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糖尿病網膜症に対する医学的介入を客観的に評価する為,MEDLINEを用いて1985〜2000年迄に発表された論文を対象に,ランダム化比較試験で糖尿病網膜症に対する効果を検討している臨床研究を検索収集し,評価を行った.検索条件を満たしたのは,40編の論文であった.これらから確認できたのは,以下の4点で,これらの結果を利用し,科学的根拠に基づく糖尿病網膜症対策を展開すべきである.1)網膜症未発症時期からの継続的な眼科管理は,網膜症による視力障害の発生を減少させる,2)厳格な血糖管理は1型糖尿病患者における網膜症の発症予防と進展抑制に有効であり,2型糖尿病患者でも同様の効果が期待されるが,現時点ではその根拠が十分でない,3)厳格な血圧管理は網膜症進展を抑制する,4)1型糖尿病患者での血圧正常者に対するangiotensin converting enzyme阻害薬は,網膜症を予防し,進展を抑制する

To evaluate the cost and effectiveness of intensive insulin therapy for type 2 diabetes on the prevention of diabetes complications in Japan, we performed economic evaluation based on a randomized controlled trial. A total of 110 patients with type 2 diabetes were randomly assigned into two groups, a multiple insulin injection therapy (MIT) group or a conventional insulin injection therapy (CIT) group, and were followed-up for 10 years. Economic evaluation (cost-consequences analysis) was applied to evaluate both health and economic outcomes. As outcome measures for effectiveness of intensive insulin therapy, the frequency of complications, such as retinopathy, nephropathy, neuropathy, macrovascular event, and diabetes-related death, was used. For estimating costs, a viewpoint of the payer (the National Health Insurance) was adopted. Direct medical costs associated with diabetes care during 10 years were calculated and evaluated. In a base case analysis, all costs were discounted to the present value at an annual rate of 3%. Sensitivity analyses were carried out to assess the robustness of the results to changes in the values of important variables. MIT reduced the relative risk in the progression of retinopathy by 67%, photocoagulation by 77%, progression of nephropathy by 66%, albuminuria by 100% and clinical neuropathy by 64%, relative to CIT. Moreover, MIT prolonged the period in which patients were free of complications, including 2.0 years for progression of retinopathy (P < 0.0001), 0.3 years for photocoagulation (P < 0.05), 1.5 years for progression of nephropathy (P < 0.01) and 2.2 years for clinical neuropathy (P < 0.0001). The total cost (discounted at 3%) per patient during the 10-year period for each group was $30 310 and 31 525, respectively. The reduction of total costs in MIT over CIT was mainly due to reduced costs for management of diabetic complications. Our results show that MIT is more beneficial than CIT in both cost and effectiveness. Therefore, MIT is recommended for the treatment of type 2 diabetic patients who require insulin therapy as early as possible from the perspective of both patients and health policy. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

第一線の医療に従事する医師の間で,医療テクノロジー・アセスメントに対してどのようなニーズが存在し,その特徴がどのようなものかを検討するために,実態調査を行った.その結果,医療技術について,臨床的有効性,経済的効率,生命倫理的問題の評価が必要であり,更にこれらの評価情報が日常臨床に役立つことを,対象者の多くが指摘していた.又,評価の必要な医療技術として,指摘頻度の多かったものは,遺伝子治療,抗癌剤,臓器移植,癌検診,低侵襲性治療等であった

Concern about the economic aspect of cancer care is increasing. However, economic evaluations for cancer care are deficient in a number of areas, despite recent important contributions. To generate better evidence for economic evaluation of care for patients with cancer and intractable disease, the recent trends and problems with economic evaluations in these areas in Japan are examined. Several examples of economic evaluations, such as those concerned with bone marrow transplantation for leukemias, breast-conserving treatment for early breast cancer, and antiemetic treatment for patients receiving cancer chemotherapy, showed substantial possibilities for evaluating value for money in health care with a view to establishing an effective and efficient health care system.

Objective. Health-related quality of life plays an important role in assessing the effectiveness of health care. The EuroQol is a generic instrument for describing and valuing health-related quality of life. To elicit health state descriptions and their preferences among the general public in Japan and compare them with cross-national data, a feasibility study for applying the EuroQol to the general public in Japan was carried out. Subjects and methods. The subjects were 120 people aged 40s-60s randomly selected in a suburban area at Aichi Prefecture in Japan. In assessing health states and their preferences, the EuroQol valuation instrument (version 12, 1991) translated into Japanese was used. The questionnaires were distributed and collected by public health nurses. The valid responses (rate) were 89 (74%). Results. The mean scores (raw scores) using the visual analogue scale (VAS) for one's own health was 89.2. No statistically significant difference in VAS scores was observed for both sex and age. The contribution ratio of own health status, sex and age was 0.326 (p&lt 0.0001). The main independent variables were three dimensions of health status. Valuations for core health states varied from 96.3 (no problems in each health status) to 6.8 (dead). These VAS scores in Japan were correlated with those from other countries (p&lt 0.001). A multivariate analysis indicated that bias from own health status on preference valuations for core health states was not observed. Conclusion. The health states and their preferences among the general public in Japan were estimated by using the EuroQol. The results show the feasibility of evaluation for health states quantitatively. Moreover, this study suggested cross-national and cross-cultural applicability of the EuroQol.

コロトコフ音スペクトルをFFT分析することにより血管壁の硬度を直接反映する動脈硬化危険指数(Rc)というパラメータを提案した.冠動脈硬化危険因子としてTC, TG, HDL-C, LDL-C, AI,喫煙,飲酒,家族歴をとり,Rc値との関連を比較検討した.TG, AI, HDL-C, LDL-Cの値が異常値である群でRc値4以上の時に異常値出現率が高くまた喫煙かつ飲酒の群,家族歴の危険因子を持つ群でRc値が高くHigh risk群として対処されるべきである事が示唆された.またRc値を経時的に測定する事により各個人についての動脈硬化の進展が把握でき,動脈硬化の予防あるはい治療効果の判定にも応用可能と思われる

血圧測定時に発生するコロトコフ音のスペクトルを分析することにより動脈硬化の定量的な診断法を提案した.20歳代〜50歳代の健常者について安静時に脈波・コロトコフ音記録計で脈波形,コロトコフ音,血圧,p-ktimeを記録しA/D変換後FFTによりスペクトルを分析した.虚血性心疾患患者(39名,平均年齢59.9歳)についても同様な測定を行った.まず血圧測定時の血行動態モデルから乱流周波数を計算しこのピーク周波数が収縮期のコロトコフ音スペクトルと良く一致したころから収縮期でのコロトコフ音の発生は乱流が原因であることを示した.つぎに健常者と虚血性心疾患患者のコロトコフ音スペクトルを比較検討した.その結果,虚血性心疾患患者のコロトコフ音スペクトルのピーク値は48.5 Hzであり健常者の25 Hz前後の値より2倍前後高くまた半値幅も2倍前後高くかつ高周波の乱れが現れることが分かった

動脈硬化の程度を無侵襲かつ定量的に診断することは予防医学の面からも臨床医学の面からも重要な問題であるが従来の健康診断では困難であり見落とされる事が多かった。本研究は血圧測定時に生じるコロトコフ音を利用しスペクトルを分析することにより人間ドックで適用可能でありかつ簡便で無侵襲定量的に血管硬度を直接反映する動脈硬化危険指数を提案し,その有用性をAIとの比較検討から確認した。