緑内障などの眼疾患による視野障害からの 交通事故リスク推定法の確立 ― 平成 27 年度（中間報告） タカタ財団助成研究論文 ― ISSN 2185-8950 研究代表者 朝岡 亮 研究実施メンバー 研究代表者 東京大学 医学部 附属病院眼科 朝岡 亮 ሗ࿌᭩ᴫせ ୧║ど㔝᥎ᐃἲ ᮏࣉࣟࢪ࢙ࢡࢺࡣ㸪 ┠ⓗ㸸ඃ║ࡼࡗ࡚⿵ṇࢆ⾜࠸ OLQHDU VFDOH ⾲♧ࡋࡓ༢║ど㔝ࢆ⏝࠸ࡿ୧║ど㔝ண ್ࡀᨵၿࡉࢀࡿ᳨ウࡍࡿࡇ ᪉ἲ㸸㛤ᨺ㝮ゅ⥳ෆ㞀 ே ║ ༢║ど㔝ࡲࡓࡣ୧║ど㔝 ᐃࡣࣁࣥࣇ࣮ࣜど㔝᳨ᰝ 6,7$VWDQGDUG ࢆ⏝࠸ࡓ ඃ║ ᐃࡣ୧║ࡶᅇࡎࡘ⾜࠸ ᖹᆒ್ࢆゎᯒ⏝࠸ ࡓ ᐃࡉࢀࡓ୧║ど㔝ࡣ௨ୗࡢ ࡘࡢ᪉ἲࢆ⏝࠸࡚༢║ど㔝ࡽண ࢆ⾜ࡗࡓ 㸨௨ୗグ㍕ᵝᘧࢧࣥࣉࣝ ձ ,9) PHWKRG ղ PRQRFXODU VHQVLWLYLW\ VXPPDWLRQ PHWKRGV RQ WKH G% VFDOH ճ ┠ ḟ㸦 㺬㺽㺐㺻㺢ኴᩥᏐ㸧 OLQHDUVFDOH/DPEHUWմPRQRFXODUVHQVLWLYLW\VXPPDWLRQPHWKRGVRQWKHOLQHDU VFDOHDGMXVWHGIRUWKHRFXODUGRPLQDQFH ⥳ෆ㞀࡞ࡢ║ᝈࡼࡿど㔝㞀ᐖࡽࡢ㏻ᨾࣜࢫࢡ᥎ᐃἲࡢ☜❧ ➨ ❶ࡣࡌࡵ ⤖ᯝ㸸⤯ᑐ್࡛⾲♧ࡋࡓ ᐃㄗᕪࡣ OLQHDU VFDOH PHDQs6' sࡀ ,9) ◊✲⫼ᬒ ࡉࡽ ඃ║ࡼࡗ࡚⿵ṇ PHWKRGsࡼࡾࡶ᭷ពᑠࡉࡗࡓS ┠ⓗ ➨ ❶᪉ἲ ࡋࡓ᪉ἲ sࡀ ⿵ṇࡋ࡞࠸᪉ἲࡼࡾࡶඃ ᐃㄗᕪࡀ᭷ពᑠࡉࡃ࡞ࡗ ୧║ど㔝᥎ᐃἲ ࡓS WKHG%VFDOHVXPPDWLRQPHWKRGsࡣࡢ᪉ἲࡼࡾࡶ ᐃㄗ ㏻ᨾどᶵ⬟ࡢ㛵㐃 ➨ ❶⤖ᯝ ᕪࡀࡁࡃ࡞ࡗࡓS ୧║ど㔝᥎ᐃἲ ࡲࡵ㸸᭱ࡶṇ☜࡞୧║ど㔝ண ࡣඃ║⿵ṇࢆ⾜ࡗࡓ ㏻ᨾどᶵ⬟ࡢ㛵㐃OLQHDUVFDOHࢆ⏝࠸ࡿࡇ࡛࠶ ࡿ㸬 ➨ ❶⪃ᐹ ➨ ❶ࡲࡵᚋࡢㄢ㢟 ㏻ᨾどᶵ⬟ࡢ㛵㐃 㸯㸷㸯ࡢ⥳ෆ㞀㏻ᨾ㛵ࡍࡿ⪺ࡁྲྀࡾㄪᰝࢆ⾜ࡗࡓࠋࡇࡢ⤖ᯝࢆ⏝ࡋ࡚ࠊどຊࠊ ୧║ど㔝ࠊᖺ㱋ࠊᛶูࠊERG\PDVVLQGH[ ࡢ࠺ࡕࠊ㏻ᨾṔ㛵㐃ࡀ࠶ࡿࡢࡣࠊᝏ࠸᪉ࡢ ║ࡢどຊ࡛࠶ࡗࡓࠋ ཧ⪃ᩥ⊩ 㘓 ᚋࡢᒎᮃ /LQHDUVFDOH ࢆ⏝࠸ࡓຍ⟬ἲࡼࡾ᥎ᐃࡉࢀࡿ୧║ど㔝㏻ᨾࡢ㛵㐃ࢆゎᯒࡍࡿࡇࠋ ᭦ࠊ✀ࠎࡢᶵᲔᏛ⩦ἲ࡞ࡶ㥑ࡋ࡚ࡼࡾṇࡋࡃ㏻ᨾࣜࢫࢡࢆணぢ࡛ࡁࡿ᳨ドࡍࡿ ࡇࠋ 1 ➨ ❶ ࡣࡌࡵ ◊✲⫼ᬒ ⮬ື㌴ᨾࡼࡿṚஸ⪅㸪Ṛയ⪅ࡣᩘᖺ๓ࡽῶᑡࡋ࡚ࡁ࡚࠸ࡿࡶࡢࡢ㸪 ᖺࡢ⮬ື㌴ ᨾࡼࡿṚஸ⪅ࡣ ே㸪Ṛയ⪅ࡣ ே௨ୖ࡛㸪࠸ࡲࡔከࡃࡢேࡀ⮬ື㌴ᨾࡢ≛≅ ࡞ࡗ࡚࠸ࡿ㸬㏆ᖺ࡞ࡗ࡚║ᝈࡼࡿどᶵ⬟㞀ᐖ㏻ᨾࡢ㛵㐃ࡀὀ┠ࡉࢀ࡚࠾ࡾࠊ ║ᝈࡢ㏻ᨾ࠼ࡿᙳ㡪ࢆゎᯒࡍࡿࡇࡣ㔜せ࡛࠶ࡿ⪃࠼ࡽࢀࡿ ⥳ෆ㞀ࡢᮏ㑥࠾ࡅࡿ᭷⋡ࡣ ṓ௨ୖࡢ⣙㸳㸣࡛࠶ࡾࠊࡲࡓᮏ㑥࠾ࡅࡿ୰㏵ኻ᫂ࡢཎ ᅉࡋ࡚᭱ࡶከ࠸ࡶࡢ࡛࠶ࡿ. ᮏ◊✲࡛ࡣ᭱ࡶ௦⾲ⓗ࡞║ᝈࡢ୍ࡘ࡛࠶ࡿ⥳ෆ㞀࠾ࡅࡿࠊ どᶵ⬟㞀ᐖ㏻ᨾࡢ㛵㐃ࢆゎᯒࡋࡓ. ⥳ෆ㞀ᝈ⪅ࡣᙜ↛㏻ᖖ୧║ࢆゎᨺࡋࡓ≧ែ࡛⏕άࡋ࡚࠸ࡿࠋࡇࢀࡲ࡛ࡢ◊✲ࡽ୧║ど㔝 ࡀどぬ⏕ά㞀ᐖᗘ㸦Quality of Visual Life㸧QoV 㛵㐃ࡋ࡚࠸ࡿࡇࡀศࡗ࡚࠸ࡿ. ࠼ ࡤQoVL Esterman ど㔝᳨ᰝ࡛ ᐃࡉࢀࡓ୧║ど㔝ࡢ㛫ᙉ࠸┦㛵㛵ಀࡀ࠶ࡿࡇࡀ ௨๓ࡼࡾሗ࿌ࡉࢀ࡚࠸ࡿ.[1-7] ᚑࡗ࡚ ㏻ᨾど㔝ࡢ㛵㐃ࢆゎᯒࡍࡿ㝿ࡶᙜ↛୧║ ど 㔝 ࢆ ⏝ ࠸ ࡿ ࡁ ࡛ ࠶ ࡿ . Esterman ୧ ║ ど 㔝 ࡣ Humphrey ど 㔝 ィ (HFA 㸹 ZeissHumphrey Systems, Dublin, CA)ࡸ Octopus 900 (Haag-Streit, Koniz, Switzerland) ࡞ࡢ㟼ⓗ⮬ືど㔝ィࢆ⏝࠸࡚ ᐃࢆ⾜ࢃࢀࡿࡀ ་⒪⌧ሙ࠾࠸࡚୧║ど㔝ࡀ ᐃࡉࢀࡿ ࡇࡣࢇ࡞ࡃ ከࡃࡢタ࡛༢║ど㔝ࢆ ᐃࡋ ᶵ⬟ホ౯ࢆ⾜ࡗ࡚࠸ࡿ. ࡑࡢ⤖ᯝ ࡋ࡚༢║ࡢど㔝ࢆ⤫ྜࡋࡓ᥎ᐃ୧║ど㔝㸦IVF㸧ࡀ⏝࠸ࡽࢀ࡚࠸ࡿ.[8-11] IVF ࡣ∦║ ࡎࡘࡢど㔝᳨ᰝ⤖ᯝࢆẚ㍑ࡋࡓ㝿 ᑐᛂࡋࡓ∦║ࡢど㔝᳨ᰝⅬࡽ ࡼࡾឤᗘࡢ㧗࠸㜈್ 2 ࢆ୧║ど㔝ឤᗘࡋ࡚᥇⏝ࡍࡿ. ௨ୖࢆ࡚ࡢ᳨ᰝⅬ࠾࠸࡚⾜࠸ ୧║ど㔝ࢆᵓ⠏ࡍࡿ. ⥳ෆ㞀ᛶど㔝Ḟᦆ࠾࠸࡚ IVF ࡣ Esterman ど㔝㏆ఝࡍࡿࡇࡀሗ࿌ࡉࢀ࡚࠾ࡾ ⱥᅜ ࡛ࡣ⥳ෆ㞀ᝈ⪅ࡢ㐠㌿㐺ᛶホ౯ࡶ⏝࠸ࡽࢀ࡚࠸ࡿ.[9,11] ࡉࡽIVF ࡣEsterman ど 㔝ࡼࡾࡶ⥳ෆ㞀ᝈ⪅࠾ࡅࡿ QoVL ࡢᝏᐦ᥋㛵㐃ࡋ࡚࠸ࡿࡇࡀ♧ࡉࢀ࡚࠾ࡾ ⥳ෆ 㞀ᝈ⪅࠾ࡅࡿ QoVL ホ౯ࡢ㝿 ከࡃࡢ◊✲࡛ IVF ࡀ⏝࠸ࡽࢀ࡚࠸ࡿ.[3,11-21] ᡃࠎ ࡣ㐣ཤ ࡼࡾⰋ࠸ឤᗘ࡛ᵓᡂࡍࡿ᪉ἲ IVF ࡢ㛫㐪࠸ࡀ࠶ࡿࡇࢆሗ࿌ࡋࡓ.[22] Nelson-Quigg ࡽࡣ IVF ࡣ୧║ຍ⟬ࣔࢹࣝ(ᩘᘧ㸹SR SL ࡣࡑࢀࡒࢀ dB ⾲グࡉࢀࡓྑ ║ᕥ║ࡢ༢║ࡎࡘࡢឤᗘࢆ♧ࡋ࡚࠸ࡿ.[17]) ẚ㍑ࡍࡿ ࡼࡾጇᙜ࡞୧║ど㔝ண ࡀ ྍ⬟࡛࠶ࢁ࠺ሗ࿌ࡋ࡚࠸ࡿ.[23] ࡋࡋ࡞ࡀࡽ ୧║ຍ㔜ࣔࢹࣝࡢィ⟬ࡢ㝿 ༢║ࡢど 㔝ឤᗘࡀ dB ⾲グ linear ⾲グࡢࡕࡽࢆ⏝࠸ࡽࢀࡿࡁ࡞ࡢ᳨ウࡉࢀ࡚࠸࡞࠸. ࡇࡢศ 㔝࡛ᗈࡃᘬ⏝ࡉࢀ࡚࠸ࡿ୧║ຍ㔜ࣔࢹ࡛ࣝ࠶ࡿ Michelson ࣔࢹࣝ[24]࠾࠸࡚ࡣ linear brightness ⾲グࢆ⏝࠸࡚࠸ࡿ.[25-28] 㐣ཤࡢࡢࣔࢹࣝࡶ ୧║ຍ⟬ࡢ㝿 ║ඃᛶࡣ⪃៖ࡉࢀ࡚࠸࡞࠸. ୧║ど㔝㜚 தࡣ ୧║␗㉁ࡢどᶆࢆぢࡏࡓሙྜ㉳ࡇࡿどぬࡢ⌧㇟࡛࠶ࡿ. ࡇࡢ㝿 ࡑࢀࡒࢀࡢ║࡛ ▱ぬࡋࡓ࣓࣮ࢪࡣ㔜ࡡྜࢃࡏ࡚ᵓ⠏ࡉࢀࡿࢃࡅ࡛ࡣ࡞ࡃ ∦║ࡽ࣓࣮ࢪࢆᢚไࡍࡿࡇ ࡼࡗ࡚ ᕥྑ║ࡕࡽࡢ࣓࣮ࢪࢆ▱ぬࡋ࡚࠸ࡿ.[29] ⥳ෆ㞀࠾࠸࡚ࡣ ᕥྑ║࡛ᑐᛂࡋࡓ⟠ᡤࡢど㔝ឤᗘࡀ ࡁࡃ␗࡞ࡿሙྜ࠾࠸࡚ ࡇࡢ୧║ど㔝㜚தࡀ㉳ࡇ ࡗ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿ. ║ඃᛶࡣ ୧║࡛ࡢ࣓࣮ࢪࡢᢚไ㢖ᗘࡢ㐪࠸ࡢ⤖ᯝ࡛࠶ ࡿ.[30] ᡃࠎࡣ║ඃᛶࢆ⪃៖ࡍࡿࡇ࡛୧║ど㔝ホ౯ἲࡀᨵၿࡉࢀࡿࡢ࡛ࡣ࡞࠸⪃ ࠼ࡓ. 3 ᭦ ࡇࢀࡲ࡛࠼ࡤࢻࣛࣅࣥࢢࢩ࣑࣮ࣗࣞࢱ࣮ࢆ⏝࠸ࡓ⤖ᯝ ,9) ࡢ㛵ಀࢆ ㄪࡓ◊✲࡞ࡣሗ࿌ࡉࢀ࡚࠸ࡿࡀ ᐇ㝿ࡢ㏻ᨾṔどᶵ⬟ࡢ㛵㐃ࢆヲ⣽ㄪࡓሗ ࿌ࡣ↓࠸ࡇࡢ◊✲ࡢࡶ࠺୍ࡘࡢ┠ⓗࡣࠊ⥳ෆ㞀ᝈ⪅࠾࠸࡚ᐇ㝿ࡢ㏻ᨾṔࢆ⫈ྲྀࡋ どᶵ⬟㏻ᨾࡢ㛵㐃ࢆヲ⣽ㄪ どᶵ⬟ィ ್ࡽ㏻ᨾࣜࢫࢡࢆணぢࡍࡿࡇࡀ ྍ⬟࡛࠶ࡿࢆ᳨ドࡍࡿࡇ࡛࠶ࡿ ┠ⓗ ࡇࡢ◊✲ࡢ᭱ึࡢ┠ⓗࡣ linear ⾲グ࡛ࡢ༢║ど㔝ឤᗘࢆ⏝࠸ࡿ᪉ἲࡸ║ඃᛶ࡛ ࡢ⿵ṇࢆ⾜࠺ࡇࡼࡗ࡚ ࡼࡾṇ☜࡞୧║ど㔝ண ࡀྍ⬟࠺ㄪࡿࡇ࡛࠶ࡿ. ࡇࢀࡲ࡛࠼ࡤࢻࣛࣅࣥࢢࢩ࣑࣮ࣗࣞࢱ࣮ࢆ⏝࠸ࡓ⤖ᯝ ,9) ࡢ㛵ಀࢆㄪࡓ ◊✲࡞ࡣሗ࿌ࡉࢀ࡚࠸ࡿࡀ ᐇ㝿ࡢ㏻ᨾṔ どᶵ⬟ࡢ㛵㐃ࢆヲ⣽ㄪࡓሗ࿌ࡣ↓ ࠸ࡇࡢ◊✲ࡢࡶ࠺୍ࡘࡢ┠ⓗࡣ⥳ෆ㞀ᝈ⪅࠾࠸࡚ᐇ㝿ࡢ㏻ᨾṔࢆ⫈ྲྀࡋどᶵ ⬟㏻ᨾࡢ㛵㐃ࢆヲ⣽ㄪ どᶵ⬟ィ ್ࡽ㏻ᨾࣜࢫࢡࢆணぢࡍࡿࡇࡀྍ⬟ ࡛࠶ࡿࢆ᳨ドࡍࡿࡇ࡛࠶ࡿ ➨ ❶ ᪉ἲ ୧║ど㔝᥎ᐃἲ ࡇࡢ◊✲ࡣᮾிᏛ་Ꮫ㒊ᒓ㝔ࡢ⌮つᐃጤဨ࠾࠸࡚ᢎㄆࡉࢀᑐ㇟ ࡞ࡗࡓᝈ⪅ࡽᮏ◊✲ཧຍࡢᢎㅙ᭩ࢆ᭩㠃ࡼࡾྲྀᚓࡋࡓᮏ◊✲ࡣ࣊ࣝࢩࣥ࢟ᐉゝ 4 ᚑࡗ࡚⾜ࢃࢀࡓ ࣭ᑐ㇟ ⥳ෆ㞀ᝈ⪅ ྡ㛤ᨺ㝮ゅ⥳ෆ㞀㸸 ྡṇᖖ║ᅽ⥳ෆ㞀㸸 ྡⴠᒌ⥳ෆ㞀㸸 ྡࢆᑐ㇟ࡋࡓ࡚ࡢᝈ⪅ࡣᮾிᏛ㝃ᒓ㝔࡚⒪ࢆཷࡅ࡚࠾ࡾ௨ୗࡢᇶ‽ࢆ‶ ࡓࡋࡓࢆᑐ㇟ࡋࡓ ṓ௨ୖ⥳ෆ㞀ࡀど㔝Ḟᦆࡸど㔝㞀ᐖࡢ၏୍ࡢ㞀ᐖ࡛ ࠶ࡿࡇ᭱ప ࣨ᭶㛫║ᅽど㔝ࡀᏳᐃࡋ࡚࠸ࡿࡇ௨ୗ♧ࡍࣥࢲ࣮ࢯ ࣭ࣥࣃࢸࣛᇶ‽࡛つᐃࡉࢀࡓ⥳ෆ㞀ᛶど㔝Ḟᦆࡀ࠶ࡿࡇࣃࢱ࣮ࣥᶆ‽೫ᕪ☜⋡ࣉࣟࢵࢺ ࠾࠸࡚☜⋡ ௨ୗࢆ♧ࡍⅬࡀ ࡘࡲࡓࡣࡑࢀ௨ୖࡢ㐃⥆ࡋࡓሙྜࡲࡓࡣ༙ど㔝 ࠾࠸࡚☜⋡ ௨ୗࡢⅬࡀ୍ࡘ࠶ࡿࡇ㸹௨ୗࡢฟ⌧☜⋡ࢆ♧ࡍࣃࢱ࣮ࣥᶆ‽೫ᕪ㸹⥳ෆ 㞀ᛶ༙ど㔝ࢸࢫࢺ࡛ṇᖖ⠊ᅖእどຊࡀ ௨ୖ࡛࠶ࡿࡇ⥺⥔ᰕᖏษ㝖⾡ ࡸᒅᢡᡭ⾡ࢆྵࡴ║ᡭ⾡ࡣྵࡲ࡞࠸ⓑෆ㞀ฟ⾡⥺⥔ᰕᖏษ㛤⾡ࡣ㝖ࡃ ࣭ど㔝᳨ᰝ ࡚ࡢ⿕㦂⪅ࣁࣥࣇ࣮ࣜど㔝᳨ᰝ+)$㸹&DUO=HLVV'XEOLQ&$ 6ZHGLVK,QWHUDFWLYH7KUHVKROG$OJRULWKP6,7$ࢆ⾜ࡋࡓᅛどⰋ)/ࡀ ௨ୖ ࡲࡓࡣഇ㝧ᛶ)3ࡀ ௨ୖࡢど㔝᳨ᰝࡣ㝖እࡋࡓഇ㝜ᛶ)1ࡣୖグࡢ㝖እ㡯┠ྵࡵ࡞ ࡗࡓ>@୧║ど㔝᳨ᰝࡣࢥࣥࢱࢡࢺࣞࣥࢬ࡚㏆ぢᒅᢡ▹ṇࢆ⾜ࡗࡓ࡚ࡢᝈ⪅ ࡣ㐣ཤ᭱పᅇࡢど㔝᳨ᰝࢆ⤒㦂ࡋ࡚࠸ࡓ୧║ど㔝᳨ᰝ࡛ࡣ)/)3)1 ࢆ ᐃࡍࡿ ࡇࡣ࡛ࡁ࡞࠸ࡢ࡛ྠ୍ࡢ᳨⪅ࡀ࡚ࡢ᳨ᰝ࠾࠸࡚ᅛど┘どࢆ⾜ࡗࡓ࡚ࡢど㔝᳨ᰝ ୧║ど㔝᳨ᰝࡣྠ᪥⾜ࢃࢀࡑࢀࡒࢀ᭱ప ศࡢఇ᠁ࢆࡣࡉࢇ࡛ᐇࡉࢀࡓࡲࡓ 5 ど㔝᳨ᰝࡣࣛࣥࢲ࣒ᐇࡉࢀᚲせᛂࡌ᳨࡚ᰝ୰࡛ࡶఇ᠁ࢆࡗࡓࣁࣥࣇ࣮ࣜど㔝᳨ ᰝ ࠾ࡅࡿ Ⅼࢆゎᯒ⏝࠸ࡓ ࣭ඃ║ィ ᅗ ࡚ࡢ่⃭ࡣ9LVDJH6DJH'9,68$/)81&7,2175$,1(5-$3$1)2&86&2/7'7RN\R -DSDQࢆ⏝࠸࡚ ࣥࢳ/&' ࣔࢽࢱ࣮3:+<81'$,.RUHDSL[HOVROXWLRQ ࡼࡗ࡚ไᚚࡉࢀࡓ ่⃭⨨ࡣ9LVDJH6DJH'9LVXDO)XQFWLRQ7UDLQHU-DSDQ)RFXV&ROWG7RN\R -DSDQࡀ⏝࠸ࡽࢀࡓ ࣥࢳ /&' ࣔࢽࢱ࣮3:+<81'$,.RUHDSL[HOVROXWLRQ ࢆ⏝ࡋࡓ5*%FGPࣔࢽࢱ࣮ࡢ୰ኸ࡚ ᐃㄪᩚࡉࢀࡓ⫼ ᬒග่⃭ࢆᥦ♧ࡋࡓ 6 ඃ║ィ ࡛ࡣྑ║ᕥ║ࡣ೫ග║㙾ࡼࡗ࡚ศ㞳ࡉࢀࡓᮏ◊✲࡛⏝ࡉࢀࡓࢹࢫ ࣉࣞࡣ∦║ወᩘ⾜ࡢࣆࢡࢭࣝࡽᫎࡋฟࡉࢀࡓീࢆぢࡏࡶ࠺∦║അᩘ⾜ࡢࣆࢡࢭ ࣝࡽࡢീࢆぢࡏࡓྑ║ᕥ║␗࡞ࡗࡓ࣓࣮ࢪࢆぢࡏࡿࡇ࡛❧యⓗ࡞どᶆ่⃭ࢆ⾜ ࡗࡓᅗ ᕥ೫ග║㙾ࣞࣥࢬࡣᕥᕳࡁࡢ೫ගࡢࡳࡀ㏻㐣ࡋྑ║ࡣྑᕳࡁࡢ೫ගࡢࡳࡀ㏻ 㐣ࡍࡿᕥᩳࡵࡢ⥺ࡣྑ║ࡢࡳࡀ▱ぬࡋྑᩳࡵࡢ⥺ࡣᕥ║ࡢࡳࡀ▱ぬࡍࡿࡇ࡞ࡿ ่⃭ࡣどゅ rࡢࢧࢬ F\FOHSHUGHJUHHFSG࡛࠶ࡿ่⃭ࡢࢥࣥࢺࣛࢫࢺࡣ➼㛫 㝸࡛ ẁ㝵5*%FGP㸸5*%FGPኚࡉࡏࡿࡇࡀྍ⬟࡛࠶ ࡿ ่⃭ගࡣィᅇࡾ/+ࡢ೫ග่⃭ࢆᕥど㔝ࡽࡲࡓィᅇࡾ5+ࡢ೫ග่⃭ࢆྑ ど㔝ࡽ่⃭ࡋࡓࡘࡲࡾᕥࡢ೫ග║㙾ࣞࣥࢬࡣ /+ ࡢ่⃭ගࡢࡳࡀྑࡢ೫ග║㙾ࣞ 7 ࣥࢬࡣ 5+ ࡢ่⃭ගࡢࡳࡀ㏻㐣ࡋᢞᙳࡉࢀࡿࡇ࡞ࡿ⤖ᯝࡋ࡚ྑୖࡽᕥୗ ࡅ࡚ὶࢀࡿ㯮Ⰽࡢ⥺ࡢࡳࡀྑ║▱ぬࡉࢀᕥୖࡽྑୗࡅ࡚ࡢ㯮⥺ࡀᕥ║ࡢࡳ▱ ぬࡉࢀࡿࡇ࡞ࡿ่⃭ࢧࢬࡣ GHJUHHF\FOHSHUGHJUHH ࡢ㛗᪉ᙧ࡛࠶ࡗࡓ่⃭ ගࡣ5*%FGPࣔࢽࢱ࣮୰ኸ࡚ ᐃࡽ 5*%FGPࣔࢽ ࢱ࣮୰ኸ࡚ ᐃࡢィ ẁ㝵࡛ࢥࣥࢺࣛࢫࢺࡀኚ᭦ྍ⬟࡛࠶ࡾඃ║ィ ୰ ẁ㝵 ࡢ⠊ᅖࡢ୰ࡽࢥࣥࢺࣛࢫࢺࢆኚࡉࡏඃ║ィ ࢆ⾜ࡗࡓඃ║ィ ࡣ୰ኸྑ ୖྑୗᕥୗᕥୖࡢィ ᡤ࡛ࡢィ ࢆ⾜࠸ྛ ᐃⅬ࡛ྠࡌ่⃭ࢧࢬࢆ⏝࠸ࡓ่ ⃭㓄⨨ࡣᅗ ♧ࡋࡓ ඃ║ ᐃࡣࠊ୰ኸᕥᩳࡵୖྑᩳࡵୖᕥᩳࡵୗྑᩳࡵୗࡢィ ᡤ࡛⾜ࡗࡓඃ ║ ᐃࡢ୰ኸ ᐃⅬࡣど㔝᳨ᰝ࠾ࡅࡿ>@>@>@>@ࡢ࢚ࣜ ࡞ࡿࡼ࠺ㄪᩚࡋࡓࠋࡢඃ║ ᐃⅬࡣࡑࢀࡒࢀࡢど㔝㇟㝈ྜ࠺ࡼ࠺ㄪᩚࡋࡓࠋ 8 ⿕㦂⪅ࡣྑᩳࡵrᕥᩳࡵrᥦ♧ࡉࢀࡓࢹࢫࣉࣞࡽ FP ࡢ㊥㞳᳨࡛ᰝࢆ ⾜ࡗࡓ ⿕㦂⪅ࡢ᳨ᰝㄝ᫂ࡢᚋࢹࣔࣥࢫࢺ࣮ࣞࢩࣙࣥカ⦎ࢆ⾜࠸ࡑࢀࡒࢀࡢ᳨ᰝ㛫 ศ 㛫ࡢఇ᠁ࢆࡣࡉࡳ ᅇࡎࡘ⾜ࡗࡓ㠀᳨ᰝ║ࡀ 5*% ࡛ᅛᐃࡉࢀ࡚࠸ࡿ่⃭ᑐࡋ࡚⿕ ᳨ᰝ║ࡢࢥࣥࢺࣛࢫࢺࢆ 5*% ㏆࡙ࡅࡿࡼ࠺ᡭඖ࠶ࡿ࣎ࢱࣥࢆᢲࡋࣔࢽࢱ࣮⾲ ♧ࡉࢀࡓ่⃭ࢥࣥࢺࣛࢫࢺࢆኚࡉࡏࡿ୧║ࡢࢥࣥࢺࣛࢫࢺࡀ୍⮴ࡋࡓㄆ㆑ࡋࡓᩘ್ࢆ ᐃࡍࡿ ᅇࡢ ᐃࡢᖹᆒ್ࢆゎᯒ⏝࠸ࡓFP ࡢ㊥㞳↔Ⅼࡀྜ࠺ࡼ࠺' ࡢ⌫ 㠃ࣞࣥࢬࢆ⏝࠸࡚ᒅᢡ▹ṇࢆ⾜ࡗࡓඃ║᳨ᰝ୰ྠ୍ࡢ᳨⪅ࡼࡗ࡚ᅛどࡸ㢦ࡢ⨨࡞ ࢆ┘どࡋࡓ ど㔝᳨ᰝ࠾࠸࡚ឤᗘ㜈್ࡢࡼࡾప࠸᳨ᰝⅬࡢඃ║.ࡣឤᗘ㜈್ࡢప࠸ഃࡢඃ║ࡢ ್'RPLQDQFHZRUVHࢆ⏝࠸࡚ồࡵࡓ 㸸 = ࣭⤫ィゎᯒ ඃ║ࡢ⌧ᛶࡣᛴෆ┦㛵ಀᩘ,&&┦㛵ಀᩘ&9ࢆ⏝࠸࡚ホ౯ࡋࡓ ୧║ど㔝ឤᗘ ᐃㄗᕪࡣ௨ୗࡢ᪉ἲ࣭ࣔࢹࣝࢆ⏝࠸࡚ィ⟬ࢆ⾜ࡗࡓ 0RGHO,9)PHWKRG୧║ど㔝ࢆẚ㍑ࡋࡓ㝿ࡼࡾⰋ࠸ឤᗘࡢ᳨ᰝⅬࡼࡗ࡚ᵓᡂ> @ 0RGHOG%VFDOHVXPPDWLRQ (better sensitivity ( 0RGHOOLQHDUVFDOHVXPPDWLRQ 9 )) + (worse sensitivity (dB)) [ORJ (better sensitivity ( G% ⾲グࢆ, 10( )/ )) + (worse sensitivity ( )) ࢆ⏝࠸࡚ OLQHDUVFDOH ኚ 0RGHOඃ║࡛⿵ṇࢆ⾜ࡗࡓ OLQHDUVFDOHVXPPDWLRQ N! 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MVC - (mean ± s.d.) N 28 163 ᖺ㱋 (years) 66.9 ± 11.4 63.1 ± 9.6 0.07 ᛶู (male/female) 20/8 121/43 0.76 B.M.I 22.4 ± 2.5 22.7 ± 3.0 0.65 Ⰻ࠸║ࡢどຊ (LogMar) 0.00 ±0.00 0.00 ± 0.02 0.26 ᝏ࠸║ࡢどຊ (LogMar) 0.03 ± 0.01 0.01 ± 0.003 0.01 Ⰻ࠸║ࡢ MD (dB) -3.0 ± 4.0 -2.5 ± 4.0 0.35 ᝏ࠸║ࡢ MD (dB) -7.1 ± 7.2 -7.0 ± 6.2 0.92 IVF-MD (dB) -2.1 ± 3.9 -1.6 ± 3.7 0.52 18/4/6 88/42/33 0.52 32.1%=9/28 21.5%=35/163 0.23 107.9 ± 180.5 98.3 ± 89.2 0.12 ⥳ෆ㞀㐍⾜ᗘ (᪩ᮇ/୰ᮇ/ P value ᪂ᚋグ) 㐣ཤࡢ MVCs (Yes/No) 㐌ࡢ㐠㌿㊥㞳 (km) Table 3. MVC + ࢢ࣮ࣝࣉ MVC-ࢢ࣮ࣝࣉࡢẚ㍑ . 16 Variable Coefficient Std. Error P ᖺ㱋 0.043305 0.024268 0.0744 Ⰻ࠸║ࡢどຊ 19.59581 6.68125 0.0034 ᝏ࠸║ࡢどຊ -452.12236 138446.52478 0.9974 BMI -0.099944 0.084664 0.2378 ᛶู㸦ዪᛶ㸧 0.060366 0.50413 0.9047 IVFMD -0.055465 0.061179 0.3646 㐣ཤࡢ MVCs 0.76108 0.47716 0.1107 Table 4 ከ㡯ᘧࣟࢪࢫࢸࢵࢡᅇᖐࡢ⤖ᯝ ➨ ❶ ⪃ᐹ ࣭୧║ど㔝᥎ᐃἲࡘ࠸࡚ ᮏ◊✲࡛ࡣ༢║ど㔝ඃ║ࢆ⏝࠸࡚୧║ど㔝ࢆホ౯ࡋࡓ୧║ど㔝 ᐃࡣ㜈್ ឤᗘࡢ㧗࠸ ᐃⅬEHWWHUH\H9)VHQVLWLYLW\㜈್ឤᗘࡢప࠸ ᐃⅬZRUVHH\H9) VHQVLWLYLW\㜈್ឤᗘࡢప࠸║ࡢඃ║್WKHGRPLQDQFHYDOXHRIWKHWHVWORFDWLRQ ZLWKZRUVHVHQVLWLYLW\ࢆ⏝࠸ࡿࡇ࡛ࡼࡾṇ☜࡞ண ࡀྍ⬟࡞ࡗࡓ 17 ⥳ෆ㞀ᛶど㔝㞀ᐖࡣ 42/ ࡢᝏ῝ࡃ㛵㐃ࡋ࡚࠸ࡿࡓࡵ>@୧║ど㔝ࢆ᥎ᐃ ࡍࡿࡇࡣ་Ꮫⓗ࡚ࡶ㔜せ࡛࠶ࡿᡃࠎࡣ୧║ࢆࡗ࡚࿘ᅖࡢ≧ἣ࡞ࢆ▱ぬࡍࡿࡇ ࡛᪥ᖖ⏕άࢆ㏦ࡗ࡚࠸ࡿࡶࢃࡽࡎ་Ꮫⓗࡣ∦║ど㔝ࡢࡳࢆホ౯ࡋ࡚࠸ࡿ༢║ど 㔝ࢆ⏝࠸࡚୧║ど㔝ࢆホ౯ࡍࡿ᪉ἲࡋ࡚࠸ࡃࡘࡢ᪉ἲࡀヨࡳࡽࢀ࡚࠸ࡿࡑࡢ୰࡛ ,9) ἲࡣ୧║ど㔝ࢆ᥎ᐃࡍࡿ㝿ከࡃ⏝ࡉࢀ࡚࠸ࡿ᪉ἲ࡛࠶ࡾࡲࡓ⡆౽࡞᪉ἲࡢࡦ ࡘ࡛࠶ࡿ>@0RGHO ᐦ᥋㛵㐃ࡋ࡚࠸ࡿࡇࡶሗ࿌ࡉࢀ࡚࠸ࡿࡋࡋ࡞ࡀࡽ㐣ཤ ࡢሗ࿌࡛ࡣ୧║ど㔝ࢆ᥎ᐃࡍࡿ㝿G% ⾲グࢆ⏝࠸ࡿࡢࡲࡓࡣ /DPEHUW ⾲グࢆ⏝࠸ࡿ ࡁ࡞ࡢࡣ᳨ウࡉࢀ࡚࠸࡞࠸㐣ཤࡢ ࡘࡢሗ࿌࡛ࡣ>@༢║ࡲࡓࡣ୧║ࡢࢥࣥࢺࣛࢫ ࢺឤᗘࡣOLQHDU ⾲グࢆ⏝࠸᳨࡚ウࡉࢀ࡚࠾ࡾ0LFKHOVRQPRGHO>@Michelson model㸹 ( ( ) /PD[ ) /PLQ ࡣ᭱ࡲࡓࡣ᭱ᑡ㍤ᗘࢆ♧ࡋ࡚࠸ࡿࠊᮏ◊✲ࡢ⤖ᯝ୍⮴ࡍࡿ ᮏ◊✲࡛ᡃࠎࡣ୧║ど㔝ឤᗘࡀ EHWWHUVHQVLWLYLW\ ᐦ᥋㛵㐃ࡋࡲࡓ OLQHDU ⾲グࣔ ࢹࣝࢆ⏝࠸ࡓࡼࡾṇ☜ண ࡛ࡁࡿࡇࢆ♧ࡋࡓ㦫ࡃࡇ㐣ཤࡢሗ࿌>@ࡣᑐ↷ ⓗG% ⾲グࣔࢹࣝࢆ⏝࠸ࡓࡼࡾࡁ࡞ ᐃㄗᕪࡀ⏕ࡌࡿࡇࡀศࡗࡓ ࡲࡓ⯆῝࠸ࡇ᭱ࡶṇ☜࡞୧║ど㔝ண 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