚࠸ࡿ๭ྜࠊၥ㢟⾜ືࡢデ᩿࣭἞⒪ࢆ⾜ࡗ࡚࠸ࡿ⋇་ᖌࡢㄆ▱ᗘࠊၥ㢟⾜ືࡢデ᩿࣭ ἞⒪ࢆ⾜ࡗ࡚࠸ࡿ⋇་ᖌࢆồࡵ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡀึࡵ࡚♧ࡉࢀࡓࠋࡇࢀࡽࡢ⤖ᯝࡣࠊ ಖ೺ᡤ࡛ࡢᘬࡁྲྀࡾ௳ᩘ௨ୖ࡟୙Ᏻ㞀ᐖࢆ♧ࡋ࠺ࡿ≟ࡀ࠸ࡿࡇ࡜ࡸࠊၥ㢟⾜ືࡢデ᩿࠾ ࡼࡧ἞⒪ࢆ⾜࠺ࡇ࡜ࡀ࡛ࡁࡿ⋇་ᖌࡀᚲせ࡜ࡉࢀ࡚࠸ࡿࡇ࡜ࢆ♧ࡍࠋࡲࡓࠊ≟ࡢྛ୙Ᏻ ⾜ື࡟ᙳ㡪ࡋ࡚࠸ࡿせᅉ࡟ࡘ࠸࡚ࡶ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡇࡢࡇ࡜࠿ࡽࠊၥ㢟⾜ື࡟ࡼࡾ᮶ 㝔ࡋࡓ≟ࡢၥデ᫬࡟ᖺ㱋ࡸධᡭ⤒㊰ࢆᑜࡡࡿࡇ࡜࡛ࠊ࠶ࡿ⛬ᗘデ᩿ࡢ᪉ྥᛶࢆỴࡵࡽࢀ ࡿྍ⬟ᛶࡀ࠶ࡿࠋ ࡇࢀࡽࡢ⤖ᯝࢆ㋃ࡲ࠼ࠊၥ㢟⾜ືࡢ▱㆑ࢆഛ࠼ࡓ⋇་ᖌࡀቑ࠼ࡿࡇ࡜࡛ࠊ㣫࠸୺ࡀ≟ ࡢ⾜ື࡟ࡘ࠸࡚⋇་ᖌ࡟┦ㄯ࡛ࡁࡿࡼ࠺࡟࡞ࢀࡤࠊၥ㢟⾜ືࡢண㜵ࡢࡓࡵ࡟㣫࠸୺ࢆᩍ ⫱ࡍࡿࡇ࡜ࡀྍ⬟࡜࡞ࡿࡇ࡜ࡀᮇᚅࡉࢀࡿࠋ

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23 ➨2 ❶

≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ᑐࡍࡿ⤒㦂ⓗ࣭⎔ቃⓗ࡞せᅉࡢᙳ㡪

⥴ゝ ➨1 ❶ࡢ⤖ᯝ࠿ࡽࠊ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ࡣᖺ㱋ࡀᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋࡇ ࢀࡽࡣࠊᛶูࡸ≟✀࡞࡝ࡢඛኳⓗ࡞せᅉ࡛ࡣ࡞ࡃࠊ⤒㦂ࡸ⎔ቃ࡞࡝ࡢᚋኳⓗ࡞せᅉ࡛࠶ ࡿࠋࡑࡢࡓࡵࠊ୙Ᏻ⾜ືࡢⓎ⌧࡟ࡣ⤒㦂ࡸ⎔ቃࡀ㛵୚ࡋ࡚࠸ࡿྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿࠋ ≟ࡢၥ㢟⾜ື࡟㛵ࡋ࡚⤒㦂ࡸ⎔ቃࡀᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࢆ♧ࡋࡓඛ⾜◊✲࡜ࡋ࡚ࡣࠊᨷ ᧁ⾜ື࡟㛵ࡍࡿࡶࡢࡀከࡃᏑᅾࡍࡿࠋ㌟యⓗ࡞⨩ࡸṇࡢ⨩ࡢ౑⏝㸦1ࠊ5ࠊ17ࠊ18ࠊ39㸧ࠊ ṇࡢᙉ໬ࡢ౑⏝㸦8ࠊ47㸧ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍ㸦2㸧ࠊࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍ㸦5㸧ࠊ Ꮚ≟ࡢ㡭ࡢ♫఍໬㸦20㸧ࡸண㜵㸦14㸧࡞࡝ࡀᨷᧁ⾜ື࡟㛵୚ࡋ࡚࠸ࡿࡇ࡜ࡀ♧၀ࡉࢀ ࡚࠸ࡿࠋࡇࡢࡼ࠺࡞ඛ⾜◊✲ࡢከࡃࡀࠊࣃࣆ࣮ࢡࣛࢫࡸࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡶྵ ࡵࡓࢺ࣮ࣞࢽࣥࢢ࡟㛵ࢃࡿࡶࡢ࡛࠶ࡿࠋᨷᧁ⾜ື࡜ྠᵝ࡟ࠊ࡝ࡢࡼ࠺࡞ࢺ࣮ࣞࢽࣥࢢࢆ ཷࡅ࡚ࡁࡓ࠿ࡀ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ࡶ㛵ࢃࡗ࡚࠸ࡿྍ⬟ᛶࡣ༑ศ࡟⪃࠼ࡽࢀࡿࠋ ຍ࠼࡚ࠊၥ㢟⾜ືࡢ἞⒪࡟ࡣࠊ㑅ᢥⓗࢭࣟࢺࢽࣥ෌ྲྀࡾ㎸ࡳ㜼ᐖ⸆ࡸ୕⎔⣔ᢠ࠺ࡘ⸆ࠊ ࣋ࣥࢰࢪ࢔ࢮࣆࣥ࡞࡝ࢆ౑⏝ࡋࡓ⸆≀⒪ἲࡶ⾜ࢃࢀࡿࡀ㸦31㸧ࠊື≀࡟ᮃࡲࡋ࠸⾜ືࢆ Ꮫ⩦࣭ࢺ࣮ࣞࢽࣥࢢࡉࡏࡿࡇ࡜࡛ࠊၥ㢟⾜ືࡢⓎ⌧ࢆᢚ࠼ࡿ⾜ືಟṇἲࡀ㢖⦾࡟⏝࠸ࡽ ࢀࡿࠋ⾜ືಟṇ࡛ࡣࠊ⣔⤫ⓗ⬺ឤసࡸᣕᢠ᮲௳௜ࡅࠊ࢜࣌ࣛࣥࢺ᮲௳௜ࡅ࡞࡝ࡢᏛ⩦ࡢ ⌮ㄽࢆ฼⏝ࡋࠊື≀࡟ࡑࡢ≧ἣ࡟࠾ࡅࡿ㐺ษ࡞⾜ືࢆᏛ⩦ࡉࡏࡿࡇ࡜࡛ၥ㢟࡜࡞ࡿ⾜ື

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24 ࡀⓎ⌧ࡋ࡞࠸ࡼ࠺࡟⾜ືࣃࢱ࣮ࣥࢆኚ໬ࡉࡏࡿ㸦26㸧ࠋᏛ⩦࣭ࢺ࣮ࣞࢽࣥࢢ࡟ࡼࡾၥ㢟⾜ືࢆᨵၿ࡛ࡁࡿࡢ࡛࠶ࢀࡤࠊࡑࢀ࡟ࡼࡾၥ㢟⾜ືࢆண㜵ࡍࡿࡇ࡜ࡶྍ⬟࠿ࡶࡋࢀ࡞࠸ࠋ ࡇࡢࡼ࠺࡞ഃ㠃࠿ࡽࡶࠊ᪥ᖖⓗ࡟⾜ࡗ࡚࠸ࡿࢺ࣮ࣞࢽࣥࢢ࡟ࡼࡾ୙Ᏻ⾜ືࡢ᭷↓࡟ᕪࡀ ⏕ࡌࡿࡇ࡜ࡣ༑ศ࡟⪃࠼ࡽࢀࡿࠋ ࡲࡓࠊࢺ࣮ࣞࢽࣥࢢ௨እࡢせᅉ࡜ࡋ࡚ྠᒃ≟ࡢ᭷↓ࡸᏊ≟ࡢ㡭ࡢᏊ౪࡜ࡢ᥋ゐ࡟ὀ┠ ࡋࡓඛ⾜◊✲ࡶᏑᅾࡍࡿࠋࡇࢀࡽࡢඛ⾜◊✲࠿ࡽࠊᏊ౪ࡀ࠸ࡿ࡜ᨷᧁࡢࣜࢫࢡࡀୖࡀࡿ ࡇ࡜㸦16㸧ࡸྠᒃ≟ࡀᑡ࡞࠸࡜ᨷᧁࡢࣜࢫࢡࡀୖࡀࡿࡇ࡜㸦22㸧ࡀ♧ࡉࢀ࡚࠸ࡿࠋᨷ ᧁ⾜ືࡢཎᅉ࣭⌮⏤ࡣᵝࠎ࡛࠶ࡿࡀࠊࡑࡢ୍㒊ࡣ୙Ᏻࡸᜍᛧ࡟ࡼࡿࡶࡢ࡛࠶ࡿ㸦26㸧ࠋ ࡑࡢࡓࡵࠊࡇࢀࡽࡢ⤖ᯝࡢ୍㒊ࡣ୙Ᏻࡸᜍᛧ࡟ࡼࡿᨷᧁ⾜ືࢆ཯ᫎࡋ࡚࠸ࡿྍ⬟ᛶࡀ࠶ ࡿࠋྠᵝ࡟ࡋ࡚ࠊྠᒃࡋ࡚࠸ࡿ≟ࡸᏊ౪ࡢ᭷↓ࡶᨷᧁ௨እࡢྛ୙Ᏻ⾜ືࡢⓎ⌧࡟ᙳ㡪ࡋ ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋ ௨ୖࡢࡇ࡜࠿ࡽࠊࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍࡢ᭷↓ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡢ᭷↓ࠊ ྠᒃ≟ࡢ᭷↓ࠊᏊ≟ࡢ㡭࡟ྠᒃࡋ࡚࠸ࡓᏊ౪ࡢ᭷↓ࡀ⤒㦂ⓗ࣭⎔ቃⓗ࡞せᅉ࡜ࡋ࡚ྛ୙ Ᏻ⾜ືࡢⓎ⌧࡟ᙳ㡪ࡋ࡚࠸ࡿ࠿ࢆㄪ࡭ࡓࠋ

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25 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ ᮏ◊✲ࡣࠊᮾி㎰ᕤ኱Ꮫ◊✲೔⌮ጤဨ఍ࡢᢎㄆࢆᚓ࡚⾜ࡗࡓ㸦⏦ㄳ␒ྕ No.27-36㸧ࠋ ㄪᰝࡣྛ㣫࠸୺ࡢྠពࢆᚓࡓୖ࡛⾜ࡗࡓࠋ

ㄪᰝࡢࡓࡵࡢ࢔ࣥࢣ࣮ࢺࢆసᡂࡋࡓ㸦supplement 4㸧ࠋ࢔ࣥࢣ࣮ࢺࡣྛ≟ࡢᇶ♏᝟ሗ ࢆ☜ㄆࡍࡿ㡯┠࡜୙Ᏻ࠾ࡼࡧࢺ࣮ࣞࢽࣥࢢ࡟ࡘ࠸࡚ࡢ㡯┠࡟ศࡅࡽࢀࡓࠋᇶ♏᝟ሗࡢ㡯 ┠࡟ࡣࠊ≟✀ࠊᛶูࠊᖺ㱋ࠊධᡭ᫬ࡢᖺ㱋ࠊධᡭ⤒㊰ࠊዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓㸦࣓ࢫ ࡢࡳ㸧ࠊ᪤ Ṕࠊྠᒃ≟ࡢ᭷↓ࡀྵࡲࢀࡓࠋ୙Ᏻ࠾ࡼࡧࢺ࣮ࣞࢽࣥࢢ࡟ࡘ࠸࡚ࡢ㡯┠࡟ ࡣࠊ௨ୗࡢ≧ἣ࡛≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ࠿㸹”ศ㞳୙Ᏻ”㸦␃Ᏺ␒୰ࡸ㣫࠸୺ࡢጼࡀぢ࠼࡞ ࠸᫬㸧ࠊ”ᔒ”㸦ᔒࡢ᫬㸧ࠊ”ⰼⅆ”㸦ⰼⅆࡢ㡢ࡀࡍࡿ᫬㸧ࠊ”㡢”㸦኱ࡁ࡞㡢ࡀࡍࡿ᫬㸧ࠊ”≉ᐃ ࡢᑐ㇟≀”㸦≉ᐃࡢேࡸ≀ࢆぢࡓ᫬㸧ࠊ”඲⯡ᛶ୙Ᏻ”㸦ᖖ࡟ࣜࣛࢵࢡࢫ࡛ࡁ࡞࠸㸧㸹ヱᙜ ࡍࡿࡶࡢࡀ࠶ࡿሙྜࡣࡑࢀࡒࢀࡢ୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ࠺࡟࡞ࡗࡓ᫬ᮇࠊ≟ࡀᛧࡀࡾ࡛ ࠶ࡿ࠿ࠊࣃࣆ࣮ࢡࣛࢫ࡟㏻ࡗ࡚࠸ࡓ࠿ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻ࡗ࡚࠸ࡿࡶࡋࡃࡣ㏻ࡗ࡚ ࠸ࡓ࠿ࠊ≟ࡀ1 ṓᮍ‶ࡢ᫬ᮇ࡟ᑠᏛ⏕ᮍ‶ࡢᏊ౪ࡀྠᒃࡋ࡚࠸ࡓ࠿ࡀྵࡲࢀࡓࠋ

ㄪᰝࡣᮾி㒔࠾ࡼࡧ⚄ዉᕝ┴ෆࡢබᅬ࡛⾜ࡗࡓࠋᅬෆࢆᩓṌ୰ࡢ≟ࡢ㣫࠸୺࠾ࡼࡧࢻ ࢵࢢࣛࣥ࡟᮶ࡓ≟ࡢ㣫࠸୺࡟ᑐࡋࠊࡑࡢሙ࡛࢔ࣥࢣ࣮ࢺ࡬ࡢグධࢆ౫㢗ࡋࡓࠋ

≟ࡀᛧࡀࡾ࡛࠶ࡿ࠿ࠊ࠾ࡼࡧ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣࢆᛂ⟅ኚᩘࠊ≟✀ࠊᛶูࠊᖺ㱋ࠊධ ᡭ᫬ࡢᖺ㱋ࠊධᡭ⤒㊰ࠊࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍࡢ᭷↓ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡢ᭷ ↓ࠊྠᒃ≟ࡢ᭷↓ࠊᏊ≟ࡢ᫬ᮇ࡟ᑠᏛ⏕ᮍ‶ࡢᏊ౪࡜ྠᒃࡋ࡚࠸ࡓ࠿ࢆㄝ᫂ኚᩘ࡜ࡋ࡚ࠊ

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26 ஧㡯ศᕸ࡟ࡼࡿ୍⯡໬⥺ᙧࣔࢹࣝࢆ⏝࠸࡚ྛㄝ᫂ኚᩘࡀᛂ⟅ኚᩘ࡟ᙳ㡪ࢆཬࡰࡋ࡚࠸ ࡿ࠿ࢆ☜ㄆࡋࡓࠋ᭷ព࡛࠶ࡗࡓㄝ᫂ኚᩘ࡟㛵ࡋ࡚ࡣࠊྛ㡯┠㛫ࡢ᭷ពᕪࢆ☜ㄆࡍࡿࡓࡵ ࡟ࠊከ㔜ẚ㍑ࢆ⾜ࡗࡓࠋ⟬ฟࡉࢀࡓp್࡟ࡣࠊHolm ἲ࡟ࡼࡿ⿵ṇࢆ࠿ࡅࡓࠋ᭷ព࡛࠶ ࡿ࠿ࢆホ౯ࡍࡿ᪉ἲ࡜ࡋ࡚ࡣࠊᑬᗘẚ᳨ᐃࢆ⏝࠸ࡓࠋࡇࡢゎᯒ࡟ࡣࠊR software (ver. 3.2.1)ࡢ lmer function ࢆ⏝࠸ࡓࠋ

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27 ⤖ᯝ ྜィ࡛307 㢌ศࡢࢹ࣮ࢱࡀᚓࡽࢀࡓࠋࡇࢀࡽࡢ≟ࡣ࡯ࡰ඲࡚㸦301 㢌㸧ࡀᐊෆ࡛㣫⫱ ࡉࢀ࡚࠸ࡓࠋ≟✀ࡣ⣧⾑✀57 ≟✀࡟㞧✀ࡀྵࡲࢀࡓࠋ➨ 1 ❶࡜ྠᵝ࡟ࠊ5 㢌௨ୗ࡛࠶ ࡗࡓ≟✀ࡣ”ࡑࡢ௚”࡜ࡋ࡚ᢅ࠺ணᐃ࡛࠶ࡗࡓࡀࠊ”ࡑࡢ௚”ࡀ඲యࡢ 4 ศࡢ 1 ࢆ㉸࠼ࡿ࡯ ࡝≟✀ࡢࡤࡽࡘࡁࡀ኱ࡁ࠿ࡗࡓࡓࡵ㸦supplement 5ࠊ307 㢌୰ 87 㢌㸧ࠊ≟✀ࡣㄝ᫂ኚ ᩘ࠿ࡽ㝖እࡋࡓࠋᖹᆒ᭶㱋ࡣ45.7ࠊධᡭ᫬ࡢᖹᆒ᭶㱋ࡣ 5.0 ࡛࠶ࡗࡓࠋᖺ㱋ࠊධᡭ᫬ࡢ ᖺ㱋࡜ࡶࠊ➨1 ❶࡜ྠᵝ࡟ࠊࡑࢀࡒࢀ 4 ࡘࡢࢢ࣮ࣝࣉ࡟ศ㢮ࡋࡓࠋᛶูࡣࠊ࢜ࢫ 43 㢌ࠊ ཤໃ࢜ࢫ123 㢌ࠊ࣓ࢫ 42 㢌ࠊ㑊ዷ࣓ࢫ 99 㢌࡛࠶ࡗࡓࠋධᡭ⤒㊰ࡣࠊ”࣌ࢵࢺࢩࣙࢵࣉ” 170 㢌ࠊ”ࣈ࣮ࣜࢲ࣮” 101 㢌ࠊ”▱ே” 11 㢌ࠊ”ࢩ࢙ࣝࢱ࣮” 15 㢌ࠊ”ࡑࡢ௚” 10 㢌࡛࠶ࡗ ࡓࠋྠᒃ≟ࡢ᭷↓ࡣࠊ࠸ࡿ≟ࡀ71 㢌ࠊ࠸࡞࠸≟ࡀ 236 㢌ࡔࡗࡓࠋ1 ṓᮍ‶ࡢ᫬ᮇ࡟ᑠ Ꮫ⏕ᮍ‶ࡢᏊ౪࡜ࡢྠᒃࡢ⤒㦂ࡢ᭷↓ࡣࠊ࠶ࡿ≟ࡀ41 㢌ࠊ࡞࠸≟ࡀ 266 㢌ࡔࡗࡓࠋࢺ ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡢ᭷↓ࡣࠊཧຍࡋ࡚࠸ࡿ࠾ࡼࡧཧຍࡋ࡚࠸ࡓ≟ࡀ92 㢌ࠊཧຍ ࡋ࡚࠸࡞࠸≟ࡀ215 㢌ࡔࡗࡓࠋࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍࡢ᭷↓ࡣࠊཧຍࡋ࡚࠸ࡓ≟ࡀ 67 㢌ࠊཧຍࡋ࡚࠸࡞࠸≟ࡀ 240 㢌ࡔࡗࡓࠋዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓࠾ࡼࡧ᪤ Ṕ࡜୙Ᏻ ⾜ືࡀぢࡽࢀࡿࡼ࠺࡟࡞ࡗࡓ᫬ᮇ࠿ࡽࠊゎᯒ࠿ࡽ㝖እࡍࡿᚲせࡀ࠶ࡿ࡜ุ᩿ࡋࡓሙྜࡣ ゎᯒ࡟ࡣ⏝࠸࡞࠸ணᐃ࡛࠶ࡗࡓࡀࠊࡑࡢࡼ࠺࡞ࢹ࣮ࢱࡣ࡞࠿ࡗࡓࠋ ≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ࡟ࡘ࠸࡚ࡣ௨ୗࡢࡼ࠺࡟࡞ࡗࡓ㸹”ศ㞳୙Ᏻ” 79 㢌ࠊ”ᔒ” 95 㢌ࠊ”ⰼⅆ” 63 㢌ࠊ”㡢” 158 㢌ࠊ”≉ᐃࡢᑐ㇟≀” 41 㢌ࠊ”඲⯡ᛶ୙Ᏻ” 5 㢌ࠋ”

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28 ඲⯡ᛶ୙Ᏻ”࡟㛵ࡋ࡚ࡣᩘࡀᑡ࡞࠿ࡗࡓࡓࡵࠊ௨㝆ࡢゎᯒ࠿ࡽࡣ㝖እࡋࡓࠋ ᑬᗘẚ᳨ᐃࡢ⤖ᯝࢆsupplement 6 ࡟ࡲ࡜ࡵࡓࠋ”ᔒ”࠾ࡼࡧ”ⰼⅆ”ࡣࢺ࣮ࣞࢽࣥࢢᩍ ᐊࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍ࡟ࡼࡾࠊ”ᔒ”࠾ࡼࡧ”ⰼⅆ”࡟ ࠾࠸࡚୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ព࡟ῶᑡࡋ࡚࠸ࡓ㸦ᅗ7ࠊᅗ 8a㸧ࠋࡲࡓࠊ➨ 1 ❶࡜ྠᵝ ࡟ࠊ”ⰼⅆ”ࡣᖺ㱋ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋຍ࠼࡚ࠊᖺ㱋ࢆࢢ࣮ࣝࣉ㛫࡛ẚ㍑ࡍࡿ࡜ࠊ” ⱝ㱋”ࠊ”ᡂ㱋”࠾ࡼࡧ”⪁㱋”ࡣ”ᗂ㱋”ࡼࡾࡶ”ⰼⅆ”࡛୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ព࡟㧗࠿ࡗ ࡓ㸦ᅗ8b㸧ࠋࡑࢀ௨እ࡟᭷ព࡞㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓࠋ

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29 ᅗ7㸸”ᔒ”࡜ࢺ࣮ࣞࢽࣥࢢࢫࢡ࣮ࣝཧຍࡢ㛵㐃 ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚ㸦*p < 0.05㸧ࠋ

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ື

ࢆ

♧

ࡍ

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ྜ

(19/92)

(76/215)

*

(34)

30 ᅗ8㸸”ⰼⅆ”࡜ࢺ࣮ࣞࢽࣥࢢࢫࢡ࣮ࣝཧຍࡢ㛵㐃(a)࠾ࡼࡧ”ⰼⅆ”࡜ᖺ㱋ࡢ㛵㐃(b) ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢ඲ಶయᩘ࡜୙Ᏻ⾜ືࢆ♧ࡋࡓಶయᩘࡢẚ㸦*p < 0.05, **p < 0.01㸧ࠋ

0%

20%

40%

60%

80%

100%

ཧຍ

୙ཧຍ

୙

Ᏻ

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๭

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(13/92)

(50/215)

*

0%

20%

40%

60%

80%

100%

ᗂ㱋

ⱝ㱋

ᡂ㱋

⪁㱋

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Ᏻ

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♧

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_(9/104)

(28/117)

(13/46)

(13/40)

**

*

(35)

31 ⪃ᐹ ௒ᅇࡢ⤖ᯝ࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡋ࡚࠸ࡿ≟ࡣ”ᔒ”࠾ࡼࡧ”ⰼⅆ”࡟ᑐࡋ࡚᭷ ព࡟୙Ᏻ⾜ືࢆ♧ࡍ㢖ᗘࡀప࠸ࡇ࡜ࡀ♧ࡉࢀࡓ㸦ᅗ7ࠊᅗ 8a㸧ࠋࡇࢀࡽࡢ⤖ᯝࡣࢺ࣮ࣞ ࢽࣥࢢ࡟ࡼࡾ୙Ᏻ⾜ືࡀῶᑡࡍࡿ࡜࠸࠺ඛ⾜◊✲࡜୍⮴ࡍࡿ㸦23㸧ࠋࡲࡓࠊࢺ࣮ࣞࢽࣥ ࢢ๓ᚋ࡛ၚᾮ୰ࡢࢥࣝࢳࢰ್࣮ࣝࢆẚ㍑ࡍࡿ࡜ࠊࢺ࣮ࣞࢽࣥࢢ๓ࡼࡾࢺ࣮ࣞࢽࣥࢢᚋ࡛ ⣙20%ࢥࣝࢳࢰ್࣮ࣝࡀపࡃ࡞ࡿ࡜࠸࠺ඛ⾜◊✲ࡀ࠶ࡿ㸦43㸧ࠋ᪥㡭࠿ࡽࢺ࣮ࣞࢽࣥࢢ ࢆ⾜ࡗ࡚࠸ࡿ≟ࡣࢫࢺࣞࢫࣞ࣋ࣝࡀపࡃࠊ୙Ᏻ⾜ືࢆ♧ࡋ࡟ࡃ࠸ࡇ࡜ࡀ♧၀ࡉࢀࡿࠋࡋ ࠿ࡋࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍ࡜ほᐹࡉࢀࡿၥ㢟⾜ືࡢᩘࡸࢩ࢙ࣝࢱ࣮࡟ධࢀࡽࢀࡿ ⌮⏤࡟㛵㐃ࡣ࡞࠸ࡇ࡜ࢆ♧ࡋࡓඛ⾜◊✲ࡶ࠶ࡿ㸦4ࠊ34㸧ࠋࡇࢀࡽࡢඛ⾜◊✲࡛ࡣࠊ୙ Ᏻ⾜ືࡢࡳ࡛࡞ࡃᨷᧁ⾜ື࡞࡝ࡶྵࡵ࡚ၥ㢟⾜ື࡜ࡋ࡚࠸ࡿࠋᨷᧁ⾜ື࡜୙Ᏻ㞀ᐖ࡛ࡣࠊ ࢺ࣮ࣞࢽࣥࢢࡀ୚࠼ࡿᙳ㡪ࡸ㔜せᛶࡀ␗࡞ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ ௒ᅇࡢ◊✲࡛ࡣࠊྠᒃ≟ࡢ᭷↓ࠊྠᒃࡋ࡚࠸ࡿᏊ౪ࡢ᭷↓࠾ࡼࡧࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧ ຍࡣ࠸ࡎࢀࡢ୙Ᏻ⾜ື࡜ࡶ㛵㐃ࡀぢࡽࢀ࡞࠿ࡗࡓࠋࡇࢀࡣࠊྠᒃ≟ࡀ࠸ࡿࡇ࡜࡛ᨷᧁ⾜ ືࡢࣜࢫࢡࡀῶᑡࡍࡿࡇ࡜ࢆ♧ࡋࡓඛ⾜◊✲㸦22㸧ࡸࠊྠᒃ≟ࡀከ࠸࡜↓㥏ྭ࠼ࡀከࡃ ࡞ࡿ࡜࠸࠺ඛ⾜◊✲㸦7㸧ࠊᏊ౪ࡀ࠸ࡿ࡜ᨷᧁ⾜ືࡢࣜࢫࢡࡀ࠶ࡀࡿ࡜࠸࠺ඛ⾜◊✲㸦16㸧ࠊ ࣃࣆ࣮ࢡࣛࢫ࡬ࡢཧຍ࡛ᨷᧁ⾜ືࡢࣜࢫࢡࡀୗࡀࡿ࡜࠸࠺ඛ⾜◊✲㸦5㸧ࠊᏊ≟ࡢ᫬ᮇࡢ ♫఍໬࡟ࡼࡾၥ㢟⾜ືࢆண㜵࡛ࡁࡿ࡜࠸࠺ඛ⾜◊✲㸦20㸧࡜ࡣ▩┪ࡍࡿࠋࡋ࠿ࡋࠊࡇࢀ ࡽࡢඛ⾜◊✲࡛ࡣࠊ୺࡟ᨷᧁ⾜ື࡟↔Ⅼࢆᙜ࡚࡚࠸ࡓࡾࠊ୙Ᏻ⾜ື௨እࡢၥ㢟⾜ືࡶྵ

(36)

32 ࡵ࡚◊✲ࢆ⾜ࡗ࡚࠸ࡿࠋ௒ᅇࡢ⤖ᯝ࡜ྜࢃࡏࡿ࡜ࠊྠᒃ≟ࡸᏊ౪ࡢ᭷↓ࠊࣃࣆ࣮ࢡࣛࢫ ࡬ࡢཧຍࡣ୺࡟ᨷᧁ⾜ື࡟ᙳ㡪ࡋࠊ୙Ᏻ⾜ື࡟ࡣᙳ㡪ࡋ࡞࠸ࡇ࡜ࡀ♧၀ࡉࢀࡿࠋ ࡲࡓࠊ➨1 ❶࡜ྠᵝ࡟ࠊ”ⰼⅆ”࡜ᖺ㱋࡟᭷ព࡞㛵㐃ࡀぢࡽࢀࡓ㸦ᅗ 8b㸧ࠋࡇࡢࡇ࡜࠿ ࡽࠊᖺ㱋ࡀ”ⰼⅆ”࡟ᑐࡋ࡚ᙉ࠸ᙳ㡪ࢆཬࡰࡍࡇ࡜ࡀ෌☜ㄆࡉࢀࡓࠋࡋ࠿ࡋࠊ”ᔒ”࡟ᑐࡋ ࡚ࡣ➨1 ❶࡛ぢࡽࢀࡓ᭷ព࡞㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓ㸦supplement 6㸧ࠋ➨ 1 ❶࡟࠾࠸࡚ ࡶࠊ”ᔒ”࡟࠾࠸࡚ࡣ”ᗂ㱋”࡜”⪁㱋”ࡢ㛫࡟࠾࠸࡚ࡢࡳ᭷ពᕪࡀぢࡽࢀ࡚࠸ࡓࠋᖺ㱋ࡣ”ᔒ” ࡟ᑐࡋ࡚ࡣ”ⰼⅆ”࡟ᑐࡍࡿ࡯࡝ᙉ࠸ᙳ㡪ࡣ࡞࠸ࡢ࠿ࡶࡋࢀ࡞࠸ࠋ௒ᅇࡢㄪᰝ࡛ࡣࠊ➨ 1 ❶࡟ẚ㍑ࡋ࡚”ᗂ㱋”࡟ᑐࡍࡿ”⪁㱋”ࡢಶయࡀ┦ᑐⓗ࡟ᑡ࡞࠿ࡗࡓ㸦➨ 1 ❶㸸”ᗂ㱋”88 ಶ యࠊ”⪁㱋”60 ಶయࠊ➨ 2 ❶㸸”ᗂ㱋”104 ಶయࠊ”⪁㱋”40 ಶయ㸧ࠋ┦ᑐⓗ࡞ಶయᩘࡢ㐪࠸ ࡀᙳ㡪ࡋ࡚࠸ࡿࡢ࠿ࡶࡋࢀ࡞࠸ࠋ”ᔒ”࡟ᑐࡍࡿᖺ㱋ࡢᙳ㡪࡟㛵ࡋ࡚ࡣࠊࡼࡾヲ⣽࡞ㄪᰝ ࢆ⾜࠺ᚲせࡀ࠶ࡿࠋ

(37)

33 ⤖ㄒ ᮏ◊✲ࡢ⤖ᯝ࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡍࡿࡇ࡜࡛≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧ࡀῶᑡࡍ ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡲࡓࠊᨷᧁ⾜ື࡜୙Ᏻ㞀ᐖ࡛ࡣࢺ࣮ࣞࢽࣥࢢࡸࣃࣆ࣮ࢡࣛࢫࠊ ྠᒃࡋ࡚࠸ࡿ≟ࡸᏊ౪ࡀ୚࠼ࡿᙳ㡪ࡀ␗࡞ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋၥ㢟⾜ື࡟ࡼࡾᚲせ࡜ ࡞ࡿண㜵᪉ἲࡀ␗࡞ࡿྍ⬟ᛶࢆ⪃៖ࡋࡓㄪᰝࡀ௒ᚋồࡵࡽࢀࡿࠋ ࡲࡓࠊ➨1 ❶࡛♧ࡉࢀࡓ”ⰼⅆ”࡟ᑐࡍࡿᖺ㱋ࡢᙳ㡪ࡀ෌☜ㄆࡉࢀࡓ୍᪉࡛ࠊ”ᔒ”࡜ᖺ 㱋ࡢ㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓࠋ”ᔒ”࡟ᑐࡍࡿᖺ㱋ࡢᙳ㡪࡟㛵ࡋ࡚ࡣࠊࡼࡾヲ⣽࡟ㄪ࡭ࡿᚲ せࡀ࠶ࡿࠋ ௒ᅇࡢㄪᰝ࡛ࡣࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻࠺㢖ᗘࡸᅇᩘࠊࢺ࣮ࣞࢽࣥࢢࡢෆᐜ࡞࡝ࡣㄪ ࡭࡚࠸࡞࠿ࡗࡓࠋࡑࡢࡓࡵࠊ௒ᚋࡣࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾ࡅࡿ࡝ࡢࡼ࠺࡞せᅉࡀ୙Ᏻ⾜ ືࡢⓎ⌧࡟ᙳ㡪ࡋ࡚࠸ࡿࡢ࠿ࢆヲࡋࡃㄪ࡭ࡿࡇ࡜ࡀồࡵࡽࢀࡿࠋ

(38)

34 ➨3 ❶

≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ᑐࡍࡿࢺ࣮ࣞࢽࣥࢢᩍᐊཧຍࡢᙳ㡪

⥴ゝ ➨2 ❶ࡢ⤖ᯝ࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡍࡿࡇ࡜࡟ࡼࡾࠊ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧ࢆ ண㜵ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋࡋ࠿ࡋࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾ࡅࡿ࡝ࡢ ࡼ࠺࡞せᅉࡀᙳ㡪ࡋ࡚࠸ࡿࡢ࠿ࡣࡲࡔ᫂ࡽ࠿࡟࡞ࡗ࡚࠸࡞࠸ࠋ ࢺ࣮ࣞࢽࣥࢢࡢ᪉ἲ࡜ࡋ࡚ࡣࠊᏛ⩦⌮ㄽࡢ࢜࣌ࣛࣥࢺ᮲௳௜ࡅࢆ౑⏝ࡍࡿࡇ࡜ࡀከ࠸ࠋ ࢜࣌ࣛࣥࢺ᮲௳௜ࡅࡣࠊື≀ࡢ⾜ື࡟ᑐࡋ࡚ᙉ໬Ꮚ࠾ࡼࡧ⨩Ꮚࢆຍ࠼ࡿࡇ࡜࡛ࠊື≀ࡢ ⮬Ⓨⓗ⾜ືࡢⓎ⌧㢖ᗘࢆኚ࠼ࡿࡼ࠺࡟ࢺ࣮ࣞࢽࣥࢢࡍࡿ᪉ἲ࡛࠶ࡿ㸦30㸧ࠋࢺ࣮ࣞࢽࣥ ࢢᩍᐊࡣࢺ࣮ࣞࢽࣥࢢࡢෆᐜ࣭᪉ἲ࡟ࡼࡾࠊ࢜࣌ࣛࣥࢺ᮲௳௜ࡅࡢṇࡢᙉ໬㸦ᮃࡲࡋ࠸ ⾜ື࡟ᑐࡋ࡚ᙉ໬Ꮚࢆຍ࠼ࡿ㸧ࠊ㈇ࡢᙉ໬㸦ᮃࡲࡋ࠸⾜ື࡟ᑐࡋ࡚⨩Ꮚࢆྲྀࡾ㝖ࡃ㸧ࠊṇ ࡢ⨩㸦ᮃࡲࡋࡃ࡞࠸⾜ື࡟ᑐࡋ࡚⨩Ꮚࢆຍ࠼ࡿ㸧ࠊ㈇ࡢ⨩㸦ᮃࡲࡋࡃ࡞࠸⾜ື࡟ᑐࡋ࡚ ᙉ໬Ꮚࢆྲྀࡾ㝖ࡃ㸧ࢆ༢⊂࡛౑⏝ࡍࡿࡶࡢࠊࡑࢀࡽࢆ⤌ࡳྜࢃࡏ࡚⾜࠺ࡶࡢ࡟ศࡅࡽࢀ ࡿࠋඛ⾜◊✲࡟ࠊṇࡢ⨩ࢆ౑⏝ࡍࡿࡇ࡜࡛ᨷᧁ⾜ືࡢࣜࢫࢡࡀୖ᪼ࡍࡿࡇ࡜ࢆ♧ࡋࡓࡶ ࡢ㸦5ࠊ39㸧ࡸṇࡢᙉ໬࡟ࡼࡾ≟࡜Ⰻዲ࡞㛵ಀࡀ⠏ࡅࡿࡇ࡜ࢆ♧ࡋࡓࡶࡢ㸦35ࠊ46㸧ࡀ ࠶ࡿࠋ≉࡟ࠊṇࡢ⨩࡜ࡋ࡚ࢳ࣮ࣙࢡࢳ࢙࣮ࣥࢆ౑⏝ࡍࡿ࡜≟ࡢ⬻࡟㔜኱࡞㞀ᐖࢆ୚࠼ࡿ ࡇ࡜ࡶ࠶ࡿࡓࡵ㸦15㸧ࠊࢳ࣮ࣙࢡࢳ࢙࣮ࣥࡢ౑⏝ࡶྵࡵṇࡢ⨩࡜ࡋ࡚㌟యⓗ࡞⨩ࢆ౑⏝ ࡍࡿࢺ࣮ࣞࢽࣥࢢࡣ㑊ࡅࡿ࡭ࡁ࡛࠶ࡿࠋࡑࡢࡓࡵࠊṇࡢᙉ໬ࢆ୰ᚰ࡟⾜ࡗ࡚࠸ࡿࢺ࣮ࣞ

(39)

35 ࢽࣥࢢᩍᐊ࡟㏻࠺ࡇ࡜ࡀၥ㢟⾜ືࡢண㜵࡟ࡣ㔜せ࡛࠶ࡿࠋ ୙Ᏻ⾜ືࡢⓎ⌧࡟㛵ࢃࡿࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾ࡅࡿせᅉ࡜ࡋ࡚ࡣࠊࢺ࣮ࣞࢽࣥࢢ࡬ࡢ ཧຍ㢖ᗘࡸཧຍᮇ㛫ࠊཧຍᅇᩘ࡞࡝ࡀᣲࡆࡽࢀࡿࠋࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡢ㢖ᗘ࡜ Ꮫ⩦ຠ⋡ࡢ㛵㐃ࢆ♧ࡋࡓඛ⾜◊✲ࡀ࠸ࡃࡘ࠿࠶ࡿ㸦6ࠊ9ࠊ12ࠊ29㸧ࠋࡇࢀࡽࡢඛ⾜◊✲ ࡛ࡣࠊࢺ࣮ࣞࢽࣥࢢࡢ㢖ᗘࡀ㧗࠸ࡇ࡜ࡼࡾࡶ㐺ษ࡛࠶ࡿࡇ࡜ࡀᏛ⩦ຠ⋡࡟࠾࠸࡚㔜せ࡛ ࠶ࡿࡇ࡜ࢆ♧ࡋ࡚࠸ࡿࠋຍ࠼࡚ࠊࢺ࣮ࣞࢽࣥࢢ࡬ࡢཧຍࡀᑡ࡞ࡍࡂࡿ࡜༑ศ࡞ᡂᯝࡀᚓ ࡽࢀࡎࠊ࠶ࡿ⛬ᗘࡢཧຍᅇᩘࡀᚲせ࡛࠶ࡿࡇ࡜ࢆ♧ࡋࡓඛ⾜◊✲ࡶᏑᅾࡍࡿ㸦25㸧ࠋྠ ᵝ࡟୙Ᏻ⾜ືࡢண㜵࡟㛵ࡋ࡚ࡶࡇࢀࡽࡢせᅉࡀ㛵୚ࡋࠊ㐺ษ࡞ࢺ࣮ࣞࢽࣥࢢ㢖ᗘࡸ᭱ప 㝈ᚲせ࡞ᮇ㛫࡞࡝ࡀ࠶ࡿྍ⬟ᛶࡀ࠶ࡿࠋ ࡲࡓࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻࠺┠ⓗࡶ⪃៖ࡍࡿᚲせࡀ࠶ࡿࠋᇶᮏⓗ࡞ࡋࡘࡅࡢࡓࡵࡔ ࡅ࡛࡞ࡃࠊၥ㢟⾜ືࡢ἞⒪ࡢࡓࡵ࡟ࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻ࡗ࡚࠸ࡿ≟ࡶ࠸ࡿࡇ࡜ࡀ⪃࠼ ࡽࢀࡿࠋࡑࡢࡼ࠺࡞≟ࡢሙྜࠊ௚ࡢ⌮⏤࡛㏻ࡗ࡚࠸ࡿ≟ࡼࡾࡶ୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ㧗 ࠸ࡇ࡜ࡀண᝿ࡉࢀࡿࡓࡵࠊᩍᐊ࡟㏻࠺⌮⏤࡟㛵ࡋ࡚ࡶ☜ㄆࡍࡿࡇ࡜ࡀᚲせ࡛࠶ࡿࠋ ࡼࡗ࡚ᮏ◊✲࡛ࡣࠊ࢜࣌ࣛࣥࢺ᮲௳௜ࡅࡢṇࡢᙉ໬࡟ࡼࡿࢺ࣮ࣞࢽࣥࢢࢆ⾜ࡗ࡚࠸ࡿ ࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾࠸࡚ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻ࡗࡓࢥ࣮ࢫࠊ㢖ᗘࠊ㏻ࡗࡓᅇᩘ࣭ᮇ 㛫࡞࡝ࡀ୙Ᏻ⾜ືࡢⓎ⌧࡟ᙳ㡪ࡋ࡚࠸ࡿ࠿ྰ࠿ࢆㄪ࡭ࡿࡇ࡜ࢆ┠ⓗ࡜ࡋ࡚ㄪᰝࢆ⾜ࡗ ࡓࠋ

(40)

36 ᐇ㦂ᮦᩱ࠾ࡼࡧᐇ㦂᪉ἲ ᮏ◊✲ࡣࠊᮾி㎰ᕤ኱Ꮫ◊✲೔⌮ጤဨ఍ࡢᢎㄆࢆᚓ࡚⾜ࡗࡓ㸦⏦ㄳ␒ྕ No.28-23㸧ࠋ ㄪᰝࡣྛ㣫࠸୺ࡢྠពࢆᚓࡓୖ࡛⾜ࡗࡓࠋ

ㄪᰝࡢࡓࡵࡢ࢔ࣥࢣ࣮ࢺࢆసᡂࡋࡓ㸦supplement 7㸧ࠋ࢔ࣥࢣ࣮ࢺࡣྛ≟ࡢᇶ♏᝟ሗ ࢆ☜ㄆࡍࡿ㡯┠࡜୙Ᏻ࠾ࡼࡧࢺ࣮ࣞࢽࣥࢢ࡟ࡘ࠸࡚ࡢ㡯┠࡟ศࡅࡽࢀࡓࠋᇶ♏᝟ሗࡢ㡯 ┠࡟ࡣࠊ≟✀ࠊᛶูࠊᖺ㱋ࠊධᡭ᫬ࡢᖺ㱋ࠊධᡭ⤒㊰ࠊዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓㸦࣓ࢫ ࡢࡳ㸧ࠊ᪤ Ṕࡀྵࡲࢀࡓࠋ୙Ᏻ࠾ࡼࡧࢺ࣮ࣞࢽࣥࢢ࡟ࡘ࠸࡚ࡢ㡯┠࡟ࡣࠊ௨ୗࡢ≧ἣ ࡛≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ࠿㸹”ศ㞳୙Ᏻ”㸦␃Ᏺ␒୰ࡸ㣫࠸୺ࡢጼࡀぢ࠼࡞࠸᫬㸧ࠊ”ᔒ”㸦ᔒ ࡢ᫬㸧ࠊ”ⰼⅆ”㸦ⰼⅆࡢ㡢ࡀࡍࡿ᫬㸧ࠊ”㡢”㸦኱ࡁ࡞㡢ࡀࡍࡿ᫬㸧ࠊ”≉ᐃࡢᑐ㇟≀”㸦≉ᐃ ࡢேࡸ≀ࢆぢࡓ᫬㸧㸹ࠊヱᙜࡍࡿࡶࡢࡀ࠶ࡿሙྜࡣࡑࢀࡒࢀࡢ୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ࠺ ࡟࡞ࡗࡓ᫬ᮇࠊ≟ࡀᛧࡀࡾ࡛࠶ࡿ࠿ࠊ㏻ࡗ࡚࠸ࡓࢥ࣮ࢫ㸦ᇶᮏࢥ࣮ࢫࠊᛂ⏝ࢥ࣮ࢫࠊၥ 㢟⾜ື἞⒪ࢥ࣮ࢫ㸧ࠊ㏻ࡗ࡚࠸ࡓᮇ㛫ࠊ㏻࠸ጞࡵࡓ᫬ࡢ≟ࡢᖺ㱋ࠊࢺ࣮ࣞࢽࣥࢢࢆཷࡅ ࡓᅇᩘ㸦5 ᅇ௨ୗࠊ6ࠥ10 ᅇࠊ11ࠥ20 ᅇࠊ21ࠥ30 ᅇࠊ31ࠥ40 ᅇࠊ41 ᅇ௨ୖ㸧ࠊ㏻ࡗ࡚ ࠸ࡓ㢖ᗘ㸦㐌࡟4 ᪥௨ୖࠊ㐌࡟ 2ࠥ3 ᅇࠊ㐌࡟ 1 ᅇࠊ᭶࡟ 2ࠥ3 ᅇ㸧ࠊ᚟⩦ࡢ᭷↓ࡀྵࡲ ࢀࡓࠋ ㄪᰝࡣᮾி㒔ࠊᇸ⋢┴࠾ࡼࡧᒣ᲍┴ෆࡢ4 ࣨᡤࡢࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡋ࡚࠸ࡿ㣫 ࠸୺ࢆᑐ㇟࡜ࡋ࡚⾜ࡗࡓࠋ࢔ࣥࢣ࣮ࢺࡢෆᐜ࠾ࡼࡧ┠ⓗ࡟㛵ࡍࡿㄝ᫂᭩ࢆㄞࢇ࡛ࡶࡽ࠸ࠊ ྠពࡋࡓሙྜࡢࡳ࢔ࣥࢣ࣮ࢺ࡟グධࡋ࡚ࡶࡽࡗࡓࠋ

(41)

37

≟ࡀᛧࡀࡾ࡛࠶ࡿ࠿ࠊ࠾ࡼࡧ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣࢆᛂ⟅ኚᩘࠊ㏻ࡗ࡚࠸ࡓࢥ࣮ࢫࠊ㏻ ࡗ࡚࠸ࡓᮇ㛫ࠊ㏻࠸ጞࡵࡓ᫬ࡢ≟ࡢᖺ㱋ࠊࢺ࣮ࣞࢽࣥࢢࢆཷࡅࡓᅇᩘࠊ㏻ࡗ࡚࠸ࡓ㢖ᗘࠊ ᚟⩦ࡢ᭷↓ࢆㄝ᫂ኚᩘ࡜ࡋ࡚ࠊ஧㡯ศᕸ࡟ࡼࡿ୍⯡໬⥺ᙧࣔࢹࣝࢆ⏝࠸࡚ྛㄝ᫂ኚᩘࡀ ᛂ⟅ኚᩘ࡟ᙳ㡪ࢆཬࡰࡋ࡚࠸ࡿ࠿ࢆ☜ㄆࡋࡓࠋ≟✀ࠊᛶูࠊᖺ㱋ࠊධᡭ᫬ࡢᖺ㱋ࠊධᡭ ⤒㊰࡟㛵ࡋ࡚ࡣࠊࢢ࣮ࣝࣉ㛫ࡢࡤࡽࡘࡁࡀ኱ࡁ࠿ࡗࡓࡓࡵㄝ᫂ኚᩘ࠿ࡽ㝖እࡋࡓࠋ᭷ព ࡛࠶ࡗࡓㄝ᫂ኚᩘ࡟㛵ࡋ࡚ࡣࠊྛ㡯┠㛫ࡢ᭷ពᕪࢆ☜ㄆࡍࡿࡓࡵ࡟ࠊከ㔜ẚ㍑ࢆ⾜ࡗࡓࠋ ⟬ฟࡉࢀࡓp್࡟ࡣࠊHolm ἲ࡟ࡼࡿ⿵ṇࢆ࠿ࡅࡓࠋ᭷ព࡛࠶ࡿ࠿ࢆホ౯ࡍࡿ᪉ἲ࡜ࡋ

࡚ࡣࠊᑬᗘẚ᳨ᐃࢆ⏝࠸ࡓࠋࡇࡢゎᯒ࡟ࡣࠊR software (ver. 3.2.1)ࡢ lmer function ࢆ ⏝࠸ࡓࠋ

(42)

38 ⤖ᯝ ྜィ࡛52 㢌ศࡢࢹ࣮ࢱࡀᚓࡽࢀࡓࠋࡇࢀࡽࡢ≟ࡣ඲࡚ࡀᐊෆ࡛㣫⫱ࡉࢀ࡚࠸ࡓࠋ≟ ✀ࡣ⣧⾑✀20 ≟✀࡟㞧✀ࡀྵࡲࢀࡓࠋᖹᆒ᭶㱋ࡣ 45.3ࠊධᡭ᫬ࡢᖹᆒ᭶㱋ࡣ 4.1 ࡛࠶ ࡗࡓࠋᛶูࡣࠊ࢜ࢫ3 㢌ࠊཤໃ࢜ࢫ 22 㢌ࠊ࣓ࢫ 7 㢌ࠊ㑊ዷ࣓ࢫ 20 㢌࡛࠶ࡗࡓࠋධᡭ ⤒㊰ࡣࠊ”࣌ࢵࢺࢩࣙࢵࣉ” 25 㢌ࠊ”ࣈ࣮ࣜࢲ࣮” 21 㢌ࠊ”▱ே” 1 㢌ࠊ”ࢩ࢙ࣝࢱ࣮” 4 㢌ࠊ” ࡑࡢ௚” 1 㢌࡛࠶ࡗࡓࠋዷፎ࣭⫱ඣࡢ⤒㦂ࡢ᭷↓࠾ࡼࡧ᪤ Ṕ࡜୙Ᏻ⾜ືࡀぢࡽࢀࡿࡼ ࠺࡟࡞ࡗࡓ᫬ᮇ࠿ࡽࠊゎᯒ࠿ࡽ㝖እࡍࡿᚲせࡀ࠶ࡿ࡜ุ᩿ࡋࡓሙྜࡣゎᯒ࡟ࡣ⏝࠸࡞࠸ ணᐃ࡛࠶ࡗࡓࡀࠊࡑࡢࡼ࠺࡞ࢹ࣮ࢱࡣ࡞࠿ࡗࡓࠋ ≟ࡀ୙Ᏻ⾜ືࢆ♧ࡍ≧ἣ࡟ࡘ࠸࡚ࡣ௨ୗࡢࡼ࠺࡟࡞ࡗࡓ㸹”ศ㞳୙Ᏻ” 12 㢌ࠊ”ᔒ” 11 㢌ࠊ”ⰼⅆ” 7 㢌ࠊ”㡢” 31 㢌ࠊ”≉ᐃࡢᑐ㇟≀” 17 㢌ࠋ ㏻ࡗ࡚࠸ࡓࢺ࣮ࣞࢽࣥࢢࡢࢥ࣮ࢫࡣࠊᇶᮏࢥ࣮ࢫ 31 㢌ࠊᛂ⏝ࢥ࣮ࢫ 11 㢌ࠊၥ㢟⾜ ື἞⒪ࢥ࣮ࢫ 10 㢌࡛࠶ࡗࡓࠋ㏻ࡗࡓᮇ㛫ࡣࠊ1 ࣨ᭶࠿ࡽ 9 ᖺ 9 ࣨ᭶㸦ᖹᆒ 1 ᖺ 6 ࣨ᭶㸧 ࡔࡗࡓࠋ㏻࠸ጞࡵࡓ᫬ࡢ≟ࡢᖺ㱋ࡣࠊ2 ࣨ᭶㱋࠿ࡽ 9 ṓ㸦ᖹᆒ 1 ṓ 3 ࣨ᭶㱋㸧ࡔࡗࡓࠋ ㏻ࡗࡓᅇᩘࡣࠊ5 ᅇ௨ୗ 5 㢌ࠊ6ࠥ10 ᅇ 13 㢌ࠊ11ࠥ20 ᅇ 15 㢌ࠊ21ࠥ30 ᅇ 4 㢌ࠊ31 ࠥ40 ᅇ 5 㢌ࠊ41 ᅇ௨ୖ 10 㢌࡛࠶ࡗࡓࡓࡵࠊ5 ᅇ௨ୗ࡜ 6ࠥ10 ᅇࢆྜࢃࡏ࡚ 10 ᅇ௨ ୗ18 㢌ࠊ11ࠥ20 ᅇ࡜ 21ࠥ30 ᅇࢆྜࢃࡏ࡚ 11㹼30 ᅇ 19 㢌ࠊ31ࠥ40 ᅇ࡜ 41 ᅇ௨ୖࢆ ྜࢃࡏ࡚31 ᅇ௨ୖ 15 㢌ࡢ 3 ࢢ࣮ࣝࣉ࡟෌ศ㢮ࡋࡓࠋ㏻ࡗࡓ㢖ᗘ࡟㛵ࡋ࡚ࡣࠊ㐌࡟ 2 㹼3 ᅇࡀ 2 㢌ࠊ㐌࡟ 1 ᅇࡀ 23 㢌ࠊ᭶࡟ 2ࠥ3 ᅇࡀ 27 㢌࡛࠶ࡗࡓࡓࡵࠊ㐌࡟ 2㹼3 ᅇ࡜

(43)

39 㐌࡟1 ᅇࢆྜࢃࡏ࡚ゎᯒࡋࡓࠋ᚟⩦ࡢ᭷↓࡟㛵ࡋ࡚ࡣࠊ᚟⩦ࢆ⾜ࡗ࡚࠸ࡿ㣫࠸୺ࡋ࠿࠸ ࡞࠿ࡗࡓࡓࡵࠊゎᯒ࠿ࡽ㝖እࡋࡓࠋ ᑬᗘẚ᳨ᐃ࡟ࡼࡿከ㔜ẚ㍑ࡢ⤖ᯝࢆsupplement 8 ࡟ࡲ࡜ࡵࡓࠋ”ᛧࡀࡾ”ࡣ㏻࠸ጞࡵ ࡓ᫬ࡢᖺ㱋ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋᛧࡀࡾ࡛࠶ࡿ≟ࡣᛧࡀࡾ࡛࡞࠸≟ࡼࡾࡶ㏻࠸ጞ ࡵࡓ᫬ࡢᖺ㱋ࡀ᭷ព࡟㧗࠿ࡗࡓ㸦ࡑࢀࡒࢀ୰ኸ್7.5 ࣨ᭶㱋࠾ࡼࡧ 4 ࣨ᭶㱋ࠊᅗ 9㸧ࠋ” ศ㞳୙Ᏻ”ࡣ㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡢᙳ㡪ࢆ᭷ព࡟ཷࡅ࡚࠸ࡓࠋ”ศ㞳୙Ᏻ”࡟࠾࠸࡚୙Ᏻ ⾜ືࢆ♧ࡍ≟ࡣ♧ࡉ࡞࠸≟ࡼࡾࡶ㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡀ᭷ព࡟㧗࠿ࡗࡓ㸦ࡑࢀࡒࢀ୰ኸ ್16 ࣨ᭶㱋࠾ࡼࡧ 5 ࣨ᭶㱋ࠊᅗ 10㸧ࠋ

(44)

40 ᅗ9㸸”ᛧࡀࡾ”࡜㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡢ㛵㐃 ࣂ࣮ࡢୖ➃ࡣ᭱኱್ࠊ⟽ࡢୖ➃ࡣ➨୕ᅄศ఩್ࠊ⟽ࡢ୰ኸ⥺ࡣ୰ኸ್ࠊ⟽ࡢୗ➃ࡣ➨୍ ᅄศ఩್ࠊࣂ࣮ࡢୗ➃ࡣ᭱ᑠ್ࢆ♧ࡍࠋ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢಶయᩘࠋ᭷ពᕪ ࡀぢࡽࢀࡓࡶࡢࡣ࢔ࢫࢱࣜࢫࢡ࡛♧ࡋࡓ㸦*p < 0.05㸧ࠋ

0

20

40

60

80

100

120 ᛧࡀࡾ

ᛧࡀࡾ࡛࡞࠸

㏻

࠸

ጞ

ࡵ

ࡓ

᫬

ࡢ

᭶

㱋

*

㸦

N=26㸧

㸦

N=26㸧

(45)

41 ᅗ10㸸”ศ㞳୙Ᏻ”࡜㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡢ㛵㐃 ࣂ࣮ࡢୖ➃ࡣ᭱኱್ࠊ⟽ࡢୖ➃ࡣ➨୕ᅄศ఩್ࠊ⟽ࡢ୰ኸ⥺ࡣ୰ኸ್ࠊ⟽ࡢୗ➃ࡣ➨୍ ᅄศ఩್ࠊࣂ࣮ࡢୗ➃ࡣ᭱ᑠ್ࢆ♧ࡍࠋ࢝ࢵࢥෆࡢᩘᏐࡣྛࢢ࣮ࣝࣉࡢಶయᩘࠋ᭷ពᕪ ࡀぢࡽࢀࡓࡶࡢࡣ࢔ࢫࢱࣜࢫࢡ࡛♧ࡋࡓ㸦*p < 0.05㸧ࠋ

0

20

40

60

80

100

120 ୙Ᏻ⾜ື᭷ࡾ

୙Ᏻ⾜ື↓ࡋ

㏻

࠸

ጞ

ࡵ

ࡓ

᫬

ࡢ

᭶

㱋

*

㸦

N=12㸧

㸦

N=40㸧

(46)

42 ⪃ᐹ ௒ᅇࡢ⤖ᯝ࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾࠸࡚㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡀ”ᛧࡀࡾ”࠾ࡼࡧ” ศ㞳୙Ᏻ”࡟ᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋ࠸ࡎࢀ࡟࠾࠸࡚ࡶࠊ㏻࠸ጞࡵࡓ᫬ࡢ ᖺ㱋ࡀ㧗࠸≟ࡢ᪉ࡀ୙Ᏻ⾜ືࢆ♧ࡍ๭ྜࡀ᭷ព࡟㧗࠿ࡗࡓ㸦ᅗ9 ࠾ࡼࡧᅗ 10㸧ࠋࡇࢀࡽ ࡣ➨2 ❶࡟࠾࠸࡚ࡣࢺ࣮ࣞࢽࣥࢢᩍᐊཧຍ࡜ࡢ᭷ព࡞㛵㐃ࡣぢࡽࢀ࡚࠸࡞࠿ࡗࡓࠋࡋ࠿ ࡋ”ศ㞳୙Ᏻ”㛵ࡋ࡚ࡣࠊ➨ 2 ❶࡟࠾࠸࡚ࡶ᭷ព࡛ࡣ࡞࠿ࡗࡓࡀഴྥࡣ࠶ࡗࡓ㸦p =0.05793ࠊ supplement 6㸧ࠋ≟ࡣ⏕ᚋ༙ᖺࡢ࠺ࡕ࡟♫఍໬ᮇࡸ㟷ᖺᮇ࡜࠸ࡗࡓࡑࡢᚋࡢ⾜ື࡟኱ࡁ ࡞ᙳ㡪ࢆ୚࠼ࡿ᫬ᮇࡀᏑᅾࡍࡿ㸦19㸧ࠋࡇࡢࡼ࠺࡞᫬ᮇ࡟ࢺ࣮ࣞࢽࣥࢢࢆ㛤ጞࡋࠊከࡃ ࡢࡶࡢࢆ⤒㦂ࡍࡿࡇ࡜࡛୙Ᏻ⾜ືࡢண㜵࡟᭷ຠ࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡿࠋ୍᪉࡛ࠊ࠶ࡿ ⛬ᗘᡂ㛗ࡋࡓᚋ࡟୙Ᏻ⾜ືࢆⓎ⌧ࡍࡿࡼ࠺࡟࡞ࡾࠊࡑࢀࢆ⌮⏤࡟ࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻ ࠸ጞࡵࡓ࡜࠸࠺ྍ⬟ᛶࡶ⪃࠼ࡽࢀࡿࠋ௒ᅇࡢㄪᰝ࡛ࡣࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻࠸ጞࡵࡓ⌮ ⏤࡟ࡘ࠸࡚ࡣㄪ࡭࡚࠸࡞࠿ࡗࡓࠋ௒ᚋࡢㄪᰝ࡛ࡣ㏻࠸ጞࡵࡓ⌮⏤࡟ࡶὀ┠ࡍࡿᚲせࡀ࠶ ࡿ࠿ࡶࡋࢀ࡞࠸ࠋ ୍᪉࡛ࠊ㏻ࡗࡓࢥ࣮ࢫࠊ㏻ࡗ࡚࠸ࡓᮇ㛫ࠊ㏻ࡗࡓᅇᩘࠊཧຍࡍࡿ㢖ᗘ࡜ྛ୙Ᏻ⾜ືࡢ 㛫࡟᭷ព࡞㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓࠋࡇࢀࡽࡢ⤖ᯝࡣࠊࢺ࣮ࣞࢽࣥࢢࢆ1 ᅇࡔࡅ⾜࠺ࡼࡾ ࡶ」ᩘᅇ⾜ࡗࡓ᪉ࡀぢ▱ࡽࡠே࡟ᑐࡍࡿ୙Ᏻ⾜ືࡀῶࡿ࡜࠸࠺ඛ⾜◊✲㸦25㸧ࡸࠊࢺࣞ ࣮ࢽࣥࢢࡢ㢖ᗘ࡜୙Ᏻ⾜ືࡢ᭷↓ࡸࢺ࣮ࣞࢽࣥࢢᡂ⦼࡜ࡢ㛵㐃ࢆ♧ࡋࡓඛ⾜◊✲㸦6ࠊ9ࠊ 12ࠊ29㸧࡜ࡣ▩┪ࡍࡿࠋࡋ࠿ࡋࠊࡇࢀࡽࡢඛ⾜◊✲࡛ࡣࢺ࣮ࣞࢽࣥࢢࡢᅇᩘࡀ 1 ᅇ࡜ 6

(47)

43 ᅇ࡜࠸࠺ᑡ࡞࠸ᅇᩘ࡟࠾࠸࡚ࡢẚ㍑ࡸࠊ1 ᪥࡟⾜࠺ࢺ࣮ࣞࢽࣥࢢࢭࢵࢩࣙࣥࡢᅇᩘࡸ㐌 ࡟⾜࠺ࢺ࣮ࣞࢽࣥࢢࡢ᪥ᩘࢆኚ࠼࡚ࡢẚ㍑ࢆࡋ࡚࠸ࡓࠋ௒ᅇࡢ⤖ᯝ࡜ẚ㍑ࡍࡿ࡜ࠊࢺࣞ ࣮ࢽࣥࢢࡢᅇᩘ࡟㛵ࡋ࡚ࡣࠊ࠶ࡿ୍ᐃ௨ୖࡢᅇᩘࢆ㉸࠼ࡿ࡜ࢺ࣮ࣞࢽࣥࢢࡢᅇᩘࡣ࠶ࡲ ࡾ኱ࡁ࡞ᙳ㡪ࢆཬࡰࡉ࡞࠸ྍ⬟ᛶࡀ♧ࡉࢀࡓࠋࡲࡓࠊ௒ᅇࡢ◊✲࡛ࡣࢺ࣮ࣞࢽࣥࢢᩍᐊ ཧຍࡢ㢖ᗘࡀ㐌࡟1 ᅇࡢࢢ࣮ࣝࣉ࡜᭶࡟ 2ࠥ3 ᅇࡢࢢ࣮ࣝࣉࡢࡳ࡛ࡋ࠿ẚ㍑ࡋ࡞࠿ࡗࡓ ࡇ࡜࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢࡢ㢖ᗘ࡟㛵ࡋ࡚ࡣ኱ࡁࡃ␗࡞ࡽ࡞࠸㝈ࡾࠊ୙Ᏻ⾜ືࡢⓎ⌧࡟୚ ࠼ࡿᙳ㡪ࡣᑠࡉ࠸ࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ ➨2 ❶࡛ࡣࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡍࡿࡇ࡜࡛”ᔒ”࡜”ⰼⅆ”࡟࠾ࡅࡿ୙Ᏻ⾜ືࡢⓎ⌧ ࡀῶᑡࡍࡿ࡜࠸࠺⤖ᯝࡀᚓࡽࢀ࡚࠸ࡓࡀࠊ௒ᅇࡢ⤖ᯝ࡛ࡣ”ᔒ”࠾ࡼࡧ”ⰼⅆ”ࡣ࠸ࡎࢀࡢ 㡯┠ࡢᙳ㡪ࡶཷࡅ࡚࠸࡞࠿ࡗࡓ㸦supplement 8㸧ࠋࡇࡢࡇ࡜࠿ࡽࠊ”ᔒ”࠾ࡼࡧ”ⰼⅆ”࡟ 㛵ࡋ࡚ࡣࢺ࣮ࣞࢽࣥࢢࢆ⾜࠺ࡇ࡜⮬య࡟ព࿡ࡀ࠶ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋᐇ㝿ࠊ”ᔒ”࠾ ࡼࡧ”ⰼⅆ”࡛୙Ᏻ⾜ືࢆ♧ࡋࡓ≟ࡣࠊࡑࢀࡒࢀ 11 㢌࠾ࡼࡧ 7 㢌࡜௚ࡢ≧ἣࡼࡾࡶᑡ࡞ ࠿ࡗࡓࠋࡇࡢⅬ࡟㛵ࡋ࡚ࡣࡼࡾヲ⣽࡟ㄪ࡭ࡿᚲせࡀ࠶ࡿࠋ ௒ᅇࡢㄪᰝ࡛ࡣ࢔ࣥࢣ࣮ࢺࢆ⾜࠺ࡇ࡜ࡀ࡛ࡁࡓࢺ࣮ࣞࢽࣥࢢᩍᐊࡀᑡ࡞ࡃࠊ༑ศ࡞౛ ᩘࡀ㞟ࡵࡽࢀ࡞࠿ࡗࡓࠋ௒ᚋࠊ౛ᩘࢆቑࡸࡋ࡚ࡉࡽ࡞ࡿㄪᰝࢆ⾜࠺ᚲせࡀ࠶ࡿࠋࡋ࠿ࡋࠊ ṇࡢᙉ໬࡟ࡼࡿࢺ࣮ࣞࢽࣥࢢ࡟ࡼࡾ≟࡜㣫࠸୺ࡢಙ㢗㛵ಀࡀ⠏ࡁࡸࡍ࠸࡜࠸࠺ඛ⾜◊ ✲ࡀ࠶ࡾ㸦35ࠊ46㸧ࠊ㐺ษ࡞ࢺ࣮ࣞࢽࣥࢢࢆ⾜࠺ࡇ࡜࡛≟࡜㣫࠸୺ࡢಙ㢗㛵ಀࡀᙉᅛ࡟ ࡞ࡾࠊၥ㢟⾜ືࢆ♧ࡋ࡟ࡃࡃ࡞ࡿࡇ࡜ࡀ♧၀ࡉࢀ࡚࠸ࡿࠋࡲࡓࠊࢺ࣮ࣞࢽࣥࢢࢆ⾜࠺ࡇ

(48)

44

࡜࡛ࢺ࣮ࣞࢽࣥࢢ๓ࡼࡾࡶࢫࢺࣞࢫࣞ࣋ࣝࡀపୗࡍࡿ࡜࠸࠺ඛ⾜◊✲ࡶ࠶ࡿ㸦43㸧ࠋṇ ࡢᙉ໬ࢆ୰ᚰ࡜ࡋࡓࢺ࣮ࣞࢽࣥࢢࡣၥ㢟⾜ືࡢண㜵࡜࠸࠺┠ⓗ௨እ࡟ࡶ✚ᴟⓗ࡟⾜࠺ ࡇ࡜ࡀ᥎ዡࡉࢀࡿࠋ

(49)

45 ⤖ㄒ ௒ᅇࡢ⤖ᯝ࠿ࡽࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟࠾࠸࡚㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡀ୙Ᏻ⾜ືࡢⓎ⌧࡟ ᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟㏻࠺㝿࡟ࡣࠊࡇࢀࡽ࡟Ẽࢆ㓄 ࡿࡇ࡜࡛ၥ㢟⾜ືࢆண㜵ࡍࡿຠᯝࢆࡼࡾ㧗ࡵࡽࢀࡿࡇ࡜ࡀᮇᚅ࡛ࡁࡿࠋ ୍᪉࡛ࠊ➨2 ❶࡛☜ㄆࡉࢀࡓ”ᔒ”࠾ࡼࡧ”ⰼⅆ”࡟㛵ࡋ࡚ࡣ࠸ࡎࢀࡢ㡯┠࡜ࡶ᭷ព࡞㛵㐃ࡣぢࡽࢀ࡞࠿ࡗࡓࠋࡇࢀࡽ࡟㛵ࡋ࡚ࡣࢺ࣮ࣞࢽࣥࢢ࡟ཧຍࡍࡿࡇ࡜⮬య࡟ண㜵ຠᯝࡀ ࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡿࠋࡶࡋࡑ࠺࡛࠶ࢀࡤࠊ㢖ᗘࡸᅇᩘ࡟㛵ࢃࡽࡎ᭱ప㝈ࡢࢺ࣮ࣞࢽࣥ ࢢࢆ⾜࠺ࡇ࡜࡛ࡶၥ㢟⾜ືࡢண㜵࡟ࡘ࡞ࡆࡽࢀࡿྍ⬟ᛶࡀ࠶ࡿࠋ ௒ᚋࡣࠊ࢜࣌ࣛࣥࢺ᮲௳௜ࡅࡢṇࡢᙉ໬௨እ࡟ࡘ࠸࡚ࡶ୙Ᏻ⾜ືࡢⓎ⌧࡟ᑐࡍࡿᙳ㡪 ࢆㄪᰝࡋࠊṇࡢᙉ໬࡜ࡢẚ㍑ࢆ⾜࠺ࡇ࡜ࡶᚲせ࡜࡞ࡿ࠿ࡶࡋࢀ࡞࠸ࠋ

(50)

46 ⤖ㄽ ᮏ◊✲ࡢ⤖ᯝ࠿ࡽࠊ᪥ᮏ࡟࠾ࡅࡿ୙Ᏻ⾜ືࢆ♧ࡋࡸࡍ࠸≟ࡢ๭ྜࡸ≟ࡢ⾜ື࡟ࡼࡾᅔ ࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋࡇࢀࡽࡣࠊ୙Ᏻ㞀ᐖࡢ⣲ᅉࢆᣢࡘ≟ࡢ๭ྜ࡟ 㛵ࡍࡿึࡢࢹ࣮ࢱ࡛࠶ࡿࠋࡲࡓࠊ≟ࡢ⾜ື࡟ࡘ࠸࡚┦ㄯࡋࡓࡇ࡜ࡀ࠶ࡿࠊࡶࡋࡃࡣ┦ㄯ ࡋࡓ࠸࡜⪃࠼࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡶุ᫂ࡋࡓࠋࡋ࠿ࡋࠊၥ㢟⾜ືࡢデ⒪ࢆ⾜ࡗ࡚࠸ࡿ⋇ ་ᖌࡢㄆ▱ᗘࡣ 20%⛬ᗘ࡜Ỵࡋ࡚㧗ࡃࡣ࡞࠿ࡗࡓࠋࡑࢀ࡟ࡶ㛵ࢃࡽࡎࠊᚲせࡀ࠶ࢀࡤ ࡑࡢࡼ࠺࡞⋇་ᖌ࡟┦ㄯࡋࡓ࠸࡜ᛮࡗ࡚࠸ࡿ㣫࠸୺ࡢ๭ྜࡣ 50%⛬ᗘ࡜ࠊㄆ▱ᗘ࡟ẚ ㍑ࡋ࡚࠿࡞ࡾ㧗࠸๭ྜ࡛࠶ࡗࡓࠋࡇࢀࡽࡢ⤖ᯝࡣࠊ⾜ືデ⒪ࢆ⾜࠺ࡇ࡜ࡀ࡛ࡁࡿ⋇་ᖌ ࡣ࠶ࡲࡾ▱ࡽࢀ࡚࠸࡞࠸࡟ࡶ㛵ࢃࡽࡎࠊࡑࡢࡼ࠺࡞⋇་ᖌࢆồࡵ࡚࠸ࡿ㣫࠸୺ࡀከࡃᏑ ᅾࡍࡿࡇ࡜ࢆ♧ࡋ࡚࠾ࡾࠊ௒ᚋ᪥ᮏ࡟࠾࠸࡚ࡶၥ㢟⾜ືࢆᢅ࠺ࡇ࡜ࡢ࡛ࡁࡿ⋇་ᖌࡢ㟂せࡀቑ࠼ࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿࠋࡇࢀࡽࢆ㋃ࡲ࠼ࡿ࡜ࠊ௒ᚋࡣ⾜ືᏛࡢ㔜せᛶࡀ㧗ࡲࡾࠊ デ⒪ࢆ⾜࠺⋇་ᖌ࡟࡜ࡗ࡚⾜ືᏛⓗ࡞▱㆑ࡀᚲせ࡜࡞ࡗ࡚࠸ࡃࡇ࡜ࡀண᝿ࡉࢀࡿࠋ⾜ື Ꮫⓗ࡞▱㆑ࢆᬑཬࡍࡿࡇ࡜ࡣ௒ᚋࡢㄢ㢟࡜࡞ࡗ࡚࠸ࡃ࡛࠶ࢁ࠺ࠋ ࡲࡓࠊ≟ࡢ୙Ᏻ⾜ືࡢⓎ⌧࡟ᖺ㱋ࡀᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡾࠊᖺ㱋ࡀୖࡀࡿ ࡯࡝㞾ࡸⰼⅆ࡟ᑐࡋ࡚୙Ᏻ⾜ືࢆ♧ࡋࡸࡍ࠿ࡗࡓࠋࡇࢀࡣࠊᖺ㱋ࡀୖࡀࡿ࡯࡝㞾ࡸⰼⅆ ࢆᜍᛧ࡜ࡋ࡚⤒㦂ࡍࡿᶵ఍ࡀቑ࠼ࡿࡓࡵ࡜⪃࠼ࡽࢀࡿࠋ≟ࡢ⤒㦂ⓗ࡞せᅉࡀ୙Ᏻ⾜ືࡢ Ⓨ⌧࡟㛵୚ࡋ࡚࠸ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ ຍ࠼࡚ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍࡀ୙Ᏻ⾜ືࡢⓎ⌧ࡢண㜵࡟ᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ᫂

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47 ࡽ࠿࡟࡞ࡗࡓࠋࢺ࣮ࣞࢽࣥࢢᩍᐊ࡟ཧຍࡋ࡚࠸ࡓ≟ࡣ㞾࠾ࡼࡧⰼⅆ࡟ᑐࡋ࡚୙Ᏻ⾜ືࢆ ♧ࡋ࡟ࡃ࠿ࡗࡓࠋ᪥㡭࠿ࡽࢺ࣮ࣞࢽࣥࢢࢆ⾜ࡗ࡚࠸ࡓࡇ࡜࡛ࠊࡑࡶࡑࡶࡢࢫࢺࣞࢫࣞ࣋ ࣝࡀపࡃ୙Ᏻ⾜ືࢆ♧ࡋ࡟ࡃ࠿ࡗࡓྍ⬟ᛶࡀ⪃࠼ࡽࢀࡿࠋ ࡉࡽ࡟ࠊࢺ࣮ࣞࢽࣥࢢᩍᐊ࡬ࡢཧຍ࡟࠾࠸࡚ࠊ㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡀ୙Ᏻ⾜ືࡢⓎ⌧ ࡟ᙳ㡪ࡋ࡚࠸ࡿࡇ࡜ࡀ᫂ࡽ࠿࡟࡞ࡗࡓࠋ㏻࠸ጞࡵࡓ᫬ࡢᖺ㱋ࡀప࠸≟ࡢ᪉ࡀ㣫࠸୺࡜㞳 ࢀࡓ᫬࡟୙Ᏻ⾜ືࢆ♧ࡋ࡟ࡃࡃࠊᛧࡀࡾ࡞ᛶ᱁࡟࡞ࡾ࡟ࡃ࠿ࡗࡓࠋ♫఍໬ᮇࡸ㟷ᖺᮇ࡟ ࢺ࣮ࣞࢽࣥࢢࢆ㛤ጞࡍࡿࡇ࡜ࡀ୙Ᏻ⾜ືࡢண㜵࡟㔜せ࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ ௒ᅇࡢ◊✲࡛ࡣࠊணഛㄪᰝࡢẁ㝵࡛㣫࠸୺ഃࡢせᅉࢆ㞟ࡵࡿࡇ࡜ࡀ㞴ࡋ࠸࡜ุ᩿ࡉࢀ ࡓࡓࡵࠊ≟࡟㛵ࡍࡿせᅉ࡟ࡢࡳ╔┠ࡋࠊ㣫࠸୺ഃࡢせᅉ࡟㛵ࡋ࡚ࡣㄪᰝ࠾ࡼࡧไ㝈ࡣࡋ ࡞࠿ࡗࡓࠋㄪᰝᆅᇦࢆ㒔ᕷ㒊࡟㝈ᐃࡋࡓࡾࠊ➨2 ❶࡟࠾࠸࡚Ꮚ౪࡜ࡢྠᒃࡢ⤒㦂ࢆᑜࡡ ࡓࡢࡳ࡛࠶ࡿࠋࡔࡀࠊ㣫࠸୺ࡢᛶูࡸᐙ᪘ᵓᡂࡀ≟ࡢ⾜ື࡟ᙳ㡪ࢆ୚࠼࡚࠸ࡿྍ⬟ᛶࡣ ྰᐃ࡛ࡁ࡞࠸ࡓࡵࠊ௒ᚋࡢㄪᰝ࡛ࡣ㣫࠸୺ഃࡢせᅉ࡟ࡘ࠸࡚ࡶㄪ࡭ࡿᚲせࡣ࠶ࡿ࠿ࡶࡋ ࢀ࡞࠸ࠋ ࡲࡓࠊ௒ᅇࡢㄪᰝ࡛ࡣ୙Ᏻ⾜ືࡢලయⓗ࡞ෆᐜࡸᛧࡀࡾ࡛࠶ࡿࡇ࡜ࡢලయⓗ࡞ᐃ⩏ࢆ ࡏࡎࠊ࡝ࡢࡼ࠺࡞≧ែࡀᛧࡀࡾ࡛࠶ࡿ࠿࠾ࡼࡧ୙Ᏻ⾜ື࡛࠶ࡿ࠿ࢆ㣫࠸୺࡟ุ᩿ࡋ࡚ࡶ ࡽࡗࡓࠋࡑࢀ࡟ࡼࡾ㣫࠸୺ࡢᅇ⟅࡟ᕪࡀ⏕ࡌࡓྍ⬟ᛶࡣྰᐃ࡛ࡁ࡞࠸ࠋࡋ࠿ࡋࠊෑ㢌࡟ ࡶ㏙࡭ࡓࡼ࠺࡟ࠊၥ㢟⾜ືࡣࠕே㛫♫఍࡜༠ㄪ࡛ࡁ࡞࠸⾜ືࠖࡶࡋࡃࡣࠕே㛫ࡀၥ㢟࡜ ឤࡌࡿ⾜ື࡛ࠖ࠶ࡾ㸦31㸧ࠊྠᵝࡢ⾜ືࡀぢࡽࢀࡓ࡜ࡋ࡚ࡶࡑࢀࡀၥ㢟⾜ື࡜ࡉࢀࡿ࠿

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48 ྰ࠿ࡣ㣫࠸୺ࡢุ᩿࡟ࡼࡾ␗࡞ࡿࠋࡑࡢࡓࡵࠊၥ㢟⾜ືࡢᐇ≧ࢆ⌮ゎࡍࡿ࠺࠼࡛ࡣ௒ᅇ ࡢ᪉ἲࡀඃࢀࡓ᪉ἲ࡛࠶ࡿ࡜ุ᩿ࡋࡓࠋ ᮏ◊✲ࡣ᪥ᮏ࡟࠾ࡅࡿၥ㢟⾜ືࡢᐇែ࠾ࡼࡧⓎ⌧࡟ᙳ㡪ࡋ࡚࠸ࡿせᅉࢆㄪᰝࡋࡓึ ࡢ◊✲࡛࠶ࡿࠋᮏ◊✲ࡀၥ㢟⾜ື࡟ᝎࡴ㣫࠸୺ࢆᩆ࠺ࡓࡵࡢ᭱ึࡢ୍Ṍ࡟࡞ࡿࡇ࡜ࢆᮇ ᚅࡍࡿࠋࡲࡓࠊၥ㢟⾜ື࡟ࡼࡿ୙Ᏻ࡟ⱞࡋࡴ≟ࢆᩆ࠺ࡓࡵࡢ୍ຓ࡟࡞ࡿࡇ࡜ࡶᮇᚅࡍࡿࠋ ࡋ࠿ࡋࠊ≟ࡢၥ㢟⾜ືࡣࡲࡔⓎᒎ㏵ୖࡢศ㔝࡛࠶ࡿࠋࡼࡾ⌮ゎࢆ㐍ࡵࡿࡓࡵ࡟ࡶࡉࡽ࡞ ࡿ◊✲ࡀᚲせ࡛࠶ࡿࠋ

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49 ㅰ㎡ ᮏ◊✲ࢆ⾜࠺࡟࠶ࡓࡾࠊ⤊ጞ᠓⠜࡞ࡿࡈᣦᑟࠊࡈ㠴᧡ࢆ㈷ࡾࡲࡋࡓᮾி㎰ᕤ኱Ꮫ బ ⸨ಇᖾ෸ᩍᤵࠊΏ㎶ඖᩍᤵࠊᒱ㜧኱Ꮫ ᚿỈὈṊᩍᤵࠊᖏᗈ␆⏘኱Ꮫ ᑠᕝᬕᏊᩍᤵ࡞ ࡽࡧ࡟ᒾᡭ኱Ꮫ బ⸨ࢀ࠼Ꮚᩍᤵ࡟῝⏒࡞ࡿㅰពࢆ⾲ࡋࡲࡍࠋࡲࡓࠊ࢔ࣥࢣ࣮ࢺㄪᰝࡢ ሙࢆᥦ౪ࡋ࡚ࡃࡔࡉࡾࡲࡋࡓ࢖࢜ࣥ࣌ࢵࢺᰴᘧ఍♫ᵝࠊබ┈㈈ᅋἲேᮾி㒔බᅬ༠఍ࡢ ⓙᵝࠊᅜ❧ᕷᙺᡤ࣭᪂ᐟ༊ᙺᡤ࣭ ༊ᙺᡤ࣭ᮡ୪༊ᙺᡤࡢⓙᵝࠊ᪂ᶓ὾බᅬࢻࢵࢢࣛࣥ ࡢࢫࢱࢵࣇࡢⓙᵝࠊධ⯪බᅬ⟶⌮஦ົᡤࡢⓙᵝࠊࢣ࣮ࢼ࢖ࣥ࢔࣑ࣥࣜࢸࢵࢻᵝࠊSUNNY

Dog Training Partner ᵝࠊDOG IN TOTAL ᵝࠊࡶࡩ ONE ᵝࠊ࢔ࣥࢣ࣮ࢺ཰㞟࡟ࡈ༠ ຊ࠸ࡓࡔࡁࡲࡋࡓᮾி㎰ᕤ኱Ꮫ㎰Ꮫ㒊ඹྠ⋇་Ꮫ⛉ື≀⾜ືᏛ◊✲ᐊࡢⓙᵝࠊከࡃࡢ࢔ ࢻࣂ࢖ࢫࢆ㡬ࡁࡲࡋࡓධ஺┾ᕭඛ⏕࡟ཌࡃᚚ♩⏦ࡋୖࡆࡲࡍࠋ

࡞࠾ࠊᮏ◊✲ࡢ୍㒊ࡣබ┈♫ᅋἲே᪥ᮏឡ⋵ື≀ᩍ఍ࡢㄪᰝ◊✲ຓᡂࢆཷࡅ࡚⾜ࢃࢀ ࡲࡋࡓࠋ㛵ಀ⪅ྛ఩࡟ᚰࡼࡾᚚ♩⏦ࡋୖࡆࡲࡍࠋ

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50 ཧ⪃ᩥ⊩

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