原 光彦

現在までRSウイルスによる気道感染が気管支喘息を発症さる因子となりうるか, また吸入抗原や食物抗原に対するIgE抗体産生を亢進させるかについて一定の結論を得ていない. 今回我々はこれらを明らかにする目的で, RSウイルスの感染を反復して受けた児を対象として臨床的に検討した.<br>1. 喘鳴を伴った呼吸障害にて入院となった454症例に鼻汁中RSウイルス抗原を検索し, 166例が陽性となり (36.5%), それらの中で11.4%の19例に反復感染を認めた.<br>2. 初回RSウイルス感染診断前から3回以上の呼吸困難を伴った呼気性喘鳴のエピソードがあり, このためすでに気管支喘息と診断されている症例が19例中13例であり (喘息群), 初回RSウイルス感染診断時が初めての呼気性喘鳴であった児が19例中6例であった (初回喘鳴群). これらのうち, 喘息群は全例2回目のRSウイルス感染診断後に重症化し, 初回喘鳴群は初回RSウイルス感染診断後に全例, 前記の基準で気管支喘息を発症した.<br>3. 初回RSウイルス感染診断時 (平均21.5ヶ月), 2回目のRSウイルス感染診断時 (平均31.1ヶ月) であり, その期間は平均9.6ヶ月であった. 初回RSウイルス感染診断時に低酸素を伴う呼吸困難 (SpO₂<90) を呈した児は19例中6例であり, 2回目のRSウイルス感染診断時には19例中4例で, 2回目のRSウイルス感染診断時には必ずしも軽症化しなかった.<br>4. IgEの産生について: 初回RSウイルス感染診断時に喘息と診断されていた群では, 反復感染後に吸入抗原, 食物抗原が陽性化したのは13例中2例のみで, 一方初回喘鳴群では6例中1例で食物抗原のみが陽性化した.<br>以上より, RSウイルスの反復感染例でみると, RSウイルスは気管支喘息の発症や重症化に影響を与えると示唆されるが, IgEの産生には影響を与えにくいと推測された.

The influence of obesity and fat distribution on serum levels of lipoprotein and apolipoprotein was investigated in 294 Japanese junior high school children (12-13 years of age). Serum levels of low-density lipoprotein cholesterol (LDLC) (P= 0.013), triglycerides (TG) (P= 0.0006), and apolipoprotein B (apoB) (P= 0.003), and the apoB/A-I ratio (P= 0.005) were significantly higher and serum levels of high-density lipoprotein cholesterol (HDLC) (P= 0.00003) and apoA-1(P = 0.003) were significantly lower in obese boys than in non-obese boys. The serum levels of TG (P = 0.013) and the apoB/A-1 ratio (P= 0.011) were significantly higher and the serum levels of HDLC (P= 0.004) was significantly lower in obese girls than in non-obese girls. The LDLC/apoB ratio was lower in obese girls than in non-obese girls (P= 0.03). Obesity (20% of ideal weight) was strongly correlated with the serum levels of lipids and apolipoproteins in boys this relationship was less clear in girls. The degree of obesity and the body mass index (BMI) were more strongly correlated with serum levels of lipids and apolipoproteins in boys than in girls. In boys, atherogenic-lipoproteins and apolipoproteins, such as LDLC and apoB, showed a stronger correlation with the thickness of the triceps skinfold, while in girls the anti-atherogenic lipoproteins and apolipoproteins, such as HDLC and apoA-1, showed a stronger correlation with both the triceps and the subscapular skinfold thicknesses. In girls the relationships between the BMI and the degree of obesity and the thickness of the subscapular skinfold (S) thickness were similar to the relationships between those parameters and the triceps skinfold (T) thickness. In boys, these parameters showed a stronger correlation with the subscapular skinfold thickness than with the triceps skinfold thickness. The correlation coefficients for the relationships between skinfold thickness and lipid and apolipoprotein levels were similar to the coefficients for the relationships between skinfold thicknesses and the severity of obesity and the BMI. The distribution of central-type fat accumulation, which is indicated by the thickness of the subscapular skinfold, the S/T ratio and S-T value, was inversely correlated with the HDLC level in both boys and girls. The degree of obesity was strongly correlated with the atherogenic lipoprotein profile in boys, in part because the subscapular skinfold thickness was strongly correlated with the degree of obesity and the BMI. In girls, the correlations between indices of central-type obesity and atherogenic lipid and apolipoprotein profiles were stronger than in boys. These data suggest that childhood obesity may be an early cardiovascular risk factor. © 2017 Wiley. All rights reserved.

We investigated the distribution of abdominal fat accumulation in obese children to know whether a clustering of coronary risk factors was demonstrated in visceral fat obesity as reported in adults. The relative indicator of intra‐abdominal fat accumulation was obtained from computed tomography scans at the umbilicus level in 36 obese subjects (24 males, 12 females). There was no visceral fat obesity in this study by reported criteria. All metabolic variables except triglyceride did not correlate significantly with intra‐abdominal fat accumulation. We conclude that visceral fat obesity is a rare status and has no close relationship to coronary risk factors in childhood. 1995 Japan Pediatric Society

The aim of this study was to evaluate the relationship between the serum levels of lipoprotein (a) [Lp (a)] and apolipoproteins (apo A‐1 and apo B) in schoolchildren with a history of coronary and cerebrovascular events in their grandparents. We measured serum concentrations of Lp (a) and apoliproteins immunochemically in 289 schoolchildren aged 12–13 years and questioned parents about coronary and cerebrovascular events in the children's grandparents. In boys and girls, mean ± s.d. levels of apo A‐1, apo B and Lp (a) were 134 ± 20.3 and 136 ± 17.4 mg/dL, 61 ± 16 and 66 ± 15 mg/dL and 12.5 ± 15.3 and 12.5 ± 15.1 mg/dL, respectively. There were no significant sex differences in the levels of apo A‐1, apo B, and Lp (a). The Lp (a) levels (mean ± s.d., 12.5 ± 15.2 mg/dL median 7.5 mg/dL, n = 289) were not affected by other variables. The Lp (a) distribution was strongly positively skewed and 75% of schoolchildren had very low levels. In the total 289 schoolchildren, thirty‐two grandparents who had had coronary vascular events (21 myocardial infarction, 11 angina pectoris) and twenty‐three grandparents who had had cerebrovascular events were recorded. By the boxplot statistical analysis, no difference was found in Lp (a) levels in children whose grandparents had myocardial infarction compared with those whose grandparents had no such history, or compared with those whose grandparents had suffered cerebrovascular events. Analysis also showed that the values of log Lp (a) in children whose grandparents had myocardial infarction tended to be higher than the values in children whose grandparents had no such history (P = 0.09). No significant differences in the levels of apo A‐1 and apo B and in the apo B/A‐1 ratio could be seen between children grouped according to the presence or absence of coronary and cerebrovascular events in their grandparents. These results suggest that high levels of Lp (a) in schoolchildren aged 12–13 years may partly reflect the existence of coronary vascular disease in older family members. Lp (a) may account for the strongest index of family history to disease risk in comparison with other apolipoproteins. Further study is needed to clarify the appropriate mass measurement method for Lp (a) in schoolchildren. 1995 Japan Pediatric Society