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Vascular wall components in thrombi obtained by acute stroke thrombectomy: clinical significance and related factors

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Title

Vascular wall components in thrombi obtained by acute stroke

thrombectomy: clinical significance and related factors( 内容と

審査の要旨(Summary) )

Author(s)

船津, 奈保子

Report No.(Doctoral

Degree)

博士(医学) 甲第1101号

Issue Date

2019-03-25

Type

博士論文

Version

ETD

URL

http://hdl.handle.net/20.500.12099/77928

※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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 Ặྡ㸦ᮏ⡠㸧  Ꮫ ఩ ࡢ ✀ 㢮  Ꮫ఩ᤵ୚␒ྕ  Ꮫ఩ᤵ୚᪥௜  Ꮫ఩ᤵ୚せ௳  Ꮫ఩ㄽᩥ㢟┠  ᑂ ᰝ ጤ ဨ ⯪ ὠ ዉ ಖ Ꮚ㸦ᒱ㜧┴㸧 ༤ ኈ㸦་Ꮫ㸧 ⏥➨1101 ྕ ᖹᡂ31 ᖺ 3 ᭶ 25 ᪥ Ꮫ఩つ๎➨㸲᮲➨㸯㡯ヱᙜ

9DVFXODU ZDOO FRPSRQHQWV LQ WKURPEL REWDLQHG E\ DFXWH VWURNH WKURPEHFWRP\FOLQLFDOVLJQLILFDQFHDQGUHODWHGIDFWRUV 㸦୺ᰝ㸧ᩍᤵ ᑠ಴ ┿἞ 㸦๪ᰝ㸧ᩍᤵ ୗ⏿ ாⰋ  ᩍᤵ ᒣཱྀ ▐ ㄽ ᩥ ෆ ᐜ ࡢ せ ᪨    ࠙⫼ᬒ࡜┠ⓗࠚ  ᛴᛶᮇ⬻୺ᖿື⬦㛢ሰᝈ⪅࡟ᑐࡍࡿࢫࢸࣥࢺᆺ࠾ࡼࡧ྾ᘬᆺ⾑ᰦᅇ཰ࢹࣂ࢖ࢫࢆ⏝࠸ࡓ⤒⓶ⓗ⾑ ᰦᅇ཰⒪ἲࡢ᭷ຠᛶ࡜Ᏻ඲ᛶࡣ☜❧ࡉࢀࡓࡀ㸪᫬࡟ᶵᲔⓗ่⃭࡟ࡼࡿ⾑⟶യᐖࢆ⏕ࡌࡿࠋᅇ཰ࡉࢀࡓ ᳨య࡟ࡣ⾑ᰦ࡜ඹ࡟⭺ཎ⥺⥔ࡀྵࡲࢀࡿࡇ࡜ࡀ࠶ࡾ㸪ᡃࠎࡣࡑࢀࡽࡀ⬻⾑⟶ቨࡢ୍㒊࡛㸪⾑ᰦᅇ཰⒪ ἲ࡟ࡼࡿ⾑⟶യᐖࡢ࣐࣮࣮࢝࡜࡞ࡿࡢ࡛ࡣ࡞࠸࠿࡜⪃࠼ࡓࠋࡑࡇ࡛㸪⾑ᰦᅇ཰⒪ἲ࡟ࡼࡾᚓࡽࢀࡓ᳨ య୰࡟⾑⟶ቨᡂศࡀᏑᅾࡍࡿ㢖ᗘ㸪㛵㐃ᅉᏊࢆ᫂ࡽ࠿࡟ࡍ࡭ࡃ㸪ᮏ◊✲ࢆ⾜ࡗࡓࠋ ࠙ᑐ㇟࡜᪉ἲࠚ  ᑐ㇟ࡣ㸪 ᖺ  ᭶࠿ࡽ  ᖺ  ᭶ࡢ㛫࡟ᅜ❧ᚠ⎔ჾ⑓◊✲ࢭࣥࢱ࣮࡛⾑ᰦᅇ཰⒪ἲࢆ⾜ࡗࡓ ᛴᛶᮇ⬻୺ᖿື⬦㛢ሰ㐃⥆  ౛୰㸪ࢫࢸࣥࢺᆺࡶࡋࡃࡣ྾ᘬᆺ⾑ᰦᅇ཰ࢹࣂ࢖ࢫࢆ౑⏝ࡋ㸪ᅇ཰᳨ యࢆ⑓⌮Ꮫⓗ࡟ホ౯ࡋࡓ⑕౛ࠋ  ᅇ཰ࡉࢀࡓ᳨య࡟ࡘ࠸࡚㸪+HPDWR[\OLQHRVLQ ᰁⰍ㸪㻹㼍㼟㼟㼛㼚䇻㼟WULFKURPH ᰁⰍࢆ⾜ࡗ࡚⾑ᰦࡢ㉥⾑ ⌫ᡂศ࡜ࣇ࢕ࣈࣜࣥ㸭⾑ᑠᯈᡂศࡢẚ⋡㸪⾑⟶ቨᡂศࡢ᭷↓ࢆゎᯒࡋࡓࠋ」ᩘᅇࡢᅇ཰ᡭᢏ㸪」ᩘࡢ ⾑ᰦᅇ཰ࢹࣂ࢖ࢫࢆ⏝࠸ࡓሙྜ࡟ࡣ㸪᳨యࡀᅇ཰ࡉࢀࡿࡓࡧ࡟ࡑࡢ㒔ᗘูࡢ᳨య࡜ࡋ࡚⑓⌮Ꮫⓗホ౯ ࢆ⾜ࡗࡓࠋ᱁Ꮚධࡾ᥋║ࣞࣥࢬࢆ⏝࠸㸪ගᏛ㢧ᚤ㙾  ಸ࡛⾑ᰦࡢ኱ࡁࡉ࡟ᛂࡌ࡚ 㹼 ど㔝ࢆほᐹ ࡋ㸪㉥⾑⌫ᡂศ࡜ࣇ࢕ࣈࣜࣥ㸭⾑ᑠᯈᡂศࡢẚ⋡ࡢᖹᆒ್ࢆ⟬ฟࡋࡓࠋ୺࡟⾑ᰦ㎶⦕㒊࡟ㄆࡵࡽࢀࡓ ቃ⏺᫂░࡞ࡦࡶ≧⭺ཎ⥺⥔࡛㸪ჾ㉁໬⾑ᰦ࡛ࡣ࡞࠸ࡶࡢࢆ⾑⟶ቨᡂศ࡜ᐃ⩏ࡋࡓࠋ  ᅇ཰᳨య୰࡟⾑⟶ቨᡂศࢆྵࢇࡔ⩌࡜㸪ྵࡲ࡞࠿ࡗࡓ⩌ࡢ  ⩌㛫࡛ᝈ⪅⫼ᬒ㸪἞⒪ᡭᢏ㸪⾑ᰦᛶ≧㸪 ⮫ᗋ㌿ᖐࢆẚ㍑ࡋࡓࠋ ࠙⤖ᯝࠚ   ౛㸦ᖹᆒᖺ㱋 s ṓ㸪ዪᛶ  ౛㸧࠿ࡽᅇ཰ࡉࢀࡓ  ᳨య㸦྾ᘬᆺ  ᳨య㸪ࢫࢸࣥࢺ ᆺ  ᳨య㸧ࡀゎᯒࡢᑐ㇟࡜࡞ࡗࡓࠋ⏝࠸ࡽࢀࡓ⾑ᰦᅇ཰ࢹࣂ࢖ࢫࡣ㸪྾ᘬᆺ  ౛㸪ࢫࢸࣥࢺᆺ  ౛㸪୧⪅ࡢే⏝  ౛࡛࠶ࡗࡓࠋᑐ㇟ᮇ㛫ࡢ኱㒊ศ࡟࠾࠸࡚㸪἞⒪ࡢ➨୍㑅ᢥࡣ྾ᘬᆺࢹࣂ࢖ࢫ࡛࠶ ࡗࡓࠋ  ⾑⟶ቨᡂศࡣ  ౛㸦㸧࠿ࡽᅇ཰ࡉࢀࡓ  ᳨య㸦㸧࡟ㄆࡵࡽࢀࡓࠋࡑࡢ࠺ࡕ  ᳨య࡛ࡣෆ ᙎᛶᯈࡀ☜ㄆࡉࢀ㸪⾑⟶യᐖࡀ୰⭷࡟ཬࢇࡔࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ⾑⟶ቨᡂศࢆྵࢇࡔ⑕౛࡜ྵࡲ࡞࠿ ࡗࡓ⑕౛࡛ࡣ㸪ᝈ⪅⫼ᬒ࡟᭷ពᕪࡣㄆࡵࡎ㸪⾡ᚋࡢࢡࣔ⭷ୗฟ⾑ࡢ㢖ᗘ࡟ᕪࡣ࡞࠿ࡗࡓࠋ⾑⟶ቨᡂศ ࢆྵࢇࡔ⑕౛࡛ࡣ᭷ຠ෌㛤㏻⋡ࡀప࠸ഴྥ࡟࠶ࡗࡓ㸦YV3 㸧ࠋ  ⾑⟶ቨᡂศࢆྵࢇࡔ᳨య࡛ࡣ㸪ྵࡲ࡞࠿ࡗࡓ᳨య࡟ẚ࡭㉥⾑⌫ᡂศࡢẚ⋡ࡀపࡃ㸦sYV s3 㸧㸪㐲఩㒊࡛ࡢᅇ཰ᡭᢏࡢ๭ྜࡀ㧗࠿ࡗࡓ㸦YV3 㸧ࠋᅇ཰ᡭᢏᅇ ᩘࡀከ࠸࡯࡝㸪⾑⟶ቨᡂศ㝧ᛶ⋡ࡀ㧗࠿ࡗࡓ㸦S IRU WUHQG 㸧ࠋࢹࣂ࢖ࢫࡢ✀㢮࡟ࡼࡾ⾑⟶ቨᡂ

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ศΰධࡢ㢖ᗘ࡟ᕪࡣ࡞࠿ࡗࡓࡀ㸪ࢫࢸࣥࢺᆺࢹࣂ࢖ࢫ࡟ࡼࡾᅇ཰ࡉࢀࡓ⾑⟶ቨᡂศࡣ㸪྾ᘬᆺ࡟ẚ࡭ ࡚ཌࡳ  ̽ ȣP YV  ̽ ȣP 3  㸪㠃✚㸦 ̽ ȣP YV ̽ ȣP3 㸧࡜ࡶ࡟኱ࡁ࠸ഴྥ࡟࠶ࡗࡓࠋ ࠙⪃ᐹࠚ  ࢫࢸࣥࢺᆺ࠾ࡼࡧ྾ᘬᆺ⾑ᰦᅇ཰ࢹࣂ࢖ࢫࢆ⏝࠸ࡓ⾑ᰦᅇ཰⒪ἲࡢ᭷ຠᛶ࡜Ᏻ඲ᛶࡣ☜❧ࡉࢀࡓ ࡀ㸪᫬࡟ࢡࣔ⭷ୗฟ⾑㸪⾑⟶ᨥ⦰㸪ື⬦✸Ꮝ㸪ື⬦ゎ㞳࡞࡝ᶵᲔⓗ่⃭࡟ࡼࡿ⾑⟶യᐖࢆ⏕ࡌࡿࡇ࡜ ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋື≀⾑⟶࡛ࡢ◊✲࡛ࡣ㸪ෆ⓶⬺ⴠ㸪୰⭷ᾋ⭘㸪ቨᅾ⾑ᰦ࡞࡝ࡢ⾑⟶യᐖࡀሗ࿌ࡉ ࢀ࡚࠸ࡿࡀ㸪ᮏ◊✲࡛ࡣᅇ཰᳨యࢆ⑓⌮Ꮫⓗ࡟᳨⣴ࡍࡿࡇ࡜࡛㸪ே㛫ࡢ⬻⾑⟶࡛ࡣ୰⭷࡟ཬࡪ⾑⟶യ ᐖࢆ⏕ࡌ࡚࠸ࡿࡇ࡜ࢆሗ࿌ࡋࡓࠋ⬻ື⬦ࡢ⬤ᙅ࡞ᵓ㐀ࡸ㸪࢔ࢪ࢔ே࡟ከ࠸࡜ࡉࢀࡿ㢌⵹ෆື⬦◳໬࡟ ࡼࡿ⾑⟶⊃✽㸪⺬⾜ࡢᙳ㡪࡛㸪ື≀ᐇ㦂࡛ࡢሗ࿌ࡼࡾࡶ῝࠸⾑⟶യᐖࢆ᮶ࡋ࡚࠸ࡿࡶࡢ࡜⪃࠼ࡽࢀࡓࠋ  ᮏ◊✲࡛ࡣ㸪㉥⾑⌫ᡂศࡢᑡ࡞࠸⾑ᰦ㸪⾑ᰦᅇ཰ࢹࣂ࢖ࢫࡢ㏻㐣ᅇᩘࡀከ࠸ࡇ࡜㸪ᮎᲈ⾑⟶࡛ࡢࢹ ࣂ࢖ࢫ౑⏝ࡀ⾑⟶ቨᡂศࡢΰධ࡟㛵㐃ࡋࡓࠋᡃࠎࡣ௨๓㸪㉥⾑⌫ᡂศ࡟ᐩࢇࡔ⾑ᰦࡣ⾑ᰦᅇ཰࡟ࡼࡾ ᭷ຠ෌㛤㏻ࡀᚓࡽࢀࡸࡍ࠸ࡇ࡜ࢆሗ࿌ࡋ࡚࠾ࡾ㸪ᅇ཰ࡉࢀ࡟ࡃ࠸㉥⾑⌫ᡂศࡢᑡ࡞࠸⾑ᰦ࡟ࡼࡿ㐲఩ ሰᰦ࡟ᑐࡍࡿ㢖ᅇࡢᅇ཰ᡭᢏ࡛ࡣ㸪⾑⟶യᐖ࡟ࡘ࡞ࡀࡾࡸࡍ࠸࡜⪃࠼ࡽࢀࡓࠋ  ྾ᘬᆺ࡜ࢫࢸࣥࢺᆺࢹࣂ࢖ࢫ࡛ࡣ㸪ࢹࢨ࢖ࣥࡸ⾑ᰦᅇ཰ᶵᗎࡀ␗࡞ࡿࡓࡵ㸪ᘬࡁ㉳ࡇࡉࢀࡿ⾑⟶യ ᐖࡢࣃࢱ࣮ࣥࡶ␗࡞ࡿࡇ࡜ࡀື≀ᐇ㦂࡛ሗ࿌ࡉࢀ࡚࠸ࡿࠋᮏ◊✲࡛ࡶ⤫ィᏛⓗ᭷ពᕪࡣ࡞࠿ࡗࡓࡀ㸪 ࢹࣂ࢖ࢫࡢ✀㢮࡟ࡼࡾΰࡌࡿ⾑⟶ቨᡂศࡢ኱ࡁࡉ࡟㐪࠸ࡀࡳࡽࢀࡓࠋࡋ࠿ࡋᮏ◊✲࡛ࡣ㸪ከࡃࡢሙྜ ࡛྾ᘬᆺࢹࣂ࢖ࢫࡀ➨୍㑅ᢥ࡜ࡋ࡚౑⏝ࡉࢀ㸪ࢫࢸࣥࢺᆺࢹࣂ࢖ࢫࡣᩆ῭⒪ἲ࡜ࡋ࡚౑⏝ࡉࢀࡓ⑕౛ ࡀከ࠿ࡗࡓࡓࡵ㸪ࣂ࢖࢔ࢫࢆ⪃៖ࡍࡿᚲせࡀ࠶ࡿࠋ ࠙⤖ㄽࠚ  ௒ᅇࡢ⾑ᰦᅇ཰⒪ἲ࡟ࡼࡾᅇ཰ࡉࢀࡓ᳨యࡢ᳨ウ࡛ࡣ㸪྾ᘬᆺ࠾ࡼࡧࢫࢸࣥࢺᆺࢹࣂ࢖ࢫ࡜ࡶ࡟㸪 ⾑⟶യᐖࢆᘬࡁ㉳ࡇࡍࡇ࡜ࡀ♧ࡉࢀࡓࠋ⾑ᰦࡢ㉥⾑⌫ᡂศẚ⋡㸪㐲఩㒊࡛ࡢࢹࣂ࢖ࢫ౑⏝㸪ࢹࣂ࢖ࢫ ࡢ㏻㐣ᅇᩘࡀ⾑⟶ቨᡂศࡢᅇ཰࡟㛵㐃ࡋࡓࠋ ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ⏦ㄳ⪅ ⯪ὠዉಖᏊࡣᛴᛶᮇ⬻୺ᖿື⬦㛢ሰᝈ⪅࡟ᑐࡍࡿࢫࢸࣥࢺᆺ࠾ࡼࡧ྾ᘬᆺ⾑ᰦᅇ཰ࢹࣂ ࢖ࢫࢆ⏝࠸ࡓ⤒⓶ⓗ⾑ᰦᅇ཰⒪ἲ࡟ࡼࡾᅇ཰ࡉࢀࡓ᳨య࡟⾑ᰦ࡜ඹ࡟ྵࡲࢀࡿ⭺ཎ⥺⥔ࡀ⬻⾑⟶ቨ ࡢ୍㒊࡛࠶ࡾ㸪ྠ⒪ἲ࡟ࡼࡿ⾑⟶യᐖࡢ࣐࣮࣮࢝࡜࡞ࡿ࡜᝿ᐃࡋࡓࠋ⤖ᯝ㸪୧ࢹࣂ࢖ࢫ࡜ࡶ࡟㸪᳨య ࠿ࡽ⭺ཎ⥺⥔ࡀ᳨ฟࡉࢀ㸪⾑⟶യᐖࢆᘬࡁ㉳ࡇࡍࡇ࡜ࡀ♧ࡉࢀࡓࠋࡲࡓ⾑ᰦࡢ㉥⾑⌫ᡂศẚ⋡㸪㐲఩ 㒊࡛ࡢࢹࣂ࢖ࢫ౑⏝㸪ࢹࣂ࢖ࢫࡢ㏻㐣ᅇᩘ➼ࡀ⾑⟶࡬ࡢ㞀ᐖ࡟ࡘ࡞ࡀࡿࡇ࡜ࢆࡶ♧ࡋࡓࠋ ᮏ◊✲ࡢᡂᯝࡣ⤒⓶ⓗ⾑ᰦᅇ཰⒪ἲࡢࡉࡽ࡟Ᏻ඲࡞᪋⾜࡟ᑐࡍࡿ♧၀ࢆ୚࠼㸪⬻༞୰἞⒪ࡢ㐍Ṍ࡟ ᑡ࡞࠿ࡽࡎᐤ୚ࡍࡿࡶࡢ࡜ㄆࡵࡿࠋ 㹙୺ㄽᩥබ⾲ㄅ㹛 1DRNR )XQDWVX 0LNLWR +D\DNDZD 7HWVX\D +DVKLPRWR +LURVKL <DPDJDPL 7HWVX 6DWRZ -XQ & 7DNDKDVKL0DVDWRVKL.RJD.D]X\XNL1DJDWVXND+DWVXH,VKLEDVKL8HGD7RUX,ZDPD.D]XQRUL 7R\RGD9DVFXODUZDOOFRPSRQHQWVLQWKURPELREWDLQHGE\DFXWHVWURNHWKURPEHFWRP\FOLQLFDO VLJQLILFDQFHDQGUHODWHGIDFWRUV

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