{"id":13,"date":"2007-05-18T18:08:07","date_gmt":"2007-05-18T09:08:07","guid":{"rendered":"http:\/\/aihara.la.coocan.jp\/blog\/?p=13"},"modified":"2014-04-16T15:36:25","modified_gmt":"2014-04-16T06:36:25","slug":"%e8%a1%80%e6%b6%b2%e6%a4%9c%e6%9f%bb%e3%81%a7d-dimer%e7%95%b0%e5%b8%b8%e3%81%aa%e3%82%89%e6%b2%bb%e7%99%82%e7%b6%99%e7%b6%9a%e3%81%99%e3%81%b9%e3%81%8d","status":"publish","type":"post","link":"http:\/\/aihara.la.coocan.jp\/?p=13","title":{"rendered":"\u8840\u6db2\u691c\u67fb\u3067D-dimer\u7570\u5e38\u306a\u3089\u6cbb\u7642\u7d99\u7d9a\u3059\u3079\u304d"},"content":{"rendered":"<div>\n<p>\u672c\u30d6\u30ed\u30b0\u3067\u306f\u57fa\u672c\u7684\u306b\u56fd\u5185\u7814\u7a76\u3092\u691c\u8a0e\u3057\u305f\u3044\u306e\u3067\u3059\u304c\u3001\u3069\u306e\u3088\u3046\u306a\u5f62\u5f0f\u3067\u7d39\u4ecb\u3057\u3066\u3044\u304f\u306e\u304b\u3068\u3044\u3046\u5177\u4f53\u7684\u306a\u4f8b\u3068\u3057\u3066\u3001\u306f\u3058\u3081\u306b\u6d77\u5916\u8ad6\u6587\u3092\u7d39\u4ecb\u3057\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p>\u57fa\u672c\u7684\u306b\u306f\u3001\uff08\u30ec\u30d3\u30e5\u30fc\u306b\u57fa\u3065\u3044\u305f\u7814\u7a76\u306b\u95a2\u3057\u3066\uff09\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3001GRADE\u3092\u5229\u7528\u3057\u305f\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\u8a55\u4fa1\u3092\u2605\u5370\u3067\u8868\u793a\u3057\u3001\u53ef\u80fd\u306a\u3089\u3070\u63a8\u5968\u5ea6\u3082\u8a18\u8f09\u3059\u308b\u3068\u3044\u3046\u65b9\u91dd\u3067\u3059\u3002<\/p>\n<p><\/p>\n<p><b>\u6587\u732e\uff1a<\/b>Palareti G, et al: An abnormal D-dimer test result indicated that anticoagulation should be continued.New Eng J Med 2006; 355: 1780-9<\/p>\n<p><\/p>\n<p><b>\u7814\u7a76\u306e\u8981\u65e8\uff1a<\/b><br \/>\n\u25a0\u81e8\u5e8a\u7591\u554f:\u9759\u8108\u8840\u6813\u75c7\uff08VTE\uff09\u306e\u521d\u56de\u767a\u4f5c\u4f8b\u30673\u30f6\u6708\u4ee5\u4e0a\u3001\u30d3\u30bf\u30df\u30f3K\u62ee\u6297\u5264\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u5834\u5408\u3067\u3001\u6cbb\u7642\u85ac\u5264\u3092\u4e2d\u65ad\u5f8c\u306e1\u30f6\u6708\u6642\u70b9\u3067\u8840\u6f3fD-dimer\u5024\u304c\u7570\u5e38\u306a\u3089VTE\u518d\u767a\u4e88\u6e2c\u306b\u3064\u306a\u304c\u308b\u304b\uff1f<br \/>\n\u25a0\u7814\u7a76\uff1aPRO-LONG\u8a66\u9a13(RCT\uff1aallocation(concealed),  Blinded)<br \/>\n\u25a0\u8a66\u9a13\u304c\u884c\u308f\u308c\u305f\u5834\u6240\uff08\u6d77\u5916\uff1a\u30a4\u30bf\u30ea\u30a2 30\u65bd\u8a2d\uff09<br \/>\n\u25a0\u89b3\u5bdf\u671f\u9593\uff1a\uff5e18\u30f6\u6708\u307e\u3067\uff08\u5e73\u5747 1.4\u5e74\uff09<\/p>\n<p><\/p>\n<p>\n\u25a0\u60a3\u8005\uff08\uff50\uff09\uff1a\u3000\u521d\u56deVTE\uff08\u6df1\u90e8\u9759\u8108\u8840\u6813\u75c7\u3084\u80ba\u6897\u585e\u3092\u542b\u3080\uff09\u767a\u4f5c\u306e\u60a3\u8005619\u4eba\uff08\u5e74\u9f62\u300018-85\u6b73\uff1a\u3000\u5e73\u574763\u6b73\u3001\u7537\u602752%\uff09\u3002\u30d3\u30bf\u30df\u30f3K\u62ee\u6297\u5264\uff08Coumadin or acenocoumarol)\u30923\u30f6\u6708\u4ee5\u4e0a\u5185\u670d\u3057\u3066\u3044\u308b\u8005\u3067\u3001INR\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u76ee\u6a19\u3068\u3057\u3066\u306f2.5\uff082.0-3.0\uff09\u3067\u3001\u6297\u51dd\u56fa\u6cbb\u7642\u3092\u4e2d\u65ad\u305730\u65e5\u5f8c\u306bD-dimer\u691c\u67fb\u3092\u5b9f\u65bd\u3057\u305f\u3002<br \/>\n\u25a0\u4ecb\u5165\uff08I\uff09\uff1a\u3000D-dimer\u7d50\u679c\u304c\u7570\u5e38\u60a3\u8005\u30922\u7fa4\u306b\u5272\u4ed8\u3057\u3001\u4e2d\u65ad\uff08n=122\uff09\u3001\u7d99\u7d9a\uff08n=105\uff09\u3068\u3057\u305f\u3002<br \/>\n\u7d99\u7d9a\u306e\u5834\u5408\u306e\u76ee\u6a19INR\u5024\u306f2.0-3.0\u3068\u3057\u3066\u3001\u691c\u67fb\u3067D-dimer\u5024\u304c\u6b63\u5e38\u306e392\u4f8b\u306f\u6cbb\u7642\u3092\u4e2d\u65ad\u3057\u305f\u3002<br \/>\n\u25a0\u30a2\u30a6\u30c8\u30ab\u30e0\uff08O\uff09\uff1a\u3000VTE\u518d\u767a\u3068\u5927\u51fa\u8840\u3002<br \/>\n\u25a0\u60a3\u8005follow-up\u7387\uff1a\u300098%\u3067\u3001ITT\uff08intention-to-treat)\u89e3\u6790\u3068\u3057\u305f\u3002<br \/>\n&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8211;<\/p>\n<p><\/p>\n<p>[\u7d50\u679c]\uff1a<br \/>\n(1)\u6297\u51dd\u56fa\u6cbb\u7642\u3092\u7d99\u7d9a\u3057\u306a\u304b\u3063\u305f\u7fa4\u3067\u3001VTE\u518d\u767a\u3001\u5927\u51fa\u8840\u304c\u591a\u304b\u3063\u305f\u3002<br \/>\n(2)D-dimer\u6b63\u5e38\u4f8b\u3067\u306eVTE\u518d\u767a\u7387\u306f\u3001\u6297\u51dd\u56fa\u6cbb\u7642\u3092\u4e2d\u65ad\u3057\u305f\u7fa4\u306b\u6bd4\u8f03\u3057\u3066\u4f4e\u304f\uff08p=0.02)\u3001\u6297\u51dd\u56fa\u6cbb\u7642\u306e\u7d99\u7d9a\u7fa4\u3068\u306f\u5dee\u304c\u306a\u304b\u3063\u305f\u3002<br \/>\n\u30aa\u30ea\u30b8\u30ca\u30eb\u6587\u732e\u3067\u306f\u3000HR(hazard ratio)\u3067\u8868\u793a\u3057\u3066\u3044\u308b\u304c\u3001\u3042\u3048\u3066\u3000\uff12\uff58\uff12\u8868\u3067\u30a4\u30d9\u30f3\u30c8\u7387\u3092\u6bd4\u8f03\u3059\u308b\u3068RR\uff1d5.15\uff0895%CI=1.56-17.0)\u3002\u3000NNH=8.3\u3002<\/p>\n<p><\/p>\n<p><a href=\"http:\/\/aihara.la.coocan.jp\/070518.php\" onclick=\"window.open('http:\/\/aihara.la.coocan.jp\/070518.php','popup','width=426,height=173,scrollbars=no,resizable=no,toolbar=no,directories=no,location=no,menubar=no,status=no,left=0,top=0'); return false\"><img decoding=\"async\" loading=\"lazy\" src=\"http:\/\/aihara.la.coocan.jp\/070518-thumb.jpg\" width=\"200\" height=\"81\" alt=\"dimer\" \/><\/a><\/p>\n<p><br clear=\"all\" \/><\/p>\n<p>[\u7d50\u8ad6]<br \/>\nVTE\u521d\u56de\u767a\u4f5c\u4f8b\u3067\u3001\u30d3\u30bf\u30df\u30f3K\u62ee\u6297\u5264\u306b\u3088\u308b\u6297\u51dd\u56fa\u6cbb\u7642\u30923\u30f6\u6708\u4ee5\u4e0a\u53d7\u3051\u3066\u3044\u308b\u60a3\u8005\u3067\u306f\u3001\u6cbb\u7642\u4e2d\u65ad\u5f8c1\u30f6\u6708\u6642\u70b9\u3067\u306eD-dimer\u691c\u67fb\u304c\u7570\u5e38\u306a\u3089\u3070\u3001\u6cbb\u7642\u518d\u958b\u3092\u691c\u8a0e\u3059\u3079\u304d\u3067\u3042\u308b\u3002<\/p>\n<p><\/p>\n<p>xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx<br \/>\n[\u30b3\u30e1\u30f3\u30c8-\uff11] ACP Journal Club 2007; 146: 29 \u53c2\u8003<br \/>\n\u6709\u76ca\u306a\u60c5\u5831\u3067\u3042\u308b\u304c\u3001\u5b9f\u5730\u57fa\u6e96\u3068\u3057\u3066\u78ba\u7acb\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u306a\u3044\u3002\u7406\u7531\u306f\u3001<br \/>\n<b>(1)<\/b>\u5358\u4e00\u306e\u8a66\u9a13\u3067\u3042\u308a\u3001\u78ba\u8a8d\u304c\u5fc5\u8981\u3067\u3042\u308b<br \/>\n<b>(2)<\/b>\u6cbb\u7642\u4e2d\u65ad\u5f8c\u3088\u308a\u306f\u3001\u6cbb\u7642\u4e2d\u65ad\u6642\u70b9\u3067\u306eVTE\u518d\u767a\u95a2\u9023\u306e\u30ea\u30b9\u30af\u56e0\u5b50\u3092\u7279\u5b9a\u3059\u308b\u3001\u5b9f\u969b\u306e\u8a3a\u7642\u62c5\u5f53\u533b\u306b\u3068\u3063\u3066\u3001\u3088\u308a\u3084\u3055\u3057\u3044\u5c64\u5225\u5316\u30b7\u30b9\u30c6\u30e0\u3067\u3042\u308b\u3079\u304d\u3068\u601d\u3046\u3002<br \/>\n<b>(3)<\/b> D-dimer\u691c\u67fb\u6cd5\u306f\u591a\u7a2e\u3042\u308a\u3001\u5404\u3005\u306e\u81e8\u5e8a\u73fe\u5834\u3067\u59a5\u5f53\u6027\u3092\u78ba\u8a8d\u3057\u306a\u304f\u3066\u306f\u306a\u3089\u306a\u3044\u3002\u672c\u7814\u7a76\u3067\u306eD-dimer\u306f\u5b9a\u6027\u691c\u67fb\uff08\u967d\u6027\/\u9670\u6027\uff09\u3067\u3042\u308a\u3001\u5b9a\u91cf\u7684\u691c\u67fb\u3092\u4f7f\u3046\u30e9\u30dc\u304c\u5897\u3048\u3066\u304d\u3066\u3044\u308b\u3002<br \/>\n<b>(4)<\/b>\u672c\u7814\u7a76\u3067\u306f\u3001\u3042\u308b\u60a3\u8005\u3067\u306f\u305f\u3063\u305f3\u30f6\u6708\u9593\u306e\u6297\u51dd\u56fa\u6cbb\u7642\u3067\u3042\u308a\u3001\u3053\u308c\u306f\u8fd1\u5e74\u306e\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u30ec\u30d9\u30eb\u304b\u3089\u3059\u308b\u3068\u77ed\u304f\u3001VTE\u518d\u767a\u30ea\u30b9\u30af\u3092\u5897\u5927\u3055\u305b\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3002<\/p>\n<p><\/p>\n<p>\u3053\u308c\u3089\u306e\u9650\u754c\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001\u672c\u7814\u7a76\u306f\u91cd\u8981\u3067\u3042\u308a\u3001VTE\u60a3\u8005\u306e\u518d\u767a\u30ea\u30b9\u30af\u3092\u7279\u5b9a\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u304c\u3001\u518d\u767a\u6e1b\u5c11\uff08\u6297\u51dd\u56fa\u6cbb\u7642\u7d99\u7d9a\uff09\u3001\u51fa\u8840\u6e1b\u5c11\uff08\u518d\u767a\u30ea\u30b9\u30af\u304c\u4f4e\u3044\u3068\u3044\u3046\u3053\u3068\u304b\u3089\u6cbb\u7642\u4e2d\u65ad\uff09\u306b\u3064\u306a\u304c\u308b\u3002<\/p>\n<p><\/p>\n<p>[\u30b3\u30e1\u30f3\u30c8\u30fc\uff12]\u76f8\u539f<br \/>\nVTE\u306e\u518d\u767a\u3084\u767a\u75c7\u7387\u306b\u95a2\u3057\u3066\u306f\u5358\u7d14\u306b\u30a4\u30bf\u30ea\u30a2\u3068\u6bd4\u8f03\u306f\u3067\u304d\u306a\u3044\u3002<br \/>\n\u51dd\u56fa\u7b2cV\u56e0\u5b50\u306e\u7570\u5e38\u983b\u5ea6\u3084D-dimer\u691c\u67fb\u6cd5\uff08\u56fd\u5185\u3067\u306f\u5b9a\u91cf\u7684\u3001\u304b\u3064\u9ad8\u611f\u5ea6\u306e\u3082\u306e\u304c\u767b\u5834\u3057\u3064\u3064\u3042\u308b\uff09\u304c\u660e\u3089\u304b\u306b\u7570\u306a\u3063\u3066\u3044\u308b\u3002<b>\u63a8\u5968\uff1a\u5f37\u2191\u2191\uff0f\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8cea\uff1a high<\/b><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>\u672c\u30d6\u30ed\u30b0\u3067\u306f\u57fa\u672c\u7684\u306b\u56fd\u5185\u7814\u7a76\u3092\u691c\u8a0e\u3057\u305f\u3044\u306e\u3067\u3059\u304c\u3001\u3069\u306e\u3088\u3046\u306a\u5f62\u5f0f\u3067\u7d39\u4ecb\u3057\u3066\u3044\u304f\u306e\u304b\u3068\u3044\u3046\u5177\u4f53\u7684\u306a\u4f8b\u3068\u3057\u3066\u3001\u306f\u3058\u3081\u306b\u6d77\u5916\u8ad6\u6587\u3092\u7d39\u4ecb\u3057\u307e\u3059\u3002 \u57fa\u672c\u7684\u306b\u306f\u3001\uff08\u30ec\u30d3\u30e5\u30fc\u306b\u57fa\u3065\u3044\u305f\u7814\u7a76\u306b\u95a2\u3057\u3066\uff09\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3001GRADE\u3092\u5229\u7528\u3057\u305f\u30a8 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[13],"tags":[15,14],"_links":{"self":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/13"}],"collection":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13"}],"version-history":[{"count":1,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/13\/revisions"}],"predecessor-version":[{"id":669,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=\/wp\/v2\/posts\/13\/revisions\/669"}],"wp:attachment":[{"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/aihara.la.coocan.jp\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}