{"id":18,"date":"2007-06-20T15:02:14","date_gmt":"2007-06-20T06:02:14","guid":{"rendered":"http:\/\/aihara.la.coocan.jp\/blog\/?p=18"},"modified":"2014-04-16T15:36:25","modified_gmt":"2014-04-16T06:36:25","slug":"%e3%83%af%e3%83%bc%e3%83%95%e3%82%a1%e3%83%aa%e3%83%b3%e3%83%bc%ef%bc%88%ef%bc%91%ef%bc%89","status":"publish","type":"post","link":"http:\/\/aihara.la.coocan.jp\/?p=18","title":{"rendered":"\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u30fc\uff08\uff11\uff09"},"content":{"rendered":"<div>\n<p>\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u306e\u57fa\u672c\u306f\u3001\u30d3\u30bf\u30df\u30f3K\u4f9d\u5b58\u6027\u51dd\u56fa\u56e0\u5b50\u3092\u4f4e\u4e0b\u3055\u305b\u3066\u8840\u6db2\u51dd\u56fa\u80fd\u3092\u6291\u5236\u3059\u308b\u3053\u3068\u306b\u3042\u308a\u3001\u8840\u6813\u75c7\u4e88\u9632\u30fb\u6cbb\u7642\u3068\u3044\u3046\u9762\u3067\u306f\u3001\u6297\u8840\u5c0f\u677f\u5264\u3068\u80a9\u3092\u4e26\u3079\u308b\u3082\u306e\u3067\u3059\u3002\u3053\u306e\u85ac\u5264\u304c\u5404\u60a3\u8005\u3067\u3069\u306e\u7a0b\u5ea6\u52b9\u679c\u304c\u767a\u73fe\u3057\u3066\u3044\u308b\u304b\u3069\u3046\u304b\u3092\u8abf\u3079\u308b\u306e\u304c<b>PT-INR<\/b>\uff08\u4ee5\u4e0bINR\uff09\u3068\u3044\u3046\u51dd\u56fa\u691c\u67fb\u3067\u3001\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u670d\u7528\u60a3\u8005\u3082\u305d\u306e\u6570\u5024\u306a\u3069\u3092\u3088\u304f\u77e5\u3063\u3066\u3044\u308b\u3068\u601d\u3044\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p>INR\u5024\u3092\u307f\u3066\u3001\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u91cf\u3092\u5897\u6e1b\u3055\u305b\u308b\u5fc5\u8981\u304c\u3042\u308a\u3001INR\u304c1\u306b\u8fd1\u3044\u3068\u52b9\u679c\u304c\u306a\u304f\u3001\u9006\u306bINR\u5024\u304c4\uff5e5\u4ee5\u4e0a\u3067\u3042\u308b\u3068\u3001\u51fa\u8840\u306e\u5371\u967a\u304c\u51fa\u3066\u304d\u307e\u3059\u3002\u3053\u308c\u306f\u306a\u306b\u3082\u65b0\u3057\u3044\u3053\u3068\u3067\u306f\u306a\u304f\u5fc3\u623f\u7d30\u52d5\u3068\u3044\u3046\u4e0d\u6574\u8108\u3067\u8133\u5352\u4e2d\u3092\u8d77\u3053\u3057\u3084\u3059\u3044\u60a3\u8005\u306b\u5bfe\u3057\u3059\u308b\u56fd\u5185\u306e\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3082\u3042\u308a\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p>\u591a\u304f\u306e\u533b\u7642\u95a2\u4fc2\u8005\u306f\u3001\u3053\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092\u53c2\u8003\u306b\u3057\u3066\u8a3a\u7642\u3092\u5b9f\u65bd\u3057\u3066\u3044\u307e\u3059\u304c\u3001\u3069\u306e\u7a0b\u5ea6\u4fe1\u983c\u3067\u304d\u308b\u306e\u3067\u3057\u3087\u3046\u304b\uff1f <br \/>\n\u30fb\u30fb\u30fb\u5fc3\u623f\u7d30\u52d5\uff0f\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u3068\u306a\u308b\u3068\u3001\u5fc5\u305a\u5f15\u7528\u3055\u308c\u308b\u56fd\u5185\u306e\u30ad\u30fc\u8ad6\u6587\u304c\u3042\u308a\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p><b>\u8ad6\u6587\uff1a<\/b>Yamaguchi T: Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation : a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. <a href=\"http:\/\/stroke.ahajournals.org\/cgi\/reprint\/31\/4\/817\">Stroke. 2000 Apr;31(4):817-21<\/a><\/p>\n<p><\/p>\n<p>\u3053\u306e\u8ad6\u6587\u306e\u5f71\u97ff\u3067\u56fd\u5185\u306e\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u4f7f\u7528\u57fa\u6e96\u304c\u6c7a\u5b9a\u3057\u305f\u3068\u3044\u3048\u308b\u307b\u3069\u306e\u5f71\u97ff\u529b\u306e\u3042\u308b\u3082\u306e\u3067\u3001\u6d77\u5916\u3067\u3082\u5f15\u7528\u3055\u308c\u201d\u65e5\u672c\u3067\u306e\u72ec\u7279\u306a\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u57fa\u6e96\u201d\u3068\u3057\u3066\u7d39\u4ecb\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u3042\u3048\u3066\u3001\u3053\u306e\u30ad\u30fc\u8ad6\u6587\u306e\u6279\u5224\u7684\u541f\u5473\u306b\u30c1\u30e3\u30ec\u30f3\u30b8\u3068\u3044\u3046\u304b\u3001\u30c1\u30a7\u30c3\u30af\u3057\u3066\u307f\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p>\u624b\u6cd5\uff1a<b>GATE\u30d5\u30ec\u30fc\u30e0<\/b>\u3001\u304a\u3088\u3073<b>GRADE\u30b7\u30b9\u30c6\u30e0<\/b>\u3092\u4f7f\u3063\u3066\u306e\u8868\u793a\u5224\u5b9a\u3067\u3059\u3002<br \/>\nPECOT-T\u306f\u3001GATE\u30d5\u30ec\u30fc\u30e0\u306e#1-3\u3001\u904e\u53bb\u30ed\u30b0\u53c2\u7167\uff085\/14)\u3002\u305d\u306e\u5f8c\u306bGRADE\u30b7\u30b9\u30c6\u30e0\u3067\u3059<\/p>\n<p><\/p>\n<p>\n\u25a0\u30af\u30ea\u30cb\u30ab\u30eb\u30fb\u30af\u30a8\u30c3\u30b7\u30e7\u30f3\uff08Q\uff09\uff1a\u975e\u5f01\u819c\u6027\u5fc3\u623f\u7d30\u52d5(NVAF\uff09\u3067\u306e\u4e8c\u6b21\u4e88\u9632\u3068\u3057\u3066\u3001\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u6cbb\u7642\u306e\u9069\u5207\u306a\u6307\u6a19\u306e\u305f\u3081\u3001\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u5f93\u6765\u91cf\u3068\u4f4e\u7528\u91cf\u6cbb\u7642\u306e\u52b9\u80fd\u3068\u5b89\u5168\u6027\u3092\u691c\u8a0e\u3002<br \/>\n\u25a0\u60a3\u8005\uff08P)\uff1a80\u6b73\u4ee5\u4e0b\u306eNVAF\u3067\u8133\u5352\u4e2d\u3084TIA\u3092\u304a\u3053\u3057\u305f\u3053\u3068\u304c\u3042\u308b\u60a3\u8005<br \/>\n\u25a0\u4ecb\u5165(I)\uff1a\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u6cbb\u7642\u3067\u3001INR\u76ee\u6a19\uff1d2.2\uff5e3.5<br \/>\n\u25a0\u5bfe\u7167\uff08C)\uff1a\u540c\u6cbb\u7642\u3067\u3001INR\u76ee\u6a19\uff1d1.5\uff5e2.2<br \/>\n\u25a0\u30a2\u30a6\u30c8\u30ab\u30e0\uff08O)\uff1a\u8133\u5352\u4e2d\u3001TIA\u3001\u526f\u4f5c\u7528\u51fa\u73fe<br \/>\n\u25a0\u671f\u9593(T)\uff1a\u6700\u4f4e2\u5e74<\/p>\n<p><\/p>\n<p>\n\u25a0\u7814\u7a76\u304c\u884c\u308f\u308c\u305f\u6240\uff1a\u3000\u56fd\u7acb\u5faa\u74b0\u5668\u30bb\u30f3\u30bf\u30fc\u3068\u56fd\u518519\u65bd\u8a2d<br \/>\n\u25a0\u7814\u7a76\u65b9\u6cd5\uff1a\u3000RCT\uff08random allocation)<br \/>\n\u25a0\u30b5\u30f3\u30d7\u30eb\u30b5\u30a4\u30ba\u898b\u7a4d\u3082\u308a\uff1d260\u4f8b(90%power, \u03b1=.05\u3001x2 test\u3001log-rank)<br \/>\n&#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>\n<a href=\"http:\/\/aihara.la.coocan.jp\/warfarin-11.php\" onclick=\"window.open('http:\/\/aihara.la.coocan.jp\/warfarin-11.php','popup','width=237,height=323,scrollbars=no,resizable=no,toolbar=no,directories=no,location=no,menubar=no,status=no,left=0,top=0'); return false\" onkeypress=\"window.open('http:\/\/aihara.la.coocan.jp\/warfarin-11.php','popup','width=237,height=323,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\/warfarin-1-thumb.jpg\" width=\"200\" height=\"272\" alt=\"af\" \/><\/a><\/p>\n<p><b>[\u7d50\u679c\u30fb\u7d50\u8ad6]\uff1a<\/b><br \/>\n(1)115\u4f8b(\u5e73\u5747\u5e74\u9f6267\u624d\uff09\u30922\u7fa4\u306b\u5206\u3051\u3066\u3001conventional\u7fa4\uff08n=55)\u3001low-intensity\u7fa4(n=60)\u3067\u6bd4\u8f03\u3001   \u89b3\u5bdf\u671f\u9593\u306f658\u00b1423\u65e5\u3067\u3042\u3063\u305f\u3002<br \/>\n(2)\u51fa\u8840\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u306f\u3001conv\u7fa4\uff086.6%\/\u5e74\uff09\u3067\u3001low dose\u7fa4\uff080%\/\u5e74\uff09\u3067\u6709\u610f\u5dee\u304c\u3042\u3063\u305f\uff08Fisher, p=0.01)<br \/>\n\u3057\u304b\u3057\u3001log-rank\u691c\u5b9a\u3067\u306f\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002<br \/>\n\u51fa\u8840\u60a3\u8005\u306f\u5168\u306674\u6b73\u4ee5\u4e0a\u3067\u3001\u30a4\u30d9\u30f3\u30c8\u524d\u306eINR\u5024\u306f2.8\u3060\u3063\u305f\u3002<br \/>\n(3)\u5e74\u9593\u306e\u865a\u8840\u6027\u8133\u5352\u4e2d\u30a4\u30d9\u30f3\u30c8\u306f\u30011.1%\/\u5e74\u30011.7%\/\u5e74\u3067\u3001\u6709\u610f\u5dee\u306f\u306a\u304b\u3063\u305f\u3002<br \/>\n(4)\u7d50\u8ad6\u306f\u3001\u9ad8\u9f62\u8005NVAF\u306e\u30ef\u30fc\u30d5\u30a1\u30ea\u30f3\u4e8c\u6b21\u4e88\u9632\u3068\u3057\u3066\u306f\u3001INR\u5024\u306f1.5-2.1\u76ee\u6a19\u304c\uff08\u5f93\u6765\u91cf\u3088\u308a\uff09\u5b89\u5168\u3002<br \/>\n(5)\u306a\u304a\u3001\u672c\u89e3\u6790\u306f\u3001\u5229\u76ca\u3068\u5bb3\u3092\u6bd4\u8f03\u691c\u8a0e\u3057\u3066\u30013\u56de\u306e\u4e2d\u9593\u89e3\u6790\u3067\u3001\u65e9\u671f\u4e2d\u65ad\u3068\u3057\u305f\u3002<\/p>\n<p>xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx<br \/>\n<b>[\u30b3\u30e1\u30f3\u30c8]<\/b>\u7d50\u8ad6\u3068\u3057\u3066\u3001\u3069\u3046\u3057\u3066\u3053\u306e\u7814\u7a76\u7d50\u679c\u304c\u56fd\u5185\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u3082\u5f71\u97ff\u3059\u308b\u3082\u306e\u304b\u7406\u89e3\u3067\u304d\u307e\u305b\u3093\u3002<\/p>\n<p><\/p>\n<p>(1)GATE\u3067\u3082\u3001GRADE\u30b7\u30b9\u30c6\u30e0\u3067\u3082\u540c\u3058\u3067\u3059\u304c\u3001RCT\u3068\u3044\u3046\u826f\u8cea\u306a\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u306f\u8a8d\u3081\u307e\u3059\u3002 \u3057\u304b\u3057\u3001<b>\u30b5\u30f3\u30d7\u30eb\u30b5\u30a4\u30ba\u304c260\u4f8b<\/b>\uff08FIsher\u3042\u308b\u3044\u306f\u30a4\u30a8\u30fc\u30c4\u88dc\u6b63\u3067\u306e\u7b97\u51fa\u304b\uff09\u3068\u3042\u308a\u306a\u304c\u3089\u3001\u5b9f\u969b\u306b\u6bd4\u8f03\u3057\u305f2\u7fa4\u306e\u4f8b\u6570\u306f\u300155\u4f8b\u306860\u4f8b\uff01\u3067\u3059\u3002\u5f93\u3063\u3066\u3001\u5f53\u521d\u306e\u898b\u7a4d\u3082\u308a\u306e1\/4\u3067\u3059\u3002\u3053\u308c\u306f\u65e9\u671f\u4e2d\u65ad\u3068\u3044\u3046\u3053\u3068\u3067\u3001GRADE\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u30ec\u30d9\u30eb\u306e\u30c0\u30a6\u30f3\u30b0\u30ec\u30fc\u30c9\u3067\u3059\uff08Montori VM, JAMA 2005; 294:2203-\u53c2\u7167)<\/p>\n<p><\/p>\n<p>\u3055\u3089\u306b\u3001\u8ad6\u6587\u306b\u306f11\u4f8b\u304c\u8131\u843d\u3068\u8a18\u8f09\u3057\u3066\u3044\u307e\u3059\u3002\u30a4\u30d9\u30f3\u30c8\u306e\u6570\u3082\u5404\u7fa4\u30671\u4ef6\u30012\u4ef6\u3067\u3042\u308a\u3001&#8221;sparse data&#8221;\u3067\u3059\u3002\u3053\u308c\u3089\u306f\u6df1\u523b\u306aimprecision\u3067\u3059\u3002 <br \/>\n\u306a\u305c\u3001\u3053\u306e\u3088\u3046\u306a\u5c11\u4eba\u6570\u3067\u306e\u7814\u7a76\u3092\u300120\u65bd\u8a2d\u3082\u306e\u533b\u7642\u6a5f\u95a2\u304c\u53c2\u52a0\u3057\u3066\u3044\u306a\u304c\u3089\u306e\u9ed9\u8a8d\u767a\u8868\u3067\u304d\u308b\u306e\u304b\u7591\u554f\u3067\u3059\u3002\u30b5\u30f3\u30d7\u30eb\u30b5\u30a4\u30ba\uff1d260\u4f8b\u3001\u3067\u5404\u7fa4\u3092\u5408\u308f\u305b\u308b\u3068\u3001520\u4f8b\u306f\u5fc5\u8981\u3067\u3059\u3002 \u540c\u30b0\u30eb\u30fc\u30d7\u306f\u305d\u306e\u5f8c\u3082\u5225\u8ad6\u6587\u3092\u767a\u8868\uff08Yasaka 2001\uff09\u3057\u3066\u3044\u307e\u3059\u304c\u3001\u540c\u3058\u3088\u3046\u306a\u904e\u3061\u3092\u7e70\u308a\u8fd4\u3057\u3066\u3044\u307e\u3059\u3002\u8981\u3059\u308b\u306b\u03b1\u30a8\u30e9\u30fc\u3084\u03b2\u30a8\u30e9\u30fc\u306e\u53ef\u80fd\u6027\u304c\u5927\u304d\u3044\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/p>\n<p><\/p>\n<p> 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\/>\n\u8457\u8005\u3089\u306f\u3001\u51dd\u56fa\u56e0\u5b50\u306e\u534a\u6e1b\u671f\u3092\u628a\u63e1\u3057\u3066\u3044\u308b\u306e\u3060\u308d\u3046\u304b\uff1fINR\u306e\u8a55\u4fa1\u306a\u3069\u306f\u30a8\u30ad\u30b9\u30d1\u30fc\u30c8\u304c\u5b9f\u65bd\u3057\u305f\u3068\u8a18\u8f09\u3057\u3066\u3044\u307e\u3059\u304c\u3001\u73fe\u5b9f\u306e\u81e8\u5e8a\u306b\u304a\u3044\u3066\u4eca\u56de\u306e\u8ad6\u6587\u306b\u3042\u308b\u3088\u3046\u306a\u7a0b\u5ea6\u306eINR\u306e\u76f8\u9055\u3092\u30b3\u30f3\u30b9\u30bf\u30f3\u30c8\u306b\u7dad\u6301\u3067\u304d\u308b\u533b\u5e2b\u306f\u7686\u7121\u3068\u601d\u3044\u307e\u3059\u3002<\/p>\n<p><\/p>\n<p>(3)<b>Mean\u00b1SD\u8868\u793a\u306b\u3064\u3044\u3066<\/b>\uff1aINR\u5024\uff1d2.3\u00b10.4\u3068\u3044\u3046\u3053\u3068\u306f\u30013SD\u3068\u3057\u3066\u3082\u3001INR\uff1d3.5\u4ee5\u5185\u306b99%\u304c\u5b58\u5728\u3057\u3066\u3044\u308b\u3067\u3042\u308d\u3046\u3057\u3001\u305d\u306e\u70b9\u304b\u3089\u3082\u7591\u554f\u306e\u3042\u308b\u30c7\u30fc\u30bf\u3067\u3059\u3002<br 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