日本語 から 英語: Assessment of age and sex-based differences in hypertension-induced changes to left ventricular morphology by three-dimensional transthoracic echocardiography
General field: 医療 | |
原書のテキスト - 日本語
背景・目的：大動脈弁狭窄症に伴う左室形態の変化の仕方は男女で異なることが知られている。一方同様に圧負荷を呈する高血圧症例で性差が左室形態に与える影響が異なるかどうかは明らかでない。今研究の目的は高血圧症例において、経胸壁３次元心エコー図法（3DTTE）を用い、左室形態を測定し、年齢や性差が左室形態に及ぼす影響について検討することである。
方法：高血圧症例７６人（年齢６９±１２歳、男性４２人）に対し3DTTEを施行し、心尖部アプローチによりfull-volume datasetを得た。解析ソフトを用いて、左室容量ならびに心筋重量を計測し、左室容量心筋重量比を求めた。
結果：体表面積補正を行った左室拡張末期容量は男性に比べ女性がより小さい傾向にあるのに対し、補正左室心筋重量に性差を認めなかった。左室容量心筋重量比は有意に女性が高値を示し（男性１．５７±０．２４ｇ/ｍｌ、ｐ＜０．０１）、同程度の心筋重量でも女性の方がより求心性肥大を呈していた。末梢血管の指標として計測した全身動脈コンプライアンスも女性の方が有意に低値を示した。多変量解析では、女性、糖尿病が左室容量心筋重量比に対する独立した因子として選ばれた。
結論：高血圧症例における左室形態の変化に性差と糖尿病が影響を与えることが示唆された。 | 翻訳 - 英語
Background and Objective: Morphological changes in the left ventricle associated with aortic valve stenosis are known to differ between men and women. However, it is unclear whether sex similarly affects left ventricular morphology in hypertensive patients with pressure overload. The objective of this study was to evaluate left ventricular morphology in hypertensive patients using three-dimensional transthoracic echocardiography (3DTTE) and to examine the effects of age and sex on that morphology.
Methods: Full-volume 3DTTE datasets were acquired from the apical approach in 76 hypertensive patients (age: 69 ± 12 years, 42 male). Left ventricular volume (LVV) and myocardial mass (MM) were measured and the ratio of LVV to MM (LVV/MM) was calculated using analytical software.
Results: Left ventricular end-diastolic volume corrected for body surface area was smaller in women than in men, but corrected left ventricular MM did not differ between the sexes. LVV/MM was significantly higher in women than in men (men: 1.57 ± 0.24 g/ml, p < 0.01), and women had greater concentric hypertrophy than men with similar myocardial mass. Women also had significantly lower systemic arterial compliance, which was measured as an index of peripheral vascular function. Multivariate analysis showed that female sex and diabetes were independent factors that determined LVV/MM.
Conclusion: Sex and diabetes may influence changes in left ventricular morphology in hypertensive patients. |
日本語 から 英語: Development of a scoring equation to detect NAFLD from items assessed in a general health checkup
General field: 医療 | |
原書のテキスト - 日本語
【背景】Nonalcoholic fatty liver disease（NAFLD）は心血管障害、糖尿病等の代謝性疾患とも深い関係を持ち、わが国でも増加し、そのスクリーニングは重要である。NAFLDの診断は腹部USが一般的であるが、健診では施行されず、またALT30以下は正常と判定されるため、見逃されているケースが多い。
【目的】ALT正常例（男性30以下、女性20以下）におけるNAFLD症例の割合と臨床的背景を検討し、一般健診項目からNAFLDを検出するためのスコア式を構築する。
【方法】企業Aの人間ドックで、アルコール摂取量が20g/日以下かつ基礎疾患を有さない30－59歳の男性8,237人、女性2,356人を対象とした。ALT正常症例を抽出し、この2/3の症例でスコア式を構築し残り1/3の症例でスコア式の妥当性を検証した。スコア式は、単変量解析、ROC曲線下面積、重解析分析にて構築し、陽性的中率（PPV）と陰性的中率（NPV）を90％に設定し、正診率、誤診率を算出する。
【結果】NAFLD有病者全体に占めるALT30以下の症例の場合は、男性で45％、女性で52％であった。ALT30以下の症例は、男性5,699人、女性1,730人で、男女それぞれ2 /3の症例でスコア式を構築した。スコア式は、男性が29.5BMI＋10.9体脂肪率＋0.5中性脂肪（TG）、女性が38.9BMI－3.3HDLであった。〔正診率、誤診率〕は、男性〔56.2％、6.3％〕女性〔75.5％、7.3％〕であった。
【結論】NAFLD症例の約半数がALT正常者であり、健診では見逃されている。Score式は、ALT正常症例におけるNAFLD”あり”、”なし”の判別に有用であると考えられた。 | 翻訳 - 英語
Background: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease and metabolic diseases such as diabetes and is becoming more prevalent in Japan, which makes screening for the disease important. Many cases are missed because NAFLD is typically diagnosed with an ultrasound examination, which is not performed during a general health checkup, and because alanine aminotransferase (ALT) levels of 30 IU/l or lower are considered normal.
Objective: To determine the prevalence of NAFLD among subjects with normal ALT (men: ≤ 30, women: ≤ 20) and examine these subjects' clinical characteristics to create a scoring equation that uses items assessed in a general health checkup to detect NAFLD.
Methods: Subjects were 8237 men and 2356 women aged 30 to 59 years who underwent Company A's health screening and were found to have no underlying disease and a daily alcohol intake of 20 g/day or less. Subjects with normal ALT levels were selected from this group; two-thirds of these subjects were used to create the scoring equation and the remaining one-third was used to assess its validity. The scoring equation was developed using univariate analysis, ROC area under the curve, and multiple regression analysis, and calculates diagnostic accuracy and the misdiagnosis rate with the positive predictive value and negative predictive value set at 90%.
Results: Of all subjects with NAFLD, 45% of men and 52% of women had ALT of 30 or lower. There were 5699 men and 1730 women with ALT of 30 or lower, and two-thirds of each sex were used to develop the scoring equation. The scoring equation was (29.5 × BMI) + (10.9 × percent body fat) + (0.5 × triglycerides) for men and (38.9 × BMI) – (3.3 × HDL) for women. The diagnostic accuracy and misdiagnosis rates were 56.2% and 6.3% for men and 75.5% and 7.3% for women.
Conclusion: About half of patients with NAFLD have normal ALT, which causes the disease to be overlooked in health checkups. This study demonstrated the usefulness of a scoring equation in determining whether patients with normal ALT have NAFLD. |
入会時期 Apr '13
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