Publishing type：Research paper (scientific journal)  

DOI： 10.3390/sports11100202

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/ncp.10968

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/ncp.10957

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ggi.14586

Publishing type：Research paper (scientific journal)  

長期介護施設4施設に入居している経口摂取困難な高齢者199例を対象に後向きコホート研究を行った。24項目の食事時観察チェックリスト(MOCL)の各項目と誤嚥性肺炎(AP)発症との関連性を調べた。年齢中央値は87歳で、131例(65.8%)が女性であった。試験期間に24例がAPを発症した。参加者の特性を調整後、以下の6項目がAP発症と関連し、「座位維持困難」「食事中の睡眠」「食事開始困難、食事開始後の頻回な食事の中断、食事への集中困難」「食事に追加時間が必要なことによる疲労」「ドライマウス」「食事補助の必要性」であった。

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/nu15051175

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clnesp.2022.12.025

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41430-022-01168-5

Publishing type：Research paper (scientific journal)  

【背景】大腸癌の5年相対生存率は良好であるが、高齢患者では大腸癌治療後に別の急性疾患などにより入院する可能性がある。本研究では、大腸癌術後の高齢患者の再入院と栄養状態の関連を検討した。【方法】社会医療法人景岳会南大阪病院において、2012年1月から2016年7月にステージIIまたはIIIの大腸癌に対して切除術が施行された65歳以上の患者のうち、術後に再発や転移が無く2019年9月まで生存した患者74名を解析対象とした。大腸癌術後に何らかの疾患の治療目的で入院した25名を再入院群、それ以外の49名を療養群とした。臨床背景や血液生化学検査を群間で比較した。また、術後の小野寺らのprognostic nutritional index(PNI)で2群に分類し累積入院率を比較した。【結果】再入院群で術後3ヵ月のPNI、術後6ヵ月の総リンパ球数及びPNIが有意に低かった。累積入院率は、術後3ヵ月PNIが48.3未満または術後6ヵ月PNIが51.0未満の患者で有意に高かった。【結論】大腸癌術後の高齢の無再発生存者において、術後3ヵ月または術後6ヵ月のPNIと術後再入院の関連が示唆された。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clnesp.2022.09.016

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/nu14142990

Publishing type：Research paper (scientific journal)  

【目的】急性期病院の慢性心不全患者に対して、GLIM基準の予後予測因子としての有用性を高める栄養スクリーニング法を探索した。【対象および方法】GLIM基準による判定の最初に用いる栄養スクリーニング法にSGA、GNRI、CONUTを用いて生命予後をアウトカムとした多変量Cox比例ハザード解析を実施した。【結果】生命予後に対するハザード比は、スクリーニング法単独(SGA、GNRI、CONUT:Trend p=0.052、0.091、0.053)およびGLIM基準と組み合わせたSGAでは有意な傾向を示さなかったが(Trend p=0.055)、GNRI(Trend p=0.003)、CONUT(Trend p=0.005)において有意に上昇する傾向を認めた。【結論】GLIM基準を用いて栄養アセスメントを行う際、CONUTとGNRIが、GLIM基準の予後予測因子としての有用性を示すスクリーニング法であった。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1123/jpah.2021-0649

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.nutos.2022.01.005

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jpen.2118

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/nu14030428

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s13075-021-02478-y

Publishing type：Research paper (scientific journal)  

療養病床入院高齢者の褥瘡発生リスクに対し、いずれの栄養評価法が最も有用かについて、褥瘡発生予測スケールであるブレーデンスケールを用いて検討した。本研究は、横断研究である。2016年1月～3月に大阪府内のA病院療養病床に新規入院した患者のうち、入院時点で褥瘡未発生であり経口摂取可能な患者で、研究調査に対し病院長と本人もしくは家族の同意が得られた122名を対象とした。身体計測値、血清アルブミン値、基本的ADL、各種栄養評価指標(MNA-SF、GNRI、GLIM)、食事摂取量を調査し、褥瘡リスクに対して有用である栄養評価指標について多変量解析を実施した。解析の結果、MNA-SFリスク有3.42(0.64-18.22)、低栄養6.79(1.35-34.10)、GNRI中等度不良2.52(0.91-6.96)、高度不良2.14(0.72-6.31)、GLIM中等度不良1.96(0.49-7.85)、高度不良1.00(0.45-2.19)となった。療養病床における高齢患者の褥瘡発生に対して、GLIMやGNRIに比し、MNA-SFで低栄養であることが褥瘡リスクを評価するうえで、より優れていることが明らかとなった。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000517950

Publishing type：Research paper (scientific journal)  

<p><b>Objective:</b> This study was conducted to evaluate whether the patient's nutritional status on admission may influence a successful return to their pre-hospitalization medical environment.</p><p><b>Method:</b> This is a single-center cohort study. We enrolled patients aged 65 years or older, hospitalized between September 2014 and October 2015 in one community hospital in Oita. Among 307 patients, 28 were excluded because of death, terminal conditions, lack of essential data on admission, and prolonged hospitalization beyond the study period, thus finally 279 patients were analyzed. Nutritional status on admission was compared between two study groups, i.e. ​a return group who could return to their home or pre-hospitalization care facility, and a non-return group who could not return to their home or pre-hospitalization medical environment.</p><p><b>Results:</b> The return group comprises 192 patients and 87 patients in the non-return groups, respectively. Compared with the return group, participants in the non-return group revealed to be older, and had lower MNA-SF (Mini Nutritional Assessment Short-Form), Barthel Index, body mass index, calf circumference, and serum albumin levels. They also had more comorbidities, and the mean hospital stay was longer in the non-return group. Cox proportional hazard analysis was performed to disclose the factors which may influence patient's non-return, however, none of nine nutrition-related factors contributed to non-return to the pre-hospitalization medical environment.</p><p><b>Conclusion:</b> In this study, there was no significant difference in the nutritional status of individuals who failed to discharge to their pre-hospitalization medical environment.</p>

DOI： 10.5264/eiyogakuzashi.79.265

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clnu.2021.08.008

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clnu.2020.12.028

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.foodhyd.2020.105727

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/opn.12301

Publishing type：Research paper (scientific journal)  

<p><b>Purpose:</b> Not many emergency and critical centers have a registered dietitian (RD) in place in Japan, and the time to initiation of enteral nutrition is reportedly longer in Japan than overseas. We evaluated the clinical effects and medical costs of introducing early enteral nutrition through the placement of a registered dietitian (RD) in an emergency and critical care center.</p><p><b>Subjects and Methods:</b> Patients who were admitted to our emergency and critical care center and could not take oral nutrition for ≥ 5 days were enrolled in the study. To investigate the effect of intervention afforded by placing the RD, patients were divided into two groups and compared: those who were admitted before the RD was placed (NRD group; n = 17, April 1, 2016 to May 31, 2017) and those who were admitted after the placement (RD group; n=18 patients, June 1, 2017 to March 31).</p><p><b>Results:</b> The RD group had significantly shorter times to initiation of enteral nutrition and resumption of oral feeding, and significantly lower costs of parenteral infusion solution and antibiotics than the NRD group.</p><p><b>Conclusion:</b> Placing an RD in the emergency and critical care center was associated with early initiation of enteral nutrition and resumption of oral feeding and lower antibiotic and medical costs.</p>

DOI： 10.11244/ejspen.2.5_290

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/hepr.13388

Publishing type：Research paper (scientific journal)  

肝細胞癌(HCC)を伴わない肝硬変(LC)患者157例(男性74例、女性83例、平均67±11歳)を対象に、血清亜鉛濃度とHCC発症との関連を前向きに調べた。HCCの累積発症率はカプランマイヤー法およびログランク検定を用いて計算した。多変量Cox回帰分析を用いて、肝発癌の予測因子を調べた。その結果、3年間の観察期間中に30例(19.1%)がHCCを発症した。HCCを発症したC型肝炎ウイルス関連LC(C-LC)患者では、血清亜鉛濃度が有意に低下した(p=0.0180)。HCC発症の危険因子は、低亜鉛血症(p=0.0014)、高αフェトプロテイン(p=0.0080)、低分岐鎖アミノ酸対チロシン比(p=0.0128)、女性であること(p=0.0228)であった。肝発癌に関する多変量Cox回帰分析では、低亜鉛血症(ハザード比1.61,p=0.0324)のみが有意な予測因子であった。これらの結果から、低亜鉛血症がC-LC患者の肝発癌と関連することが示唆された。

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12877-019-1206-z

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/nu11061338

Publishing type：Research paper (scientific journal)  

DOI： 10.14740/jocmr3704

Publishing type：Research paper (scientific journal)  

DOI： 10.14740/jocmr3738

Publishing type：Research paper (scientific journal)  

居宅療養者のセルフマネジメント用に田中らが開発した栄養管理ツール(栄養手帳)を用いた栄養指導を、要介護認定を受けている51名へ、全国17ヶ所の病院や診療所で月2回、3ヵ月にわたり実施し、個々に設定した栄養改善方針が非達成の24名(男性12名、女性12名、年齢中央値78.0歳:非達成群)と達成した27名(男性9名、女性18名、年齢中央値83.0歳:達成群)の比較から、栄養手帳を用いた栄養管理が奏功しない対象者の特性を分析した。その結果、非達成群は達成群より平均年齢が有意に低く、男性の割合が約半数と多く、約8割が自立または要支援レベルで、自宅生活者が多かった。また、非達成群では糖尿病を有する者が約65%と、達成群に比べ多かった。

Publishing type：Research paper (scientific journal)  

Background &amp
aims: The Mediterranean diet is reportedly effective in suppressing disease activity in rheumatoid arthritis (RA), but the key elements responsible for this effect remain unknown. The presented study therefore aimed to identify such elements. Methods: This study included 208 consecutive patients with RA (RA group) and 205 age- and sex-matched healthy volunteers (controls) from the prospective “TOMORROW” cohort study that has been ongoing since 2010 were included in this study. Food and nutrient intake was assessed using the brief self-administered diet history questionnaire (BDHQ), Mediterranean diet scores were calculated based on intake by controls and disease activity was determined from disease activity scores in 28 joints and erythrocyte sedimentation rates (DAS28-ESR). Results: Intake of monounsaturated fatty acids (MUFA) was significantly lower in the RA, than in the control group (P = 0.003) and the ratio of consumed monounsaturated to saturated fatty acid (MUFA/SFA) significantly differed within the RA group after being sub-classified according to DAS28-ESR. Moreover, DAS28-ESR significantly correlated with MUFA/SFA intake after age adjustment (R = -0.228, P &lt
0.01). Logistic regression analysis selected high MUFA intake as an independent predictor of remission in the RA group with borderline boundary significance (odds ratio, 1.97
95% CI, 0.98–3.98
P = 0.057). Changes in DAS28-ESR between 2010 and 2011 significantly correlated with MUFA/SFA intake after age adjustment (R = 0.180, P = 0.01). Conclusions: Daily MUFA intake, a component of the Mediterranean diet score, might suppress disease activity in RA patients.

DOI： 10.1016/j.clnu.2017.02.011

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/hepr.13000

Publishing type：Research paper (scientific journal)  

慢性肝疾患患者の骨格筋量(SMI)減少に関連する臨床学的因子を明らかにするため、当院で肝切除術が予定された肝細胞癌患者118例を対象とする横断研究を行った。解析データが得られた112例のうち、SMI減少は30例(男性25例、女性5例、平均72±10歳)にみられ、対照群82例(男性60例、女性22例、平均68±11歳)と比較して体重、BMI、ビリルビン値が有意に低かった。また、骨粗鬆症診断基準に用いられるTスコアおよび最大酸素摂取量(PeakVO2)も低SMI群で有意に低く、ピアソンの積率相関係数を用いた評価では、これらの数値とSMIとの間に有意な正の相関がみられた。SMI減少に関連する因子を調べるためにロジスティック解析を行ったところ、単変量解析ではTスコアおよびPeakVO2がSMI減少と有意に関連していた。年齢および性別との関連はみられなかったが、年齢は骨密度や筋量の減少の主要因子として知られており、女性では骨粗鬆症の罹患率が高いため、これらの因子を調整係数として多変量解析を行ったところ、TスコアおよびPeakVO2はSMI減少の有意な独立因子であった。以上より、慢性肝疾患における骨格筋の減少は運動耐容性および骨粗鬆症と密接に関連しており、これらの因子は日常生活における運動不足と関連していることが示唆された。

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10388-017-0584-6

Publishing type：Research paper (scientific journal)  

食道切除患者を対象に、術後12ヵ月における体重回復に寄与する栄養状態の経時的変化について調べた。対象は食道切除を施行した食道癌患者80例とした。80例中、12ヵ月の追跡調査を完了した40例を解析対象とした。術前および術後1ヵ月、3ヵ月、6ヵ月、12ヵ月の臨床データ、身体計測データ、検査値、栄養状態について評価を実施した。食道癌患者の7.2%が罹患前の標準体重(UBW)と比較して術前期における体重減少を認めた。患者の9.3%が術前期から術後12ヵ月までに体重が減少した。術後期の体重増加は有意ではなかった。術後の栄養状態における経時的な変化には時間差が認められた。多変量解析の結果、UBWと比較して術前10%以上の体重減少は術後12ヵ月における85%以上の体重回復に否定的に寄与する独立因子であることが示された。以上から、食道切除施行患者における十分な栄養状態のためには、術前の体重減少を最小限に抑える必要があることが示された。

Publishing type：Research paper (scientific journal)  

Background: Although the anti-inflammatory effects of immunomodulating diets (IMDs) have recently attracted attention, the efficacy of enteral feeding of such diets after radical surgery remains controversial. Thus, we conducted a new prospective, randomized controlled study to elucidate any beneficial effect of an IMD containing eicosapentaenoic acid (EPA) and γ-linolenic acid (GLA) in patients undergoing radical esophagectomy for thoracic esophageal cancer. Methods: From November 2009 to July 2011, 87 consecutive patients were randomized to receive either an IMD enriched with EPA, GLA, and antioxidants (n = 42) or a standard isocaloric, isonitrogenous diet (control group, n = 45) after esophagectomy with radical lymphadenectomy. The primary outcome measure was changes in the oxygenation status (PaO2/FIO2 ratio), and the secondary outcome measures were body composition, inflammation-related factors, coagulation markers, cholesterol concentrations, and major clinical outcomes. Results: Oxygenation was significantly better on postoperative days (PODs) 4, 6, and 8 in the IMD than control group (366.5 ± 63.3 vs. 317.3 ± 58.8, P = 0.001
361.5 ± 52.6 vs. 314.0 ± 53.2, P &lt
 0.001
365.4 ± 71.2 vs. 315.2 ± 56.9, P = 0.001, respectively). Changes in the ratio of body weight on PODs 14 and 21 and lean body weight on POD 21 were significantly greater in the IMD than control group. No significant differences were observed in other measures. Conclusions: An enteral IMD enriched with EPA and GLA improved oxygenation and maintained the body composition of patients undergoing radical esophagectomy, indicating the potential efficacy of such a diet after esophagectomy.

DOI： 10.1007/s00268-017-3893-y

PubMed

Publishing type：Research paper (scientific journal)  

Aim: The aim of the present study was to identify factors associated with sarcopenia in community-dwelling elderly women in Japan. Methods: A total of 186 women aged over 65 years attending preventive care classes were enrolled in the study. Muscle mass was assessed using bioelectrical impedance analysis. Sarcopenia was defined as low muscle mass and low muscle strength in accord with the consensus report of the Asian Working Group for Sarcopenia. Data regarding household status (living alone, with a spouse, or with children and/or grandchildren), calf circumference and the presence of locomotive syndrome were obtained, as well as dietary variety score, Tokyo Metropolitan Institute of Gerontology Index of Competence and Mini-Nutritional Assessment short form, and 10-item Eating Assessment Tool scores. Results: Sarcopenia was identified in 21.0% of participants. Participants with sarcopenia were older, had a lower body mass index and calf circumference, and were more likely to have locomotive syndrome, and living with children and/or grandchildren. In multivariate analysis, age, body mass index &lt
18.5 and locomotive syndrome were significantly associated with sarcopenia, as were associated living alone (OR 1.69, 95% CI 0.45–6.41), and living with children and/or grandchildren (OR 2.46, 95% CI 0.71–8.54) and dietary variety score ≥9 (OR 4.98, 95% CI 0.97–25.56). Conclusions: Age, body mass index, dietary variety score, locomotive syndrome and household status were associated with sarcopenia. Early interventions are required for older adults identified as having a higher risk of sarcopenia to prevent its adverse health consequences. Geriatr Gerontol Int 2017
17: 54–60.

DOI： 10.1111/ggi.12674

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ggi.12836

PubMed

Publishing type：Research paper (scientific journal)  

<p>We validated the evaluation method of the official Japanese report of the Nutrition Support Team (NST) for the outcome of NST in an acute hospital and analyzed factors relevant to the outcome of NST. We identified the specific items corresponding to the each particles of NST outcome measurement. We then compared the objective nutritional date of the good responder group (GR) and the poor responder group (PR) for the NST intervention. <br/>We classified the main interventional methods into 4 types: modification of food supply, enteral nutrition, parenteral nutrition, and drug administration. Subsequently, we analyzed the efficacy of these methods as NST interventional tools. <br/>At enrollment, serum albumin (Alb), hemoglobin (Hb), and transthyretin (TTR) levels and the prognostic nutritional index (PNI) of the GR were significantly lower than those of the PR. After NST interventions, Alb, TTR, and Hb levels and PNI of the GR significantly improved. Enteral nutrition and modification of food supply could improve the energy sufficiency rate and the balance of energy intake of the study subjects. <br/>The method of evaluation of the official Japanese report of the NST with respect to the outcome of the NST might be useful to some extent. Enteral nutrition and modification of food supply were useful in NST interventions.</p>

DOI： 10.11379/jjda.60.449

CiNii Article

Publishing type：Research paper (scientific journal)  

我が国で外来治療を受けるHIV陽性者の栄養状況を総合的に評価するとともに、CD4陽性リンパ球数(CD4カウント)との関連について検討した。対象は2014年4月～12月の間に著者らの施設の感染症内科を受診したHIV陽性患者のうち、82名(年齢35～58歳、平均年齢44歳)とした。方法は栄養素摂取量調査と体組成測定を行い、血液検査項目は患者のカルテより抽出した。その結果、1)対象者全体では肥満者が29.3%、メタボリックシンドロームと診断された者が26.8%と国民健康・栄養調査結果との差はみられなかった。だが、CD4≧500/mm3群では肥満(46.5%)、メタボリックシンドローム(34.9%)の割合が高く、一方でCD4<500/mm3群ではCotrolling Nutritional Statusにより栄養不良と評価される者の割合が約40%とCD4≧500/mm3群より有意に高かった。2)CD4≧500/mm3群の栄養素摂取量はCD4<500/mm3群と比べて低かったが、身体活動レベルの「軽い」者の割合も高い傾向にあった。3)HIV陽性者の栄養問題は均一ではなく、CD4カウントおよび患者の長期予後を考慮した栄養評価、栄養治療が必要と考えられた。

Publishing type：Research paper (scientific journal)  

DOI： 10.11272/jssabst.41.0_S181_2

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.11272/jssabst.41.0_s181_2

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11605-015-2838-8

Publishing type：Research paper (scientific journal)  

異所性脂肪蓄積の一つである、膵への脂肪沈着に注目し、腹部超音波における膵臓と脾臓の輝度の差(膵脾差)を測定し、この膵脾差の大きなBright Pancreas所見の虚血性心疾患に対するリスク要因としての有用性を検証した。冠動脈疾患を発症した直後の19例(虚血性心疾患群)と、人間ドック症例のうち年齢、性別をマッチングさせた36例(ドック脂肪肝群)との症例対照研究を行った。虚血性心疾患群では、ドック脂肪肝群に比して膵輝度や膵脾差は高値であった。肥満や喫煙、飲酒など虚血性心疾患発症のリスクファクターとして知られている要因を投入して行った多変量解析において、肝腎コントラスト差の大きさに加え、膵脾差79以上のBright Pancreasの所見は、独立した影響因子であることが明らかになった。肝臓のみでなく膵臓の輝度上昇所見も加えたスクリーニング法を用いることで、脂肪肝のうち、将来的に虚血性心疾患を発症する可能性の高い、病的脂肪肝を抽出できることが示唆された。(著者抄録)

Publishing type：Research paper (scientific journal)  

【目的】関節リウマチ(以下、RA)患者における、サルコペニア該当者の生活習慣の特徴を抽出する。【対象及び方法】外来通院中のRA患者208名を対象とした。骨格筋量は二重エネルギーX線吸収測定法(DXA法)により測定した。四肢の骨格筋量の合計を身長で除した骨格筋指数が男性6.87kg/m2、女性5.46kg/m2以下である者をサルコペニアと判定した。栄養素・食事摂取量は簡易型食事歴質問票(BDHQ)を用いて調査した。【結果】RA患者においてサルコペニア該当群は非該当群と比較し疾患活動性が高く、運動制限を指導されている者が多く、日常生活動作(ADL)が低かった。栄養面では、カルシウム摂取量が少なく、乳製品の摂取量が有意に少なかった。【結論】RA患者におけるサルコペニア該当者では、運動制限、ADLの低下、乳製品摂取量が少ないことが特徴であった。(著者抄録)

Publishing type：Research paper (scientific journal)  

Objectives. The effect of serum 25-hydroxycalciferol [25(OH)D] on rheumatoid arthritis (RA) activity remains controversial. This study was undertaken with an aim to clarify the relationship between serum 25(OH) D and RA activity, and to determine the effects of dietary vitamin D intake and age on serum 25(OH) D level.
Methods. A total of 208 outpatients with RA were matched according to age and sex with 205 individuals without RA (controls) from the TOMORROW study (UMIN000003876). We excluded 27 patients with RA and 19 control subjects who had been prescribed vitamin D medication or were taking vitamin D supplements. Vitamin D intake was assessed in the remaining 181 patients and 186 controls using the brief-type dietary history questionnaire. Serum 25(OH) D levels were measured using a radioimmunoassay.
Results. Serum 25(OH) D levels were significantly lower in patients with RA than in the controls (p &lt; 0.001). There was a significant and positive correlation between age and 25(OH) D in the patients (r = 0.283, p &lt; 0.001), as with vitamin D intake and 25(OH) D, even after adjusting for age (r = 0.313, p &lt; 0.001). Disease activity and 25(OH) D did not significantly correlate.
Conclusions. Patients with RA were observed to have serum 25(OH) D levels which correlated with vitamin D intake and age but not disease activity.

DOI： 10.3109/14397595.2014.952487

Publishing type：Research paper (scientific journal)  

血清25-ヒドロキシカルシフェロール[25(OH)D]と関節リウマチ(RA)活動性と関連を明らかにし、血清25(OH)Dに対する食事によるビタミンD摂取量と年齢の影響を判定した。RA患者181例(女性151例、男性30例、年齢51～69歳)と、非RAの対照186例(女性155例、男性31例、年齢51～66歳)のビタミンD摂取量を簡易版食事歴質問票により評価し、血清25(OH)Dをラジオイムノアッセイにより測定した。RA患者における疾患活動性は、赤血球沈降速度に基づく28関節に対する疾患活動性スコアで評価した。RA患者よりも非RAの方がビタミンD摂取量は多い傾向にあり、血清25(OH)Dも有意に高かった。RA患者、非RAともに年齢はビタミンD摂取量と血清25(OH)Dに陽性の関連があり、年齢補正後もこの関連は維持された。血清25(OH)Dと疾患活動性は有意な関連を示さなかった。

Publishing type：Research paper (scientific journal)  

<b>Objective:</b> To clarify lifestyle characteristics of rheumatoid arthritis (RA) patients with sarcopenia. <br><b>Subjects and Methods:</b> A total of 208 consecutive RA outpatients were assessed. Skeletal muscle mass was measured by dual energy x-ray absorptiometry (DXA). The criterion of sarcopenia was defined as a low skeletal muscle index (appendicular muscle mass/height² , kg/m²; men, ≤6.87 kg/m²; women, ≤5.46 kg/m²; reference population, Japanese young adults aged 18-40 years). Brief-type self-administered diet history questionnaire (BDHQ) was used for investigation of the intake of energy, nutrients and food. <br><b>Results:</b> In RA patients, the sarcopenia group showed significantly higher disease activity and lower activity of daily living (ADL) compared to those in the non-sarcopenia group. In addition, a greater number of patients in the sarcopenia group had exercise restrictions than in the non-sarcopenia group. Calcium intake had a tendency to be lower, and intake of milk and other dairy products was significantly lower, in the sarcopenia group than in the non-sarcopenia group.<br><b>Conclusion:</b> Exercise restriction, low ADL, and low intake of milk and other dairy products were determined to be the lifestyle characteristics of RA patients with sarcopenia.

DOI： 10.11244/jspen.30.793

CiNii Article

Publishing type：Research paper (scientific journal)  

We focus on the bright pancreas, with fat accumulation in the pancreas, and evaluated the brightness by histogram values. The difference in brightness between pancreas and spleen was indicated as &ldquo;pancreas-spleen difference&rdquo; and was measured by abdominal ultrasonography. The risk of ischemic heart disease based on this pancreas-spleen difference was verified.<br> Nineteen-patients which showed symptoms of coronary artery disease were used for a case-control study with 36 patients who had come to the hospital for a thorough physical check. Patients were matched for age and sex. The pancreas-spleen difference of the ischemic-heart-disease group was significant. A multivariate analysis conducted by using known risk factors for the onset of ischemic heart disease, such as obesity, smoking, and drinking, showed the importance of the pancreas-spleen contrast difference.<br> By using the screening method which added not only the liver, but the brightness elevation view of the pancreas, it became clear that brightness was the independent affector, with a high possibility for showing symptoms of ischemic heart disease.

DOI： 10.11272/jss.40.295

CiNii Article

Publishing type：Research paper (scientific journal)  

<b>Objective:</b> To clarify lifestyle characteristics of rheumatoid arthritis (RA) patients with sarcopenia. <br><b>Subjects and Methods:</b> A total of 208 consecutive RA outpatients were assessed. Skeletal muscle mass was measured by dual energy x-ray absorptiometry (DXA). The criterion of sarcopenia was defined as a low skeletal muscle index (appendicular muscle mass/height² , kg/m²; men, ≤6.87 kg/m²; women, ≤5.46 kg/m²; reference population, Japanese young adults aged 18-40 years). Brief-type self-administered diet history questionnaire (BDHQ) was used for investigation of the intake of energy, nutrients and food. <br><b>Results:</b> In RA patients, the sarcopenia group showed significantly higher disease activity and lower activity of daily living (ADL) compared to those in the non-sarcopenia group. In addition, a greater number of patients in the sarcopenia group had exercise restrictions than in the non-sarcopenia group. Calcium intake had a tendency to be lower, and intake of milk and other dairy products was significantly lower, in the sarcopenia group than in the non-sarcopenia group.<br><b>Conclusion:</b> Exercise restriction, low ADL, and low intake of milk and other dairy products were determined to be the lifestyle characteristics of RA patients with sarcopenia.

DOI： 10.11244/jspen.30.793

CiNii Article

Publishing type：Research paper (scientific journal)  

We focus on the bright pancreas, with fat accumulation in the pancreas, and evaluated the brightness by histogram values. The difference in brightness between pancreas and spleen was indicated as “pancreas-spleen difference” and was measured by abdominal ultrasonography. The risk of ischemic heart disease based on this pancreas-spleen difference was verified.<br> Nineteen-patients which showed symptoms of coronary artery disease were used for a case-control study with 36 patients who had come to the hospital for a thorough physical check. Patients were matched for age and sex. The pancreas-spleen difference of the ischemic-heart-disease group was significant. A multivariate analysis conducted by using known risk factors for the onset of ischemic heart disease, such as obesity, smoking, and drinking, showed the importance of the pancreas-spleen contrast difference.<br> By using the screening method which added not only the liver, but the brightness elevation view of the pancreas, it became clear that brightness was the independent affector, with a high possibility for showing symptoms of ischemic heart disease.

DOI： 10.11272/jss.40.295

CiNii Article

Publishing type：Research paper (scientific journal)  

Objective: To our knowledge, no randomized study has shown whether zinc replacement therapy is effective for hyperammonemia in liver cirrhosis
therefore, we performed a double-blind, placebo-controlled trial to examine efficacy and safety of the zinc replacement therapy. Methods: Patients with liver cirrhosis and hyperammonemia (at or above the institutional reference value) and hypozincemia (≤65 μg/dL) were enrolled in the outpatient units of the participating institutions and were randomly divided to receive placebo (P group) or zinc acetate preparation at a dose of 3 capsules/d for a total zinc content of 150 mg/d (Z group) by the envelope method. Of the 18 enrolled patients, 6 dropped out
thus, the analyses included 12 patients (5 in the P group and 7 in the Z group). Variations in blood concentrations of zinc and ammonia as well as liver function test results were compared. Results: Blood zinc levels significantly increased in the Z group (P = 0.0037
Friedman test) but not the P group. Blood ammonia levels significantly decreased in the Z group (P = 0.0114
Friedman test) but not the P group. The percent change in blood ammonia level also revealed significant reduction at the eighth week in the Z group (P = 0.0188: Mann-Whitney test). No serious adverse events attributable to the zinc preparation were noted. Conclusion: Although this study is preliminary and includes a small sample, it is, to our knowledge, the first randomized controlled trial to show that zinc supplementation for 3 mo seems effective and safe for treating hyperammonemia in liver cirrhosis. Studies with a larger sample size are needed to confirm our findings.

DOI： 10.1016/j.nut.2014.04.018

PubMed

Publishing type：Research paper (scientific journal)  

サルコペニアは慢性肝疾患患者の予後との関連が報告されている。今回、われわれは手術を受けた肝癌患者におけるサルコペニアの影響について検討した。その結果、サルコペニアを併存する肝癌患者は術前の最高酸素摂取量が有意に低下し、術後の運動療法でも改善しなかった。このことから、サルコペニアは肝癌患者に対する術後の運動療法に影響する可能性を示した。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2014-eular.3937

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND & AIMS: Although a low plasma level of branched-chain amino acids (BCAAs) is a marker of cirrhosis, it is not clear whether BCAA supplements affect disease progression. We performed a multicenter study to evaluate the effects of BCAA supplementation on hepatocarcinogenesis and survival in patients with cirrhosis. METHODS: We enrolled 299 patients from 14 medical institutions in Japan in a prospective, multicenter study in 2009; 267 patients were followed through 2011. Patients were given BCAA supplements (5.5-12.0 g/day) for more than 2 years (n = 85) or no BCAAs (controls, n = 182). The primary end points were onset of hepatocellular carcinoma (HCC) and death. Factors associated with these events were analyzed by competing risk analysis. RESULTS: During the study period, 41 of 182 controls and 11 of 85 patients given BCAAs developed HCC. On the basis of the Cox and the Fine and Gray models of regression analyses, level of α-fetoprotein, ratio of BCAA:tyrosine, and BCAA supplementation were associated with development of HCC (relative risk for BCAAs, 0.45; 95% confidence interval, 0.24-0.88; P = .019). Sixteen controls and 2 patients given BCAAs died. Factors significantly associated with death were Child-Pugh score, blood level of urea nitrogen, platelet count, male sex, and BCAA supplementation (relative risk of death for BCAAs, 0.009; 95% confidence interval, 0.0002-0.365; P = .015) in both regression models. CONCLUSIONS: On the basis of a prospective study, amino acid imbalance is a significant risk factor for the onset of HCC in patients with cirrhosis. BCAA supplementation reduces the risk for HCC and prolongs survival of patients with cirrhosis.

DOI： 10.1016/j.cgh.2013.08.050

PubMed

Publishing type：Research paper (scientific journal)  

脂肪肝と生活習慣との関連について検討するため、人間ドックを受診し超音波検査で脂肪肝を認めた240名(男161名、女79名、平均55.3歳)を対象に、腹膜前脂肪肥厚(内臓脂肪蓄積型)、肝腫大(肝腫大型)、高輝度膵(脂肪膵型)の有無を調べると共に、ライフスタイル調査を行った。3項目の所見をいずれも認めなかったのは31%で、単独陽性は内臓脂肪蓄積型が33%、2項目陽性は内臓脂肪蓄積型と脂肪膵型あるいは肝腫大との併存がそれぞれ9%、8%であった。各タイプにおける生活習慣として、20歳時点と比較して体重増加がある、不規則な食生活、飲酒量が多い、歩行速度が遅い、などが有意に関連していた。多変量解析の結果、独立した影響因子として抽出されたのは、内臓脂肪蓄積型および肝腫大型で「体重増加」「飲酒量」、脂肪膵型ではこれらに加え「生活習慣改善の意思があり実施している」であった。

Publishing type：Research paper (scientific journal)  

主観的包括的栄養評価(SGA)、MNA-SF、NRS2002、MSTと各種客観的栄養指標(ODA)、身体計測値および3年生存率との関連性を比較した。4つの評価法のうち、MNA-SFによる評価がほかの客観的栄養指標との関連性が最も認められた。MNA-SFにおいて不良群に該当した患者は、3年後までの生存率が有意に低かった(log-rank test、p=0.005)。急性期病院における高齢入院患者に対する栄養スクリーニング法としては、MNA-SFが優れていた。(著者抄録)

Publishing type：Research paper (scientific journal)  

当院人間ドックを受診した脂肪肝患者121例を対象として、腹部エコーを用いた膵脾コントラスト値(膵脾差)より高膵脾差群と低膵脾差群に分け、その病態を比較検討した。ROC解析の結果、カットオフ値は膵脾差45であり、感度0.652、特異度0.702であった。低膵脾差群(膵脾差<45)と比べ高膵脾差群(膵脾差≧45)では、メタボリック症候群を高率に併存し、CTによる内臓脂肪面積が有意に高値で、体重、BMI、ウエスト周囲径も有意に高値であり、より動脈硬化症のリスクの大きい脂肪肝であることが示唆された。

Publishing type：Research paper (scientific journal)  

(Objective) The most frequently observed abnormality in abdominal ultrasonography is fatty liver. However, it is difficult to conduct thorough examination in all patients with fatty liver. In recent years, fat accumulation in the pancreas has attracted attention as a risk factor of arteriosclerotic disease. In this study, we focused on the degree of fat accumulation in the pancreas for the purpose of extracting fatty livers with a greater risk of arteriosclerosis. <BR>(Subjective and Methods) One hundred and twenty one patients with fatty liver were investigated. As an index to show the degree of fat accumulation in the pancreas, brightness was evaluated by histogram values and the difference in brightness between the pancreas and spleen was indicated as the &ldquo;pancreas-spleen difference.&rdquo; <BR>(Results) In patients with fatty liver, receiver operating characteristic analysis (ROC) was performed for the pancreas-spleen difference with the presence or absence of concurrent metabolic syndrome as the outcome, and the pancreas-spleen difference cutoff value was set at 45. It resulted in moderate accuracy with sensitivity of 0.652, specificity of 0.702, and area under the curve (AUC) of 0.705. The patients in the group with a high pancreas-spleen difference had concurrent metabolic syndrome at a higher frequency and had higher values of visceral fat area, higher body weight, higher BMI and higher abdominal circumference, suggesting that it is a group of patients with fatty liver with a greater risk of arteriosclerosis. <BR>(Conclusion) It was indicated that adding the pancreas-spleen difference to the ultrasonic screening test could extract types of fatty livers that have high affinity for metabolic syndrome.

DOI： 10.11404/jsgcs.52.61

CiNii Article

Publishing type：Research paper (scientific journal)  

The epidemic of obesity is now a major public health concern in many parts of the world. Face-to-face tailored lifestyle modification therapy is one of the major approaches used for weight loss. However, the lack of time for multiple visits and the lack of resources for administering therapy hinder its implementation. We administered a web-based weight loss program for obese patients from July 2010 to January 2012 that required only 2 personal interviews over 6 months. The program used a system of auto-extraction of behavioural objectives and autorecording of daily weight and number of steps taken. The subjects included 3 obese men (mean age, 35.7±2.3 years
mean body mass index (BMI), 30.4±0.8 kg/m2) and 17 obese women (mean age, 39.3±9.5 years
mean BMI, 28.1±1.8 kg/m2) who volunteered to participate in this weight loss program. Weight loss achieved through this program was significant (mean, 2.7%, p=0.047). Abdominal visceral fat area (VFA) decreased significantly (mean, 12.6%, p=0.017), and the serum cholinesterase and alanine aminotransferase levels improved (mean, 33 U/L, p=0.003
mean, 7 IU/L, p=0.033 respectively). Metabolic syndrome criteria number had a tendency to decrease. Dietary and nutrient intake levels on the food frequency questionnaire improved. Weight loss ratio after 6 months and initial weight loss ratio were strongly significantly correlated. A web-based weight loss program with auto-extraction of behavioural objectives and recording of daily weight and steps can achieve weight loss, as determined by VFA reduction, on low manpower.

DOI： 10.6133/apjcn.2014.23.3.17

PubMed

Publishing type：Research paper (scientific journal)  

(Objective) The most frequently observed abnormality in abdominal ultrasonography is fatty liver. However, it is difficult to conduct thorough examination in all patients with fatty liver. In recent years, fat accumulation in the pancreas has attracted attention as a risk factor of arteriosclerotic disease. In this study, we focused on the degree of fat accumulation in the pancreas for the purpose of extracting fatty livers with a greater risk of arteriosclerosis. <BR>(Subjective and Methods) One hundred and twenty one patients with fatty liver were investigated. As an index to show the degree of fat accumulation in the pancreas, brightness was evaluated by histogram values and the difference in brightness between the pancreas and spleen was indicated as the “pancreas-spleen difference.” <BR>(Results) In patients with fatty liver, receiver operating characteristic analysis (ROC) was performed for the pancreas-spleen difference with the presence or absence of concurrent metabolic syndrome as the outcome, and the pancreas-spleen difference cutoff value was set at 45. It resulted in moderate accuracy with sensitivity of 0.652, specificity of 0.702, and area under the curve (AUC) of 0.705. The patients in the group with a high pancreas-spleen difference had concurrent metabolic syndrome at a higher frequency and had higher values of visceral fat area, higher body weight, higher BMI and higher abdominal circumference, suggesting that it is a group of patients with fatty liver with a greater risk of arteriosclerosis. <BR>(Conclusion) It was indicated that adding the pancreas-spleen difference to the ultrasonic screening test could extract types of fatty livers that have high affinity for metabolic syndrome.

DOI： 10.11404/jsgcs.52.61

CiNii Article

Publishing type：Research paper (scientific journal)  

Introduction: To date, there have been no prospective studies examining the effect of coffee consumption on serum alanine aminotransferase (ALT) level among individuals infected with the hepatitis C virus (HCV). We conducted a hospital-based cohort study among patients with chronic HCV infection to assess an association between baseline coffee consumption and subsequent ALT levels for 12 months.
Materials and Methods: From 1 August 2005 to 31 July 2006, total 376 HCV-RNA positive patients were recruited. A baseline questionnaire elicited information on the frequency of coffee consumption and other caffeine-containing beverages. ALT level as a study outcome was followed through the patients' medical records during 12 months. The association between baseline beverage consumption and subsequent ALT levels was evaluated separately among patients with baseline ALT levels within normal range (&lt;= 45 IU/L) and among those with higher ALT levels (&gt;45 IU/L).
Results: Among 229 patients with baseline ALT levels within normal range, 186 (81%) retained normal ALT levels at 12 months after recruitment. Daily drinkers of filtered coffee were three times more likely to preserve a normal ALT level than non-drinkers (OR=2.74; P=0.037). However, decaffeinated coffee drinkers had a somewhat inverse effect for sustained normal ALT levels, with marginal significance (OR=0.26; P=0.076). In addition, among 147 patients with higher baseline ALT levels, 39 patients (27%) had ALT reductions of &gt;= 20 IU/L at 12 months after recruitment. Daily drinkers of filtered coffee had a significantly increased OR for ALT reduction (OR=3.79; P=0.034). However, in decaffeinated coffee drinkers, OR could not be calculated because no patients had ALT reduction.
Conclusion: Among patients with chronic HCV infection, daily consumption of filtered coffee may have a beneficial effect on the stabilization of ALT levels.

DOI： 10.1371/journal.pone.0083382

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/hepr.12085

Publishing type：Research paper (scientific journal)  

肝硬変患者における栄養因子と筋肉減少症に関連があるかどうか検討した。41歳以上の肝硬変患者50名を被験者とし、食事習慣について面接を受け、日々の身体活動を歩数計により測定した。生体電気インピーダンス法を用いて四肢骨格筋量(ASM)を測定し、骨格筋体積指数(SMI)を算出した。握力計を用いて握力を測定した。筋肉減少症はSMIと握力から判定した。肝硬変患者を正常群と筋肉減少症群に分類し、2群の比較を行った。単変量および多変量ロジスティック回帰モデル化法を用いて肝硬変患者における筋肉減少症の罹患率を決定した。その結果、身長、理想体重(IBW)に対するエネルギー摂取量、そして歩数が筋肉減少症の独立の関連因子であった。さらに、筋肉減少症群では有意に多い数の患者がIBWに対するエネルギー摂取量と歩数の両方の指数で低い値を示した。以上の結果から、1日に5000歩以上の歩行と30kcal/IBWの総エネルギー摂取量を維持することで代償性肝硬変患者の生活様式の指針に関する基準が充足される可能性が示された。

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

CiNii Article

Publishing type：Research paper (scientific journal)  

過栄養状態と術後手術部位感染との関連性について、消化器がん手術待機患者を対象に検討した。2008年7月～2009年5月までに東住吉森本病院外科病棟に入院した胃がん・大腸がん・肝がんの手術待機患者114名を対象とし、術前に多周波生体電気インピーダンス測定法にて体脂肪率を測定した。男性25%女性37%を基準として体脂肪過多群、非体脂肪過多群の2群に分けた。その他の過栄養系の指標として、BMI25を基準値としてBMI25≧群、BMI<25群に、内臓脂肪面積100cm2基準値として内臓脂肪面積≧100cm2群、内臓脂肪面積<100cm2群に、糖尿病併存の有無で2群に、それぞれ分類した。また、BMI25未満で体脂肪率が男性25%以上女性37%以上を隠れ肥満群、BMI25以上を肥満群と別途定義し、術後手術部位感染の発症率を比較した。多変量ロジスティック回帰分析の結果、体脂肪過多(体脂肪率成人男性25%、成人女性37%以上)であることが、術後手術部位感染発症に関連する唯一の独立した有意な要因であることを示した。隠れ肥満群、肥満群の術後手術部位感染発症率は、ほぼ同等であった。本研究において、術前に体脂肪過多過であることが、術後手術部位感染発症と有意に関連することが明らかになり、従来から報告されている糖尿病併存の有無、BMIだけでなく、術前のリスク要因として体脂肪率を加えることが望ましいと考えられた。(著者抄録)

Publishing type：Research paper (scientific journal)  

通院中のNAFLD 42名、NASH 58名、対照群として健常者57名において、生活習慣病の保健指導支援ソフトウェア"ヘルッチェ"(スズケン)や、生活習慣記録機ライフコーダ(スズケン)などを用いて、日常の生活習慣を分析した。結果、NAFLD/NASHでは健常者に比べ、体組成的に脂肪量が多く握力が低下している傾向が見られた。この傾向はNASH群においてより顕著であった。食習慣については、健常群と比して総摂取カロリーの過剰や、PFC比の偏りは見られず、食習慣改善に対するステージモデルにおいても、実行期・維持期の割合が有意に高く、意識して改善している傾向が見られた。しかし男性では健常者に比して魚介類の摂取量が少ないことなどから、摂取食品、食材にまで気を配った食事指導が望まれた。運動習慣について、身体活動量や歩数が低値を示し、生活活動強度が低い傾向が見られた。男女ともに、NAFLD/NASH群は自らの病識も明確で、食習慣は改善意識が高く改善傾向が見られたが、生活活動強度/運動習慣においては改善の余地があった。NAFLD/NASH患者には、食事指導のみならず、生活活動強度の向上、無理のないエクササイズ実施、継続など、包括的な生活改善支援が望まれる。(著者抄録)

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Background: Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.
Methods: Sixty-one HCC patients underwent preoperative cardiopulmonary exercise testing to determine their anaerobic threshold (AT). The AT was defined as the break point between carbon dioxide production and oxygen consumption per unit of time (VO2). Postoperative events including recurrence of HCC, death, liver failure, and complications of cirrhosis were recorded. Univariate and multivariate analyses were performed to evaluate associations between 35 clinical factors and outcomes, and identify independent prognostic indicators of event-free survival and maintenance of Child-Pugh class.
Results: Multivariate analyses identified preoperative branched-chain amino acid/tyrosine ratio (BTR) &lt;5, alanine aminotransferase level &gt;= 42 IU/l, and AT VO2 &lt;11.5 ml/min/kg as independent prognostic indicators of event-free survival. AT VO2 &lt;11.5 ml/min/kg and BTR &lt;5 were identified as independent prognostic indicators of maintenance of Child-Pugh class.
Conclusions: This study identified preoperative exercise capacity as an independent prognostic indicator of event-free survival and maintenance of Child-Pugh class in HCC patients with chronic liver injury undergoing hepatectomy.

DOI： 10.1186/1471-230X-13-119

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2010年6月～2011年9月に肝切除を施行し、慢性肝炎、肝硬変を併存している肝癌患者25例(男性21例、女性4例、69.5±6.0歳)を対象に、対照群(運動療法群25例(男性17例、女性8例、68.0±9.1歳、栄養指導群26例(男性19例、女性7例、71.3±8.8歳))と比べ、障害肝合併肝癌患者に対する周術期に行う分枝鎖アミノ酸(BCAA)顆粒製剤投与を追加することによる運動・栄養療法を組み合わせた包括的リハビリテーションの検討を行った。ウイルス性肝炎は3群ともC型肝炎が多く栄養療法群、BCAA投与運動療法群、運動療法群で各44%、69%、56%であった。術前肝機能は3群間で差を認めなかった。病理組織学的検討においても非腫瘍部肝組織が慢性肝炎であったものが最も多く、各44%、53%、44%であった。術後入院期間に有意差はないものの運動療法群、BCAA投与運動療法群が短期間である傾向にあった。障害肝合併肝癌患者に対して術前術後6ヵ月間のBCAA投与および運動療法により脂肪量減少による体重減少、インスリン抵抗の改善効果が認められたが、骨格筋量増加には至らなかった。

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近年、リハビリテーション(リハビリ)を必要とする高齢患者に栄養障害を認めることが報告されているが、栄養状態とリハビリとの関連性を示す報告は少ない。そこで、入院患者の栄養状態をMNA-SFにより分類し、リハビリの効果を検討したところ、より低栄養状態の患者ではリハビリの効果が十分でなかった。以上のことから、適切な栄養管理とリハビリの併用が必要であると考えられた。(著者抄録)

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【目的】病態が活動期で入院を要した炎症性腸疾患患者について、NSTによる適切な栄養学的介入を行うことを目的に栄養状態の評価を行った。【対象及び方法】潰瘍性大腸炎患者、クローン病患者に対し、入院時に身体計測、インピーダンス法を用いた身体組成分析、血液検査・血液生化学検査、SGAを用いて栄養学的評価を行った。【結果】入院を要した炎症性腸疾患患者は栄養状態が不良であることが示唆された。特に潰瘍性大腸炎患者は、急激な病状の増悪による炎症反応の亢進や重篤な消化器症状により、代謝の亢進、食事摂取量の低下が起こり、急激に低栄養状態に陥っていると考えられた。【結論】潰瘍性大腸炎はクローン病に比して栄養療法の必要性が低いと認識されがちであるが、急激な栄養状態の悪化のみられる潰瘍性大腸炎患者においても、原疾患の治療とともにNSTを通じた積極的な栄養学的サポートが必要であると考えられた。(著者抄録)

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肝臓の形態変化、特に肝臓径と皮下脂肪厚及び内臓脂肪厚を計測し、それらの有無を組み合わせた新たな指標を取り入れた。腹部超音波検査にて脂肪肝の所見を認めた130例を対象とした。従来の計測方法と、左葉、右葉で高い相関があった。超音波での皮下脂肪厚測定値と腹部CTによる皮下脂肪面積と有意な相関を認めた。腹部脂肪厚測定値と腹部CTによる内臓脂肪面積についての相関内臓脂肪においてもと有意な相関が見られた。超音波にて脂肪肝に肝腫大を伴った群は、腹囲、BMI、収縮期血庄、CTによる内臓脂肪面積中性脂肪値が高値で、メタボリック症候群及び予備群の頻度も高く、肝機能異常も高度であった。脂肪肝所見に皮下あるいは腹部脂肪厚の肥厚を伴った群は、体重、BMI、腹囲が高値で、CTによる内臓脂肪面積、空腹時血糖、HbA1cが高値で、メタボリック症候群診断項目の異常の度合いが高頻度で、肝機能異常も高度であった。

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DOI： 10.3748/wjg.v18.i40.5759

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[OBJECTIVE] We evaluated the nutritional condition of patients with active inflammatory bowel disease (IBD) on admission so that the nutrition support team (NST) could provide them appropriate nutritional therapy.<br>[METHODS] We measured anthropometric parameters, determined body composition by bioelectrical impedance analysis (BIA), performed biochemical assessments of blood, and performed subjective global assessment (SGA) of the nutritional status of IBD patients on admission.<br>[RESULTS] Our results showed that typically, the nutritional conditions of patients with active IBD on admission were very poor. In particular, the nutritional condition of patients with ulcerative colitis (UC) was worse than that of patients with Crohn disease (CD), because patients with UC had greater active inflammation, severe gastrointestinal symptoms, hypermetabolic disorders, and shortage of food intake.<br>[CONCLUSION] Although it might be commonly thought that patients with UC require lesser nutritional support than patients with CD, patients with active UC on admission had poorer nutritional conditions than those of CD patients. Thus, patients with active CD on admission require appropriate nutritional support by the NST.

DOI： 10.11244/jjspen.27.1361

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DOI： 10.11272/jssabst.37.0_s139_1

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To identify patients with serious pathogenesis, we proposed a new classification system for fatty liver, which is the most common finding in medical ultrasonographic examination of the abdomen. The thicknesses of subcutaneous and visceral fat measured by ultrasonography exhibits a good correlation with the areas of subcutaneous and visceral fat, respectively, measured by abdominal computed tomography (CT) (r = 0.781 and 0.532, respectively). Compared to subjects having fatty liver without hepatomegaly, subjects having fatty liver with hepatomegaly have larger waist, higher body mass index (BMI), higher blood pressure, higher serum triglyceride levels, higher levels of serum aspartate aminotransferase (AST) and alanine aminotranferease (ALT), and lager visceral fat area (determined by CT findings). Subjects having fatty liver with hepatomegaly exhibit higher comorbidities of metabolic syndrome than those having fatty liver without hepatomegaly. <BR>Subjects having fatty liver with thick fat tissue have greater body weight, larger waist, higher BMI, larger visceral fat area (determined by CT), higher blood sugar levels, higher glycated hemoglobin (HbA1c) levels, and higher levels of serum AST and ALT than subjects having fatty liver with thin fat tissue. Subjects having fatty liver with thick fat tissue exhibit higher comorbidities of metabolic syndrome than those having fatty liver with thin fat tissue. Fatty liver with hepatomegaly or thick fat tissue (measured by ultrasonography) may be a serious pathological condition; therefore, it should be monitored carefully as a high-risk condition associated with metabolic disorders.

DOI： 10.11404/jsgcs.50.707

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[OBJECTIVE] We evaluated the nutritional condition of patients with active inflammatory bowel disease (IBD) on admission so that the nutrition support team (NST) could provide them appropriate nutritional therapy.<br>[METHODS] We measured anthropometric parameters, determined body composition by bioelectrical impedance analysis (BIA), performed biochemical assessments of blood, and performed subjective global assessment (SGA) of the nutritional status of IBD patients on admission.<br>[RESULTS] Our results showed that typically, the nutritional conditions of patients with active IBD on admission were very poor. In particular, the nutritional condition of patients with ulcerative colitis (UC) was worse than that of patients with Crohn disease (CD), because patients with UC had greater active inflammation, severe gastrointestinal symptoms, hypermetabolic disorders, and shortage of food intake.<br>[CONCLUSION] Although it might be commonly thought that patients with UC require lesser nutritional support than patients with CD, patients with active UC on admission had poorer nutritional conditions than those of CD patients. Thus, patients with active CD on admission require appropriate nutritional support by the NST.

DOI： 10.11244/jjspen.27.1361

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SGA、MNAについて、各種ODAとの関連性を検討した。また、SGAとMNAの評価が乖離した症例の特徴を解析し、高齢患者にSGAを用いる上での注意点を検討した。SGA、MNAによる判定の結果、それぞれ70%、79%の患者が栄養状態不良に分類され、栄養状態良好群に比べBMI、Hb、%AC、%TSF、%CCが有意に低かった。両判定が乖離した症例については、A群(SGA良MNA不良)とD群(SGA不良MNA不良)の2群間で過去3ヵ月の食事量の減少・体重減少、果物・野菜の摂取状況、栄養状態自己評価、CCの項目に有意差が認められた。以上よりSGA、MNAはともに高齢患者に対する栄養スクリーニングツールとして有用であるが、SGAの評価のみでは、比較的体格が良い・過去3ヵ月の体重減少が少ない・自己の栄養評価が高いといった特徴を持つ高齢患者の低栄養リスクを見落とす可能性があり、注意が必要である。(著者抄録)

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身体計測、血液生化学的指標、基本的ADL(bADL)、骨密度、併存疾患指数、食事量との関連を調査し、MNAの有用性について検討した。MNAの点数分類のうち、栄養状態不良群はほかの2群に比べbADL、身体計測、骨密度の値が有意に低下していた。また、栄養状態良好群、栄養不良リスクあり群、栄養状態不良群の順に摂食率が低下する傾向がみられた。MNAは高齢者の身体状況全般を反映するツールとして有用な可能性が考えられる。(著者抄録)

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慢性B型肝炎において、過渡エラストグラフィの有用性、特に治療中の肝線維症の程度をモニタリングするツールとしての有用性について検討した。慢性B型肝炎ウイルス感染患者50名を対象とした。38名の患者において肝生検が実施され、血小板数が50×10^9/L以下の患者12名においては、肝硬変は門脈圧亢進という特異的な徴候に基づいて臨床的に診断した。試験参加後3ヵ月以内にentecavirを開始したヌクレオチド未治療患者20名において、肝硬度を、ベースライン時および12ヵ月の治療後、過渡エラストグラフィにより測定した。20名(40%)の患者がF1、10名(20%)がF2、5名(10%)がF3、15名(30%)がF4(肝硬変)に分類された。肝硬度中央値は線維症ステージF1～F4それぞれについて7.0kPa、9.8kPa、9.8kPa、17.3kPaとなった。肝硬度は線維症ステージと有意に相関した。Entecavirを開始した患者において、肝硬度中央値は、12ヵ月の治療期間中に有意に低下した。III型プロコラーゲンのアミノ末端ペプチドおよびIV型コラーゲン7Sドメインの血清中濃度中央値はそれぞれ有意に低下した。慢性B型肝炎ウイルス感染患者において、肝硬度の測定はentecavir投与中の肝線維症退縮モニタリングに有用である可能性が示唆された。

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A 57-year-old woman presented with a purpuric rash. Cryoglobulins were detected, and a skin biopsy showed leukocytoclastic vasculitis. The alanine aminotransferase level was 119 IU/L, and the platelet count 63,000/mm³. The hepatitis B virus (HBV) DNA was 6.4 log₁₀ copies/mL and became negative by week 6 of entecavir therapy. The antiphosphatidylserine-prothrombin complex antibody (anti-PS/PT) was 390-510 U/mL, and decreased to 69 U/mL at week 24, after cryoglobulin had become negative and the rash resolved. Among 20 HBV-infected patients without extrahepatic manifestations, low titers of anti-PS/PT were detected in 8 (40%). Clinical characteristics were similar in patients with or without anti-PS/PT. Low titers of anti-PS/PT in chronic hepatitis B have little clinical significance, whereas high titers may promote cryoprecipitate formation.<br>

DOI： 10.2957/kanzo.51.454

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57歳女。両下肢の腫脹と紫斑を主訴とした。血清クリオグロブリン陽性と皮膚生検にて白血球破砕性血管炎を認め、B型肝炎ウイルス(HBV)DNA陽性でありHBV関連クリオグロブリン血管炎と診断した。エンテカビル投与によりHBV DNAは6週目までに陰性化し、治療前390～510U/mLと高力価を認めた抗ホスファチジルセリン・プロトロンビン複合体(anti-PS/PT)は24週目に69U/mLまで低下した。クリオグロブリンも陰性化し紫斑は徐々に消失した。一方、肝外病変を認めないB型慢性肝疾患20例(男16例、女4例、平均年齢50歳)のうち8例(40%)からanti-PS/PT陽性を検出したがいずれも低力価であり、anti-PS/PT陽性例と陰性例の間に臨床的差異は認めなかった。HBV関連クリオグロブリン血症の成立にanti-PS/PTが関与している可能性が考えられた。

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DOI： 10.1111/j.1365-2893.2009.01160.x

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A 57-year-old woman presented with a purpuric rash. Cryoglobulins were detected, and a skin biopsy showed leukocytoclastic vasculitis. The alanine aminotransferase level was 119 IU/L, and the platelet count 63,000/mm³. The hepatitis B virus (HBV) DNA was 6.4 log₁₀ copies/mL and became negative by week 6 of entecavir therapy. The antiphosphatidylserine-prothrombin complex antibody (anti-PS/PT) was 390-510 U/mL, and decreased to 69 U/mL at week 24, after cryoglobulin had become negative and the rash resolved. Among 20 HBV-infected patients without extrahepatic manifestations, low titers of anti-PS/PT were detected in 8 (40%). Clinical characteristics were similar in patients with or without anti-PS/PT. Low titers of anti-PS/PT in chronic hepatitis B have little clinical significance, whereas high titers may promote cryoprecipitate formation.<br>

DOI： 10.2957/kanzo.51.454

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Because of the chronic shortage of liver donors, hepatologists are required to prolong the liver transplant waiting period by preserving the hepatic reserve of scheduled recipients. This study examined the effectiveness of oral branched-chain amino acids (BCAAs), using outcome markers indicating pretransplant hepatic reserve. Fifty-six consecutive eligible patients with Child class A cirrhosis without major complications were randomly assigned to receive oral BCAA granules (12.45 g/day) for least 1 year or no BCAAs. Differences between groups in the Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, asialoscintigraphic clearance index (Cl), and complications were examined. Of 50 remaining patients, 27 received BCAAs, and 23 received no BCAAs (mean duration, 3.2 years). The mean annual changes in the MELD score, CTP score, and asialoscintigraphic Cl were smaller in the BCAA group than in the control group (-0.06 +/- 0.23 versus 0.10 +/- 0.40, P = 0.024, 0.06 +/- 0.30 versus 0.30 +/- 0.48, P = 0.037, and 0.00 +/- 0.02 versus 0.02 +/- 0.04, P = 0.040, respectively). The mean annual changes in the serum total bilirubin and the serum albumin in the BCAA group were better preserved than those in the control group (-0.07 +/- 0.20 versus 0.12 +/- 0.18 mg/dL, P &lt; 0.001, and 0.07 +/- 0.13 versus -0.02 +/- 0.19 g/dL, P = 0.005, respectively); other laboratory variables were not significant. The incidence of overall major cirrhotic complications was lower in the BCAA group than in the control group [14.8% (4 of 27 patients) versus 30.4% (7 of 23 patients) at 3 years, P = 0.043]; only ascites was significant individually. In conclusion, early interventional oral BCAAs might prolong the liver transplant waiting period by preserving hepatic reserve in cirrhosis. Liver Transpl 15:790-797, 2009. (C) 2009 AASLD.

DOI： 10.1002/lt.21758

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The mechanism of hepatocarcinogenesis remains unclear in patients in whom hepatitis C virus (HCV) disappears after interferon (IFN) therapy. We compared molecular alterations in hepatocellular carcinoma (HCC) between patients with a sustained virological response (SVR) to IFN and patients with HCV.
The study group comprised 44 patients with HCV and 13 patients with SVR. One patient in the SVR group had two tumour nodules, both of which were examined. Mitochondrial DNA (mtDNA) mutations in displacement-loop lesions were directly sequenced. Mutation of the TP53 gene was examined by direct sequencing. The methylation status of p16, p15, p14, RB and PTEN genes was evaluated by a methylation-specific polymerase chain reaction.
The average number of mtDNA mutations was 4.2 in 44 HCCs with HCV and 2.0 in 14 HCCs with SVR (P=0.0021). mtDNA mutation was less frequently detected in HCCs from patients with SVR than in patients with HCV. TP53 mutations were detected in 12 (27%) of 44 HCCs with HCV and 2 (14%) of 14 SVR-HCCs. Hypermethylation of the p16, p15, p14, RB and PTEN promoters was, respectively, detected in 34, 13, 8, 12 and 11 of 44 HCCs from patients with HCV and 14, 0, 0, 2 and 2 of 14 HCCs from patients with SVR (P=0.049, 0.021, 0.085, 0.322 and 0.402). Hypermethylation of p16 was one of the most important alterations in SVR-HCC.
Molecular alterations in hepatocarcinogenesis of patients with SVR-HCC were different from those of patients with continuous HCV infection.

DOI： 10.1111/j.1478-3231.2008.01772.x

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Medical staff (55) and out-patients (176) of 22 hospitals in Osaka were asked to respond to questionnaires about educational classes on liver disease. In seven hospitals, such classes were held regularly, but not in fifteen. Factors interfering with the holding of classes regularly were lack of motivation, shortage of trained staff, and lack of preparation time. However, 95% of the medical staff and 94% of the patients thought such classes to be useful for self-management, promotion of the active acceptance of treatment, and reduction of anxiety. The most important information provided was considered by the medical staff to be 'knowledges about liver disease', while the patients chose 'methods of treatment'. These findings point to the need to develop an effective method for the education of patients with chronic liver disease.<br>

DOI： 10.2957/kanzo.50.356

CiNii Article

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Background/Aims: The purpose of this study was to validate the usefulness of positron emission tomography with fluorine-18-fluoiodeoxyglucose (FDG-PET) in predicting degree of malignancy and prognosis, evaluated in terms of Japan Integrated Staging (JIS) score, in cirrhotic patients with hepatocellular carcinoma (HCC).
Methodology: FDG-PET was performed in 50 patients with HCC. The activity within regions of interest placed over tumors was measured, and standardized uptake values (SUVs) were calculated by dividing the tissue activity by injected dose of radioactivity per unit body weight. SUV ratio (SUVR) was expressed as tumor-to-nontumor ratio of SUV. Patients were allocated to 3 groups of similar size: group A, SUVR &lt;= 51.1; group B, 1.1 &lt; SUVR &lt; 1.6; and group C, 1.6 &lt;= SUVR.
Results: SUVR significantly correlated with tumor node metastasis stage score (p &lt; 0.001) or JIS score (p=0.022). Survival rate in SUVR group C Was significantly lower than that in group A (p &lt; 0.001), and close to being significantly lower than that in group B. On multivariate analysis, JIS scores 2 and &gt;= 3, SUVR group C were significantly related to survival (All p &lt; 0.05).
Conclusions: SUVR was well associated with a tumor staging which is the factor of JIS score and with survival, and indicated malignancy and prognosis of patients especially with high-grade HCC.

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remains unclear whether mutational patterns of the hepatitis B virus (HBV) genome are associated with the development of severe hepatitis after the emergence of tyrosine-methionine-aspartate-aspartate (YMDD) variants during lamivudine treatment. Thirty patients with chronic hepatitis B who had YMDD variants during lamivudine therapy and were followed up subsequently while receiving lamivudine alone for at least 6 months were examined retrospectively. The lamivudine resistant mutations in the HBV polymerase gene were detected by a line probe assay, and the full-length sequences of HBV DNA were determined in some patients. Between months 5 and 33 of therapy, mutations from methionine to isoleucine at rt204 (rtM2041) were detected in 18 patients, and mutations from methionine to valine at rt204 (rtM204V) were detected in 12. The rtM204V mutations were always accompanied by mutations from leucine to methionine at rt180 (rtL180M), while rtM2041 mutations were not. Baseline characteristics, alanine aminotransferase (ALT) levels, and HBV DNA levels within 6 months after the emergence of YMDD variants did not differ significantly between patients with rtM2041 alone and those with rtL180M/rtM204V. No specific mutation was identified on full-length sequence analysis in three patients with a hepatitis flare. During long term follow-up, the addition of rtL180M to rtM2041 was found in four patients 7-31 months after detecting the change at rt204 and was linked to increased ALT levels. In conclusion, mutational patterns of HBV DNA at the time of emergence of YMDD variants were apparently unrelated to the clinical outcomes in Japanese patients with chronic hepatitis B during lamivudine therapy.

DOI： 10.1002/jmv.20984

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DOI： 10.1111/i.1872-034X.2007.00202.x

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The extrapancreatic bile duct lesions in autoimmune pancreatitis are termed sclerosing cholangitis (SC with AIP), which is known to complicate AIP somewhat more frequently than other extrapancreatic lesions. In cases of SC with AIP, differentiation from primary SC, pancreatic cancer, and bile duct cancer is often difficult. In our patient, pancreatic cancer had to be ruled out at admission, given the findings of obstructive jaundice, pancreatic duct stenosis, and swelling of the pancreas. Fluorine-18-fluorodeoxyglucose positron emission tomography was useful in checking for the presence of extrapancreatic lesions, including SC, and was also useful in the evaluation of the response to steroid therapy for following the course of AIR

DOI： 10.1007/s12149-007-0008-0

Publishing type：Research paper (scientific journal)  

We report a 67-year-old woman with systemic lupus erythematosus and systemic disseminated tuberculosis affecting the femoral trochanteric bursae, a site rarely affected by tuberculosis. For quantification of the inflammation with gallium-67 scintigraphy, we calculated the radioisotope Count ratio in the most inflamed areas, the right lateral thorax and bursa of the right greater trochanter. Systemic scanning with this modality allowed evaluation of the extent of lesions and simple quantitative determination of the severity of inflammation, yielding information useful for the follow-up of the patient during the course of tuberculosis treatment.

DOI： 10.1007/s12149-007-0014-2

Publishing type：Research paper (scientific journal)  

Idiopathic portal hypertension (IPH) is a disorder of unknown etiology, clinically associated with portal hypertension in the absence of cirrhosis. This study was designed to delineate the characteristics of IPH RNA expression in liver specimens from patients with IPH. Liver specimens from patients with IPH and patients without liver diseases underwent cDNA expression analysis and in situ hybridization studies. Connective tissue growth factor (CTGF) levels in serum were examined in 76 patients with IPH, 84 patients with hepatitis C virus infection (including those with cirrhosis), and 38 healthy volunteers. Among 588 genes sorted on macroarray, seven up-regulated genes, including CTGF, were detected. In situ hybridization studies showed that positive reactions for CTGF mRNA were most intense in the epithelial cells of proliferating bile ducts within portal tracts in patients with IPH. In the liver parenchyma, there was no appreciable staining of hepatocytes, sinusoidal endothelial cells, or hepatic stellate cells (HSCs), and there were few positive signals for CTGF mRNA in normal liver. The serum CTGF level in patients with IPH was significantly higher than the value in healthy volunteers. Six (8%) of the 76 patients with IPH had serum CTGF levels greater than 80 ng/mL, far exceeding the level of any patient with cirrhosis. In conclusion, overexpression of CTGF is one of the most important features of IPH.

DOI： 10.2119/2006-00093.Morikawa

Publishing type：Research paper (scientific journal)  

Background: Interferon (IFN) improves hepatic inflammation/fibrosis and reduces the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CH-C). However, HCC develops in some patients who have a sustained virological response (SVR) to IFN therapy. We designed this study to establish a follow-up protocol for patients with CH-C who have SVR to IFN therapy. Methods: We retrospectively studied 1124 patients with CH-C who received IFN. Results: HCC developed in 3.5% of patients with SVR to IFN. As compared with SVR patients without HCC, SVR patients with HCC were predominantly male (P=0.003), older at the initiation of IFN therapy (P=0.002), and at a more advanced histologic stage of disease (P &lt; 0.001). However, three of the 13 SVR HCC patients had mild fibrosis. The mean interval from IFN therapy to the detection of HCC in SVR HCC patients was 5.8 years and did not differ significantly from that in non-SVR HCC patients (P=0.304). Although most patients with HCC received curative therapy, the prognosis of some SVR HCC patients was poor, probably because of insufficient follow-up, resulting in delayed detection of HCC. Conclusions: SVR patients with CH-C who are elderly, male, or have an advanced histologic stage are at a high risk for the development of HCC after IFN therapy. We recommend that SVR patients should be observed carefully for more than 10 years after the completion of IFN therapy, even if they only have early fibrosis.

DOI： 10.1111/j.1478-3231.2006.01406.x

Publishing type：Research paper (scientific journal)  

Sequential treatment with lamivudine and interferon (IFN) has induced sustained biochemical and virologic responses in the majority of patients with chronic hepatitis B in France. However, the efficacy of sequential treatment in patients with chronic hepatitis B virus (HBV) genotype C infection has not been evaluated. Twenty-four HBe antigen-positive patients were treated with 100 mg lamivudine alone for 16 - 32 weeks, then with both 6 MU IFN-beta and lamivudine for 4 weeks, and lastly with IFN-beta alone for 20 weeks. Sustained response was achieved in 7 (29%) patients 24 weeks after the end of therapy. No lamivudine-resistant variants emerged in any patient. Hepatitis flare occurred in 3 patients after the withdrawal of lamivudine, but none had decompensation. The patients with sustained response were significantly younger at baseline (p = 0.033) and had a significantly lower HBV DNA level at the start of IFN (p = 0.020) than those without sustained response. In conclusion, the rate of response to sequential therapy with lamivudine and IFN in HBe antigen-positive patients with HBV genotype C infection was lower than the rate reported previously. Patients who were young or who had a favorable virologic response to lamivudine were more likely to have a sustained response.

DOI： 10.1089/jir.2006.0140

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Objective: A late evening snack improves the catabolic state in patients with advanced liver cirrhosis. We tested whether long-term (3 mo) late evening snacking that: included a branched-chain amino acid (BCAA)-enriched nutrient mixture produces a better nutritional state and better quality of life than ordinary food in patients with hepatitis C virus-posifive liver cirrhosis.
Methods: In a multicenter, randomized study, 48 patients with liver cirrhosis received late-evening supplementation with the BCAA-enriched nutrient mixture or ordinary food, such as a rice ball or bread, for 3 mo. During the study period, each patient was instructed on energy and protein intake. Blood biochemical data, nitrogen balance, respiratory quotient, and health-related quality of life (Short Form 36 questionnaire) were evaluated at baseline and at the end of the study.
Results: Total and late-evening energy intakes were similar in the two groups at 3 mo. Serum albumin level, nitrogen balance, and respiratory quotient were significantly improved by the BCAA mixture but not by ordinary food. The parameters of the Short Form 36 did not statistically significantly improve over 3 mo in either group.
Conclusion: Long-term oral supplementation with a BCAA mixture is better than ordinary food in a late evening snack at improving the serum albumin level and the energy metabolism in patients with cirrhosis. (C) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2006.10.008

Publishing type：Research paper (scientific journal)  

Background and aim: Thiopurine S-methyltransferase (TPMT) genotypes or phenotypes may be a predictive factor for azathioprine-induced toxicities. We investigated the genotypic status of TPMT to evaluate the risk of azathioprine-related adverse effects in Japanese patients with different liver diseases, including autoimmune hepatitis (AIH). Methods: 49 patients with AIH, 67 with primary biliary cirrhosis (PBC), and 120 with hepatitis C virus (HCV) were examined. TPMT genotypes were determined by PCR-restriction fragment length polymorphism-based assays. Results: The distribution of TPMT genotypes was 90% TPMT(*)1/TPMT(*)1, 8% TPMT(*)1/TPMT(*)3C, and 2% TPMT(*)3C/TPMT(*)3C in AIH, and 94% TPMT(*)1/TPMT(*)1, 4.5% TPMT(*)1/TPMT(*)3C, and 1.5% TPMT(*)3C/TPMT(*)3C in PBC. All except 1 patient with HCV had the TPMT(*)1/TPMT(*)1 genotype. Severe myelosuppression occurred in two of nine patients with AIH who received azathioprine, one of whom was homozygous for TPMT(*)3C. Conclusions: TPMT(*)3C variants are more frequent in patients with AIH or PBC than in patients with viral hepatitis or healthy volunteers in Japan. Pharmacogenetic screening for TPMT polymorphisms before commencing azathioprine therapy may help to prevent severe hematotoxicity in patients with TPMT deficiency.

DOI： 10.1111/j.1478-3231.2006.01392.x

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A 70-year-old man was admitted for suspected hepatocellular carcinoma (HCC). Abdominal CT detected a tumor mass 2.5 cm in diameter protruding from the surface of the right lobe of his liver. We decided to perform radiofrequency ablation (RFA) with laparoscopic guidance. Laparoscopy revealed the HCC being adjacent to the costae on the outermost side of the right lobe; it was difficult to safely puncture an electrode needle into the tumor. Hence, we infused normal saline (artificial ascites) into the space between the liver and abdominal wall, and then performed percutaneous RFA with ultrasonography guidance. Using this laparoscopic artificial ascites technique, we could safely and easily perform ultrasonography-guided percutaneous RFA for HCC on the outermost side of the right lobe of the liver, which is otherwise difficult to treat by laparoscopic or percutaneous approach.

DOI： 10.3380/jmicrowavesurg.25.105

CiNii Article

Publishing type：Research paper (scientific journal)  

A 70-year-old man was admitted for suspected hepatocellular carcinoma (HCC). Abdominal CT detected a tumor mass 2.5 cm in diameter protruding from the surface of the right lobe of his liver. We decided to perform radiofrequency ablation (RFA) with laparoscopic guidance. Laparoscopy revealed the HCC being adjacent to the costae on the outermost side of the right lobe; it was difficult to safely puncture an electrode needle into the tumor. Hence, we infused normal saline (artificial ascites) into the space between the liver and abdominal wall, and then performed percutaneous RFA with ultrasonography guidance. Using this laparoscopic artificial ascites technique, we could safely and easily perform ultrasonography-guided percutaneous RFA for HCC on the outermost side of the right lobe of the liver, which is otherwise difficult to treat by laparoscopic or percutaneous approach.

DOI： 10.3380/jmicrowavesurg.25.105

CiNii Article

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CiNii Article

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DOI： 10.11477/mf.1407100991

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We analyzed the survival rates, local recurrence rates, and another recurrence rates for patients with solitary hepatocellular carcinoma who received thermal ablation therapies as primary treatment (naive patients). In these 89 patients, 35 cases were ablated by percutaneous radiofrequency ablation (PRFA), 32 were treated by laparoscopic microwave coagulation (LMCT), and 22 were treated by percutaneous microwave coagulation (PMCT). 5-year survival rates were 87% in PRFA, 56% in LMCT, 76% in PMCT. The differences of survival rates were not statistically significant among PRFA, LMCT, and PMCT. 5-year local recurrence rates were 49%, 26%, and 44%, consecutively. No differences were found between therapies. 5-year another recurrence rates were 100%, 81%, and 80%, consecutively. No differences were found statistically.

DOI： 10.3380/jmicrowavesurg.24.87

CiNii Article

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A 53-year-old man with a history of nausea and elevated liver functions presented to our clinic. A CT scan showed a small tumor in the right lobe of the liver. Fluorine-18-fluorodeoxyglucose ( 18F-FDG) positron emission tomography confirm abnormal metabolic activity with a high standardized uptake value of 7.3 in the lesion. These findings could indicate a malignancy such as well-differentiated hepatocellular carcinoma or cholangiocarcinoma, or a benign lesion such as hepatic abscess. He was diagnosed by histopathological examination as having an epithelioid granuloma with many inflammatory cells. This is the rare report of hepatic inflammatory pseudotumor featuring markedly increased 18F-FDG uptake.

DOI： 10.1007/BF02984650

PubMed

Publishing type：Research paper (scientific journal)  

We analyzed the survival rates, local recurrence rates, and another recurrence rates for patients with solitary hepatocellular carcinoma who received thermal ablation therapies as primary treatment (naive patients). In these 89 patients, 35 cases were ablated by percutaneous radiofrequency ablation (PRFA), 32 were treated by laparoscopic microwave coagulation (LMCT), and 22 were treated by percutaneous microwave coagulation (PMCT). 5-year survival rates were 87% in PRFA, 56% in LMCT, 76% in PMCT. The differences of survival rates were not statistically significant among PRFA, LMCT, and PMCT. 5-year local recurrence rates were 49%, 26%, and 44%, consecutively. No differences were found between therapies. 5-year another recurrence rates were 100%, 81%, and 80%, consecutively. No differences were found statistically.

DOI： 10.3380/jmicrowavesurg.24.87

CiNii Article

Publishing type：Research paper (scientific journal)  

Background/Aims: We propose a method, named US score, for semi-quantitative determination of the stage of chronic type C liver disease by ultrasonography.
Methodology: The subjects were 454 patients with chronic type C liver disease. Of the patients with chronic hepatitis C, 208 underwent US-guided or laparoscopic liver biopsy. US score was the sum of the scores representing five morphological variables, to be evaluated semi-quantitatively, and change in US score with chronic liver disease progression was determined.
Results: The average US score was 2.5 +/- 0.4 for For 2.8 +/- 0.6 for F-1, 3.0 +/- 0.6 for F-2, 3.7 +/- 0.9 for F-3 and 5.5 +/- 0.8 for F-4. There was a significant correlation between US score and the degree of fibrosis of chronic hepatitis C as assessed by the new European classification (p&lt;0.0001). The average US score was 5.6 +/- 0.9 for Child A, 6.6 +/- 1.1 for Child B, and 7.8 +/- 0.7 for Child C. There was a significant correlation between US score and the results of classification by Child-Turcotte criteria (P&lt;0.0001).
Conclusions: These results suggest that US score is a stable, convenient method of evaluating the degree of progression of chronic type C liver disease.

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This study evaluated an updated chemiluminescence enzyme immunoassay (CLEIA) for hepatitis C virus (HCV) core protein for monitoring viral kinetics during treatment with interferon (IFN)-α and ribavirin. Using the CLEIA, serum levels of HCV core protein were measured in 17 patients with genotype 1 and high baseline viral loads during the first 4 weeks of combination therapy. HCV RNA was measured by the Amplicor Monitor test for comparison. At the start of therapy, the median HCV level (interquartile range) was 700 (540-940) kIU/ml of viral RNA and 11,310 (5,528-14,238) fmol/L of core protein. HCV RNA was above the upper limit of the linear range of the Amplicor Monitor test in 13 of the 17 patients, while the core protein level was within the linear range of the CLEIA in all patients. During therapy, the proportion of patients with HCV levels below the cutoff values at each time point was less with the Amplicor Monitor test than with CLEIA. Serum HCV core protein level decreased rapidly during the first 24 hr of therapy and more slowly thereafter, with median exponential decays of 1.08 and 0.046 log10/day, respectively. In the second phase, between day 1 and 28, the median decrease in HCV core protein level was higher in four patients with sustained virologic response (0.13 log10/day) than in 13 patients with no response (0.028 log10/day, P=0.042). The wide linear range of the HCV core protein assay is appropriate for measuring viral loads during therapy with IFN-α and ribavirin. © 2005 Wiley-Liss, Inc.

DOI： 10.1002/jmv.20416

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

OBJECTIVES: Hepatocellular carcinoma (HCC) has been reported in patients in whom hepatitis C virus (HCV) was eliminated by interferon (IFN) therapy. We examined the pathogenesis of HCC in patients with sustained viral response.
METHODS: Operable HCC developed in 7 of 342 patients cured of HCV infection by IFN monotherapy. No patient abused alcohol or had diabetes mellitus or obesity. Resected specimens of HCC were histologically evaluated. DNA extracted from HCC was examined by polymerase chain reaction (PCR) to locate hepatitis B virus (HBV) DNA. HBV integration sites in human genome were identified by cassette-ligation-mediated PCR.
RESULTS: HBV DNA was not amplified in serum samples from any of the seven patients with HCC and was found in liver in four patients. In the latter four patients, HBV DNA was integrated into the human genome of HCC. In two of these patients, covalently closed circular HBV (cccHBV) was also detected. The patients with HBV DNA integration were free of HCV for more than 3 yr. In two of the three patients without HBV DNA integration, the surrounding liver showed cirrhosis. The liver of HCC with HBV DNA integration had not progressed to cirrhosis. Three of the four tumors with HBV integration had one integration site each, located at chromosomes 11q12, 11q22-23, and 22q11, respectively. The other tumor had two integration sites, situated at chromosomes 11q13 and 14q32. At chromosome 11q12, HBV DNA was integrated into protein-coding genome, the function of which remains unclear.
CONCLUSION: Integrated HBV DNA may play a role in hepatocarcinogenesis after the clearance of HCV by IFN treatment.

DOI： 10.1111/j.1572-0241.2005.41914.x

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The authors report unusual splenic accumulation of Tc-99m hydroxymethylene diphosphonate (HMDP) on bone scintigraphy of a patient with alcoholic cirrhosis of the liver. Laboratory studies showed hemolytic anemia and hemochromatosis resulting from alcohol abuse, both of which are thought to be related to the diffuse splenic uptake observed. When diffuse splenic accumulation by Tc-99m HMDP is seen, the existence of alcoholic hepatopathy might be considered.

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CiNii Article

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The usefulness of fully automated chemiluminescent microparticle immunoassay (Architect HBsAg QT) for monitoring serum levels of hepatitis B virus (HBV) during antiviral therapy remains unclear. Using this assay, hepatitis B surface antigen (HBsAg) was measured in 20 patients with chronic hepatitis B before and during lamivudine treatment. At the start of therapy, 12 patients had detectable hepatitis B e antigen (HBeAg) and 8 did not. The median serum HBV DNA level and HBsAg concentration (25th-75th centile) were 7.2 (6.1-7.8) log genome equivalents/ml and 3,932 (1,585-12,330) IU/ml, respectively. The HBsAg concentration was significantly higher in HBeAg positive than in HBeAg negative patients (P = 0.031). There was a significant correlation between the HBsAg concentration and HBV DNA level (r = 0.490, P = 0.027). The HBsAg concentration negatively correlated with patient age (r = -0.395, P = 0.085). After the start of lamivudine therapy, HBV DNA levels fell rapidly in all patients. Serum HBsAg concentrations also fell in most patients, but to a lesser extent. When drug-resistant variants emerged, serum HBsAg usually increased before biochemical breakthrough. Although HBV DNA was elevated persistently after the emergence of drug-resistant variants, the increase in HBsAg was transient. In some patients, the increase in HBsAg preceded the increase in HBV DNA. Monitoring of serum HBsAg concentrations with the use of Architect HBsAg QT, in addition to measurement of HBV DNA levels, is helpful for evaluating the response to lamivudine treatment and for the early detection of drug-resistant strains. (C) 2004 Wiley-Liss, Inc.

DOI： 10.1002/jmv.20262

Publishing type：Research paper (scientific journal)  

68 patients with hepatocellular carcinoma were treated with laparoscopic microwave coagulation therapy between April 1995 and February 2003 at our institution. For these 68 case, we analyzed prognostic factors contributing to survival with univariate and multivariate analysis. When the survival rate was assessed for all patients treated with laparoscopic microwave coagulation, one-year survival was 97%, three-year survival was 81%, and five-year survival was 43%. On univariate analysis, only histology was a significant factor for survival. And on multivariate analysis, whether the therapy was primary or secondary HCC strongly influenced survival.

DOI： 10.3380/jmicrowavesurg.23.31

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

68 patients with hepatocellular carcinoma were treated with laparoscopic microwave coagulation therapy between April 1995 and February 2003 at our institution. For these 68 case, we analyzed prognostic factors contributing to survival with univariate and multivariate analysis. When the survival rate was assessed for all patients treated with laparoscopic microwave coagulation, one-year survival was 97%, three-year survival was 81%, and five-year survival was 43%. On univariate analysis, only histology was a significant factor for survival. And on multivariate analysis, whether the therapy was primary or secondary HCC strongly influenced survival.

DOI： 10.3380/jmicrowavesurg.23.31

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Book type：Scholarly book

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肝硬変は従来、低栄養状態をきたす代表的な病態と認識されてきた。しかし近年、肝硬変においても過栄養の患者が少なからず存在し、肥満、インスリン抵抗性が肝発癌のリスクとして注目されるようになった。脂肪性肝疾患、非アルコール性脂肪性肝疾患(NASH)の増加も相まって、肝硬変に対する栄養学的評価・治療はパラダイムシフトを求められている。本稿では肝硬変の栄養評価、栄養治療のガイドライン、鉄制限食、late evening snack(LES)、運動を含む生活指導に関して述べた。非代償期肝硬変に対しては低栄養・消耗性疾患の様相を呈することが多く、nutrition support team(NST)を通じた手厚い低栄養対策が必要である。代償期肝硬変に対しては一律に低栄養として対処するのではなく、個々の症例の食事摂取調査、栄養評価および患者の個性、嗜好に合わせた、行動変容を促す綿密で繊細な食事・生活指導が必要である。肝硬変患者に対する食事栄養療法の分野にも、管理栄養士も参加したテーラーメイドな食事・生活指導の普及が望まれる。(著者抄録)

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Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)