著者

佐々木 結花 倉島 篤行 森本 耕三 奥村 昌夫 渡辺 雅人 吉山 崇 尾形 英雄 後藤 元 工藤 翔二 鈴木 裕章

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.89, no.11, pp.797-802, 2014 (Released:2016-09-16)

参考文献数

24

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〔目的〕イソニアジド(INH),リファンピシン(RFP),エタンブトール(EB),クラリスロマイシン(CAM)について,薬剤アレルギーによって投与が中断された後,急速減感作療法(rapid drug desensitization: RDD)を用い再投与が可能となるか検討した。〔対象と方法〕対象は肺結核ないしは肺Mycobacterium avium complex症治療において,何らかのアレルギー反応を生じ治療中断となった13症例で,肺結核6例,肺M.avium症7例であった。RDDのプロトコールは,Hollandら,Cernandasらに準じ作成した。〔結果〕RDDの結果,INH2例,CAM2例は投与可能となった。RFP 12例では8例(66.7%)で,EBでは6例中4例(66.7%)で投与可能となった。〔考察〕ピラジナミド,EBは薬剤耐性結核症例で,EB,CAMは非結核性抗酸菌治療で各々主要薬剤であるが,従来のガイドラインには含まれておらず,結核および非結核性抗酸菌治療に用いる薬剤すべてに施行しうる減感作療法の確立および減感作療法の選択肢を拡大するために,RDDについて検討することは有用であると考えられた。

著者

西浦 博

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.78, no.6, pp.419-426, 2003-06-15 (Released:2011-05-24)

参考文献数

26

被引用文献数

1

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適切な結核対策を進めるための一助とする目的で, われわれは社会経済因子に対する結核罹患率およびその変化率の関係について検討を行った. 東京都特別区において, 1992年統計より得た8つの社会経済因子と, 1988年から1997年の結核新登録患者数から得た標準化結核罹患率より計算した平均年齢調整結核罹患率およびその変化率との関係について後向き生態学的研究を実施した. 重回帰分析の結果, 生活扶助世帯割合 (p<0.001), 10万人当たり公衆浴場数 (p<0.001), 人口密度 (p=0.012), および最低居住水準未満の世帯割合 (P=0.024) について平均年齢調整結核罹患率と正の相関関係を認めた. また, 持ち家世帯割合 (p=0.001), 1人当たり畳数 (p=0.021), および生活扶助世帯割合 (P=0.038) と平均年齢調整結核罹患率変化率との問に負の相関関係を認めた. これらの結果より, 結核罹患に関して明らかな社会経済的要因が存在することが示された. また, 本研究手法は結核に関係していると考えられる個々の社会経済的要因ごとに罹患率の変化を検討する方法として有用であると考えられた.

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.18, no.8, pp.754-754, 1940 (Released:2011-05-24)

著者

青木 正和 片山 透 山岸 文雄 横田 総一郎 亀田 和彦 斎藤 肇 原 耕平 江崎 孝行 河合 忠 四元 秀毅 関口 進

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.69, no.10, pp.593-605, 1994-10-15 (Released:2011-05-24)

参考文献数

8

被引用文献数

8

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Recently, a new kit to detect and indentify mycobacteria in clinical specimens was developed by Japan Roche Co. Limited. The new method is based on amplification of DNA of mycobacteria in clinical specimens by PCR and hybridization of amplified DNA b. microwell plate hybridization method, which is the “AmplicorTM Mycobacteria, Roche. (AMP-M) ”. Cooperative study was organized with 15 tuberculosis hospitals and institu tions throughout Japan, and 349 clinical specimens from newly admitted tuberculosis patients and/or suspects were collected during July and August, 1993. All the specimens were examined by smear microscopy (Ziehl-Neelsen's staining), culture on Ogawa egg media, culture on variant 7H9 liquid media and by AMP-M. Excluding 25 specimens which had failed to identify the species of mycobacteria because of contamination, disability to multiply on the transplanted solid media and so on, the results of the examinations in 324 specimens consisting of 167 specimens from previously untreated cases and those of 157 specimens from previously treated cases were analysed. Main results obtained were as follows;1. Of 70 smear positive specimens from previously untreated cases, culture positive on Ogawa media and 7H9 media, and by AMP-M positive were 59 (84.3%), 61 (87.1%) and 66 (94.3%), respectively. Of 97 smear negative specimens, culture positive were 20 (20.6%), 22 (22.7%) and 27 (27.8%), respectively. The AMP-M showed the highest positive rate in both groups.2. The sensitivity and the specificity of AMP-M in previously untreated cases were calculated by assuming that positive on Ogawa and/or variant 7H9 media is “positive”. The sensitivity was 95.8% (68/71) and the specificity was 94.8% (91/96) for M. tuberculosis in previously untreated cases. The sensitivity and the specificity for M. avium and M. intracellulare were all 100%, although the numbers observed were small.3. So-called false positive of the AMP-M were observed in 5 cases out of 96 culture negatives on both Ogawa and variant 7H9 media. However, all 5 cases were positive by repeated AMP-M, 3 become culture positive later, and another 2 showed clinical findings consistent with tuberculosis. Hence, the authors considered that the false positive rate of the AMP-M method is to be very low in previously untreated cases.4. Of 86 smear positive cases with history of previous chemotherapy, the positive culture on Ogawa media, variant 7H9 media and that by AMP-M method were 64 (74.4%), 77 (89.5%) and 85 (98.8%), respectively. In the smear negative cases, culture positive was 10 out of 71 (14.1%), 13 (18.3%) and 24 (33.8%), respectively.5. The sensitivity and the specificity of the AMP-M were 98.7% (77/78) and 81.0% (64/79) for M. tuberculosis in previously treated cases calculated by the same method as in previously untreated cases. They were 77.8% (7/9) and 100% (148/148) for M. avium, and 100% (4/4) and 100% (153/153) for M. intracellulare.Based on these results, the authors concluded that the AMP-M is a very efficient and rapid method to detect and identify M. tuberculosis, M. avium and/or M. intracellulare in clinical specimens. This method will be useful to diagnose tuberculosis and diseases caused by mycobacteria other than M. tuberculosis rapidly.

著者

結核療法研究協議会

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.46, no.8, pp.325-333, 1971 (Released:2011-05-24)

参考文献数

6

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Tuberculosis Research Committee (Ryoken) investigated comparatively the therapeutic effects of three regimens, i. e., standard triple treatment with SM⋅INH⋅PAS (EB0 group), standard triple treatment plus EB twice weekly (EB2 group) and standard triple treatment plus EB daily (EB7 group), in order to intensify the initial treatment for pulmonary tuberculosis.The cases with positive tubercle bacilli and cavities were subjected to this study and were allocated at random for three regimens.The total number of the c a ses was 272 at the beginning of the treatment, but 48 cases were excluded from the analysis because of the primary drug resistance, etc. Finally, 74cases of EB0 group, 74 cases of EB2 group and 76 cases of EB7 group were analyzed.SM was injected 1 g a day twice weekly, INH was given O.4 g daily in two divided doses, PAS was administered 10 g daily in three divided doses, and EB was given 750 mg daily or twice weekly at the same day when SM was injected.The background factors of the cases in ea c h group were almost similar, but the cases with abundant bacilli on smear and (_??_) by culture were observed somewhat less frequently in EB2 group than in the other two groups.As to the rates of the radiological improvement and the sputum conversion rate, there was no significant difference among three groups. However, the moderate improvement of the fibrocaseous lesions and cavities were recognized sooner in EB2 and EB7 groups than in EB0 group.The number of cases, in which the regimens were changed because of side effects or ineffectiveness, were 8 cases in EB0, group, 9 cases in EB2 group and 5 cases in EB7 group. The number of cases with positive sputum by smear or culture after 12 month's treatments were 3 in EB0 group, none in EB2 group and 1 in EB7 group. Therefore, the rate of these unsuccesful cases in EB0, group, EB2 group and EB7 group was 16.7%, 13.6% and 8.3%, respectively.In order to prove the difference in the effectiveness among three regimens, the follow up-studies for longer period might be required.

著者

伊藤 邦彦 吉山 崇 加藤 誠也 石川 信克

出版者

一般社団法人 日本結核病学会

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.84, no.1, pp.9-14, 2009 (Released:2012-02-21)

参考文献数

6

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〔目的〕一般病院における結核診療の可能性と問題点を探索する。〔対象と方法〕結核モデル病床事業を運営する病院に対してアンケートを行う。〔結果〕アンケート対象75施設の回答率は57%(43⁄75)であった。モデル病床の運営状況はきわめて様々であった。大半の結核患者を一般病院で診療していくことは(条件さえそろえば)可能であると回答した病院は74%であった。モデル病床運営上の問題点としては,感染対策手技の手間(37%),高い空床率(30%),感染対策設備の問題(28%),結核患者診療への超過労働力や人件費(21%),低い診療報酬(16%),看護上の問題(16%),アメニティの不足(14%), 結核患者受け入れ態勢の問題(12%),看護職の知識面での負担増大(12%),診療の質確保(7%),感染のリスク(5%),その他(16%)であった。〔考察と結論〕今後本邦においても一般病院での結核入院診療を推進していかなければならないものと思われるが,これにあたっては未だ多くの解決すべき問題点がある。現在のようなモデル病床事業を拡大し,より広く経験を蓄積していくことが今後も必要と思われる。