{"id":49,"date":"2025-02-23T21:59:29","date_gmt":"2025-02-23T12:59:29","guid":{"rendered":"https:\/\/kumagai-clinic.jp\/blog\/?p=49"},"modified":"2025-02-23T21:59:30","modified_gmt":"2025-02-23T12:59:30","slug":"post-49","status":"publish","type":"post","link":"https:\/\/kumagai-clinic.jp\/blog\/index.php\/2025\/02\/23\/post-49\/","title":{"rendered":"\u814e\u6027\u8ca7\u8840\u6cbb\u7642\u306b\u3064\u3044\u3066\u306e\u8b1b\u6f14\u4f1a"},"content":{"rendered":"\u814e\u6027\u8ca7\u8840\u6cbb\u7642\u306b\u3064\u3044\u3066\u306e\u8b1b\u6f14\u4f1a\u30922025\u5e742\u670819\u65e5\u306b\u5175\u5eab\u770c\u5c3c\u5d0e\u5e02\u897f\u6606\u967d\u306b\u3066\u884c\u3044\u307e\u3057\u305f\u3002\u5f53\u65e5\u306f\u3044\u308d\u3044\u308d\u3068\u8cea\u554f\u3044\u305f\u3060\u304d\u3001\u3044\u308d\u3044\u308d\u3068\u52c9\u5f37\u306b\u306a\u308a\u307e\u3057\u305f\u3002<br \/>\u8b1b\u6f14\u306e\u5185\u5bb9\u3092\u4ee5\u4e0b\u306b\u7c21\u5358\u306b\u8a18\u8f09\u3057\u307e\u3059\u3002<br \/>\u2606\u814e\u6027\u8ca7\u8840\u3068\u306f<br \/>\u814e\u6027\u8ca7\u8840\u306f\u3001\u814e\u969c\u5bb3\u306b\u4f34\u3044\u51fa\u73fe\u3059\u308b\u8ca7\u8840\u3067\u3042\u308a\u3001\u305d\u306e\u4e3b\u305f\u308b\u539f\u56e0\u306f\u814e\u81d3\u304b\u3089\u7523\u751f\u3055\u308c\u308b\u8d64\u8840\u7403\u7523\u751f\u523a\u6fc0\u56e0\u5b50\u3067\u3042\u308b\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u306e\u76f8\u5bfe\u7684\u5206\u6ccc\u4f4e\u4e0b\u3067\u3042\u308b\u3002<br \/>\u305d\u308c\u306e\u307f\u304c\u539f\u56e0\u3067\u306f\u306a\u304f\u3001\u814e\u969c\u5bb3\u306b\u4f34\u3046\u5c3f\u6bd2\u75c7\u3001\u9178\u5316\u30b9\u30c8\u30ec\u30b9\u3001\u6162\u6027\u708e\u75c7\u306a\u3069\u306b\u3088\u308b\u8d64\u8840\u7403\u7523\u751f\u306e\u6291\u5236\u3001\u3042\u308b\u3044\u306f\u8d64\u8840\u7403\u5bff\u547d\u306e\u77ed\u7e2e\u306a\u3069\u3082\u539f\u56e0\u3068\u3057\u3066\u95a2\u4e0e\u3057\u3066\u3044\u308b\u3002<br \/>\u814e\u6027\u8ca7\u8840\u306f\u3001\u814e\u6a5f\u80fd\u4f4e\u4e0b\u3092\u6307\u6a19\u3068\u3057\u3066\u307f\u305f\u5834\u5408\u306f\u3001\u6162\u6027\u814e\u81d3\u75c5\u30b9\u30c6\u30fc\u30b8\u3067\u3044\u3048\u3070\u3001\u30b9\u30c6\u30fc\u30b8G3\u4ee5\u964d\u306b\u8a8d\u3081\u3089\u308c\u308b\u3053\u3068\u304c\u307b\u3068\u3093\u3069\u3067\u3042\u308b\u3002\u305d\u3057\u3066\u3001\u814e\u6a5f\u80fd\u304c\u4f4e\u4e0b\u3059\u308b\u306b\u3064\u308c\u814e\u6027\u8ca7\u8840\u306f\u5897\u52a0\u3059\u308b\u3002<br \/>\u307b\u3068\u3093\u3069\u306e\u814e\u6027\u8ca7\u8840\u75c7\u4f8b\u3067\u306f\u3001\u8840\u4e2d\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u30ec\u30d9\u30eb\u306f\u6b63\u5e38\u4e0a\u9650\u3092\u3084\u3084\u8d85\u3048\u305f\u7d0450\u56fd\u969b\u5358\u4f4d\uff08IU\uff09\/mL\u672a\u6e80\u306b\u3068\u3069\u307e\u308b\u3002<br \/>\u814e\u6027\u8ca7\u8840\u306e\u554f\u8a3a\u3067\u306f\u3001\u75c7\u72b6\u3068\u3057\u3066\u8ca7\u8840\u75be\u60a3\u306b\u5171\u901a\u3057\u3066\u307f\u3089\u308c\u308b\u5168\u8eab\u5026\u6020\u611f\u3001\u52b4\u4f5c\u6642\u606f\u5207\u308c\u3001\u52d5\u60b8\u306a\u3069\u304c\u8074\u53d6\u3055\u308c\u308b\u3002<br \/>\u3057\u304b\u3057\u3001\u6162\u6027\u7684\u306b\u9032\u884c\u3059\u308b\u8ca7\u8840\u306a\u306e\u3067\u3001\u60a3\u8005\u81ea\u8eab\u306f\u8ca7\u8840\u75c7\u72b6\u3092\u81ea\u899a\u3057\u3066\u3044\u306a\u3044\u3053\u3068\u304c\u591a\u3044\u3002<br \/>\u8a3a\u5bdf\u4e0a\u3001\u773c\u77bc\u7d50\u819c\u306e\u8ca7\u8840\u6240\u898b\u304c\u91cd\u8981\u3067\u3042\u308b\u3002<br \/><br \/>\u2606\u814e\u6027\u8ca7\u8840\u306e\u8a3a\u65ad<br \/>\u8ca7\u8840\u304c\u8a8d\u3081\u3089\u308c\u3001eGFR<60mL\/min\/1.73m2\u3067\u3042\u308c\u3070\u814e\u6027\u8ca7\u8840\u3092\u601d\u3044\u6d6e\u304b\u3079\u308b\u3002<br \/>\u6b21\u306b\u3001\u9451\u5225\u8a3a\u65ad\u3068\u3057\u3066\u5e73\u5747\u8d64\u8840\u7403\u5bb9\u7a4d\uff08MCV\uff09\u3092\u6e2c\u5b9a\u3059\u308b\u3002\u814e\u6027\u8ca7\u8840\u306e\u307b\u3068\u3093\u3069\u306f\u3001\u6b63\u7403\u6027\u8ca7\u8840\u306b\u5c5e\u3059\u308b\u304c\u3001\u4e00\u90e8\u306e\u75c7\u4f8b\u306f\u5927\u7403\u6027\u8ca7\u8840\u306e\u7bc4\u56f2\u306eMCV\u5024\u3092\u5448\u3059\u308b\u3002\u5c0f\u7403\u6027\u8ca7\u8840\u3067\u3042\u308c\u3070\u3001\u9244\u6b20\u4e4f\u6027\u8ca7\u8840\u306a\u3069\u4ed6\u306e\u8ca7\u8840\u75be\u60a3\u306e\u5408\u4f75\u3092\u8003\u3048\u308b\u3002<br \/>\u7db2\u8d64\u8840\u7403\u306f\u9aa8\u9ac4\u3067\u306e\u8d64\u8840\u7403\u9020\u8840\u3092\u53cd\u6620\u3057\u3066\u304a\u308a\u3001\u814e\u6027\u8ca7\u8840\u3067\u306f\u6b63\u5e38\uff5e\u6e1b\u5c11\u3092\u5448\u3059\u308b\u3002\u7db2\u8d64\u8840\u7403\u306e\u6a19\u6e96\u5316\u3055\u308c\u305f\u57fa\u6e96\u5024\u306f\u306a\u3044\u304c\u300110\u4e07\/\u03bcL\u4ee5\u4e0b\u3067\u3042\u308b\u5834\u5408\u306f\u6b63\u5e38\uff5e\u6e1b\u5c11\u3068\u5224\u65ad\u3059\u308b\u3002<br \/>\u8840\u4e2d\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u6fc3\u5ea6\u6e2c\u5b9a\u306f\u53c2\u8003\u306b\u306a\u308b\u300250 IU\/mL\u672a\u6e80\u3067\u306f\u814e\u6027\u8ca7\u8840\u306e\u53ef\u80fd\u6027\u3092\u7591\u3046\u3002<br \/>\u814e\u6a5f\u80fd\u304ceGFR\uff1e60 mL\/min\/1.73 m2\u3067\u3042\u308c\u3070\u3001\u814e\u6027\u8ca7\u8840\u306f\u5426\u5b9a\u7684\u3067\u3042\u308b\u3002<br \/>\u3057\u304b\u3057\u3001\u9ad8\u9f62\u8005\u3067\u306f\u814e\u6a5f\u80fd\u304ceGFR\uff1e60 mL\/min\/1.73 m2\u3067\u3042\u3063\u3066\u3082\u3001\u814e\u81d3\u304b\u3089\u306e\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u7523\u751f\u304c\u4f4e\u4e0b\u3057\u3066\u3044\u308b\u5834\u5408\u304c\u3042\u308b\u3002\u305d\u306e\u5834\u5408\u306f\u3001\u8840\u4e2d\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u30ec\u30d9\u30eb\u304c50 mIU\/mL\u672a\u6e80\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3057\u3066\u814e\u6027\u8ca7\u8840\u3068\u8a3a\u65ad\u3059\u308b\u3002<br \/><br \/>\u2606\u814e\u6027\u8ca7\u8840\u306e\u6cbb\u7642<br \/>\u814e\u6027\u8ca7\u8840\u306b\u5bfe\u3057\u3066\u306f\u3001\u6cbb\u7642\u85ac\u3068\u3057\u3066\u8d64\u8840\u7403\u9020\u8840\u523a\u6fc0\u56e0\u5b50\u88fd\u5264\uff08ESA\uff09\u3082\u3057\u304f\u306fHIF-PH\u963b\u5bb3\u85ac\u3092\u4f7f\u7528\u3059\u308b\u3002\u5c11\u91cf\u306e\u4f7f\u7528\u91cf\u304b\u3089\u958b\u59cb\u3057\u3001Hb\u5024\u3042\u308b\u3044\u306fHb\u5024\u4e0a\u6607\u901f\u5ea6\u3092\u898b\u306a\u304c\u3089\u4f7f\u7528\u91cf\u3092\u5897\u3084\u3059\u3002<br \/>\u9244\u6b20\u4e4f\u6027\u8ca7\u8840\u304c\u3042\u308c\u3070\u3001\u814e\u6027\u8ca7\u8840\u6cbb\u7642\u85ac\u4f7f\u7528\u524d\u306b\u9244\u5264\u3067\u88dc\u5145\u6cbb\u7642\u3092\u3059\u308b\u3002\u539f\u5247\u3068\u3057\u3066\u6cbb\u7642\u306b\u306f\u5185\u670d\u9244\u5264\u3092\u7528\u3044\u308b\u3002\u8840\u6db2\u900f\u6790\u60a3\u8005\u3067\u3042\u308c\u3070\u9759\u6ce8\u9244\u5264\u3092\u8003\u616e\u3059\u308b\u3002<br \/>\u8d64\u8840\u7403\u9020\u8840\u523a\u6fc0\u56e0\u5b50\u88fd\u5264\uff08ESA\uff09\u306e\u7a2e\u985e\u306b\u306f\u3001\u2460\u30a8\u30dd\u30a8\u30c1\u30f3\u30a2\u30eb\u30d5\u30a1\uff08\u30a8\u30b9\u30dd\u30fc\uff09\u307e\u305f\u306f\u30d9\u30fc\u30bf\uff08\u30a8\u30dd\u30b8\u30f3\uff09\u3001\u2461\u30c0\u30eb\u30d9\u30dd\u30a8\u30c1\u30f3\u30a2\u30eb\u30d5\u30a1\uff08\u30cd\u30b9\u30d7\uff09\u3001\u2462\u30a8\u30dd\u30a8\u30c1\u30f3\u30d9\u30fc\u30bf\u30da\u30b4\u30eb\uff08\u30df\u30eb\u30bb\u30e9\uff09\u306e3\u7a2e\u985e\u304c\u5b58\u5728\u3059\u308b\u3002\u4fdd\u5b58\u671f\u814e\u4e0d\u5168\u60a3\u8005\u3067\u306f\u3001\u6295\u4e0e\u9593\u9694\u304c\u3042\u3051\u3089\u308c\u308b\u9577\u671f\u4f5c\u7528\u578bESA\u3067\u3042\u308b\u30c0\u30eb\u30d9\u30dd\u30a8\u30c1\u30f3\u30a2\u30eb\u30d5\u30a1\u3001\u30a8\u30dd\u30a8\u30c1\u30f3\u30d9\u30fc\u30bf\u30da\u30b4\u30eb\u304c\u4f7f\u7528\u3057\u3084\u3059\u3044\u3002<br \/>\u9577\u6642\u9593\u4f5c\u7528\u578bESA\u306f\u3001\u4f7f\u7528\u91cf\u306e\u8abf\u7bc0\u306b\u3088\u308aHb\u5024\u30aa\u30fc\u30d0\u30fc\u30b7\u30e5\u30fc\u30c8\uff08Hb\u5024\uff1e13.0 g\/dL\uff09\u306e\u7387\u3092\u6e1b\u3089\u3059\u3053\u3068\u304c\u3067\u304d\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002<br \/>\u6025\u6fc0\u306aHb\u5024\u306e\u4e0a\u6607\u306b\u3088\u308a\u9ad8\u8840\u5727\u3092\u60f9\u8d77\u3059\u308b\u75c7\u4f8b\u304c\u5b58\u5728\u3059\u308b\u306e\u3067\u3001\u964d\u5727\u7642\u6cd5\u3092\u5341\u5206\u306b\u884c\u3044\u306a\u304c\u3089\u6025\u6fc0\u306aHb\u5024\u306e\u4e0a\u6607\u3092\u56de\u907f\u3057ESA\u6cbb\u7642\u3059\u308b\u3053\u3068\u3092\u63a8\u5968\u3059\u308b\u3002<br \/>ESA\u306e\u526f\u4f5c\u7528\u3068\u3057\u3066\u306f\u3001\u9ad8\u8840\u5727\u3001\u8840\u6813\u75c7\u306b\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002<br \/>\u8d64\u82bd\u7403\u7646\uff08\u983b\u5ea6\u4e0d\u660e\uff09\uff1aESA\u4f7f\u7528\u6642\u3001\u6297\u30a8\u30ea\u30b9\u30ed\u30dd\u30a8\u30c1\u30f3\u6297\u4f53\u7523\u751f\u3092\u4f34\u3046\u8d64\u82bd\u7403\u7646\u304c\u73fe\u308c\u308b\u3053\u3068\u304c\u3042\u308b\u306e\u3067\u3001\u6295\u4e0e\u4e2d\u306f\u5341\u5206\u6ce8\u610f\u3057\u3001\u5fc5\u8981\u306b\u5fdc\u3058\u3066\u85ac\u5264\u306e\u6295\u4e0e\u3092\u4e2d\u6b62\u3059\u308b\u3002<br \/>\u60aa\u6027\u816b\u760d\u306e\u3042\u308b\u75c7\u4f8b\u306b ESA\u3092\u4f7f\u7528\u3059\u308b\u969b\u306f\u3001\u816b\u760d\u60aa\u5316\u306b\u6ce8\u610f\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002<br \/><br \/>\u2606\u7d30\u80de\u306e\u4f4e\u9178\u7d20\u5fdc\u7b54-HIF<br \/>2019\u5e74\u306e\u30ce\u30fc\u30d9\u30eb\u533b\u5b66\u751f\u7406\u5b66\u8cde\uff1a\u7d30\u80de\u304c\u9178\u7d20\u4e0d\u8db3\u306e\u74b0\u5883\u3067\u3082\u5fdc\u7b54\u3059\u308b\u4ed5\u7d44\u307f\u3092\u89e3\u660e<br \/>\u4f4e\u9178\u7d20\u306e\u74b0\u5883\u3067\u306f\uff0cHIF-1\u03b1\u304c\u5206\u89e3\u305b\u305a\u6838\u5185\u306b\u84c4\u7a4d\u3059\u308b\u3002\u3053\u306e\u3068\u304dHIF-1\u306e\u4e00\u90e8\u3067\u3042\u308bARNT\u304c\uff0c\u4f4e\u9178\u7d20\u306b\u5fdc\u7b54\u3059\u308b\u907a\u4f1d\u5b50\u306e\u8ee2\u5199\u8abf\u7bc0\u9818\u57df\u306b\u3042\u308b\u7279\u5b9a\u306eDNA\u9818\u57df\u3068\u7d50\u5408\u3059\u308b\u3002\u9178\u7d20\u304c\u666e\u901a\u306b\u3042\u308b\u3068\u304d\u306f\uff0cHIF-1\u03b1\u306f\u30d7\u30ed\u30c6\u30a2\u30bd\u30fc\u30e0\u306b\u3088\u3063\u3066\u8fc5\u901f\u306b\u5206\u89e3\u3055\u308c\u308b\u3002HIF-1\u03b1\u304c\u6c34\u9178\u5316\u3055\u308c\uff0cVHL\u30bf\u30f3\u30d1\u30af\u8cea\u304cHIF-1\u03b1\u3092\u8a8d\u8b58\u3057\u3066\u7d50\u5408\u3057\uff0c\u5206\u89e3\u304c\u9032\u3080\u3002<br \/><br \/>HIF\u306f\u03b1\u9396\u3068\u03b2\u9396\u306b\u3088\u308b\u30d8\u30c6\u30ed\u4e8c\u91cf\u4f53\u3092\u69cb\u6210\u3059\u308b\uff0e<br \/><br \/>HIF-\u03b1\u306b\u306fHIF-1\u03b1\uff0cHIF-2\u03b1\uff0cHIF-3\u03b1\u306e\u30a2\u30a4\u30bd\u30d5\u30a9\u30fc\u30e0\u304c\u5b58\u5728\u3057\uff0c\u305d\u308c\u305e\u308c\u56fa\u6709\u306e\u6a5f\u80fd\u3092\u6709\u3057\u3066\u3044\u308b\uff0eEPO\u306e\u7523\u751f\u306b\u95a2\u4e0e\u3057\u3066\u3044\u308b\u306e\u306fHIF-2\u03b1\u3068\u3055\u308c\u3066\u3044\u308b\uff0e<br \/><br \/>\u9178\u7d20\u5206\u5b50\u306e\u5b58\u5728\u4e0b\u3067\u03b1\u9396\u306e\u30d7\u30ed\u30ea\u30f3\u6b8b\u57fa\u304c\u6c34\u9178\u5316\u3055\u308c\uff0c\u3053\u308c\u304c\u5f15\u304d\u91d1\u3068\u306a\u3063\u3066\u30e6\u30d3\u30ad\u30c1\u30f3\u30ea\u30ac\u30fc\u30bc\u8907\u5408\u4f53\u306e\u69cb\u6210\u6210\u5206\u3067\u3042\u308bvon Hippel-Lindau\uff08pVHL\uff09\u30bf\u30f3\u30d1\u30af\u304c\u7d50\u5408\u3057\uff0c\u30d7\u30ed\u30c6\u30a2\u30bd\u30fc\u30e0\u5206\u89e3\u3092\u53d7\u3051\u308b\uff0e<br 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