臨床検査63巻1号

2019年01月発行

今月の特集1 発症を予測する臨床検査—先制医療で5疾病に立ち向かう！

脳血管障害における先制医療

著者： 植木香奈¹ 吾郷哲朗¹ 北園孝成¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学

ページ範囲：P.26 - P.31

Point

●脳ドックの普及などにより，無症候性脳血管障害の発見が増えている．無症候性病変を症候化させないための先制医療が必要である．

●脳血管障害のなかで，最も重症度が高く寝たきりや介護の原因となる心原性脳塞栓症に対しては，特に積極的な先制医療を施す必要がある．

●脳血管障害ハイリスク患者では，発症後の転帰まで考慮に入れた先制医療を施すことも必要かもしれない．

参考文献

1）Yuan C, Zhang SX, Polissar NL, et al：Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation　105：181-185，2002

2）Rothwell PM, Howard SC, Spence JD, et al：Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease. Stroke　34：2583-2590，2003

3）Yamauchi H, Kagawa S, Kishibe Y, et al：Misery perfusion, blood pressure control, and 5-year stroke risk in symptomatic major cerebral artery disease. Stroke　46：265-268，2015

4）Cannon CP, Blazing MA, Giugliano RP, et al：Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med　372：2387-2397，2015

5）Sabatine MS, Giugliano RP, Keech AC, et al：Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med　376：1713-1722，2017

6）Tanaka K, Ishikawa Y, Yokoyama M, et al：Reduction in the recurrence of stroke by eicosapentaenoic acid for hypercholesterolemic patients: subanalysis of the JELIS trial. Stroke　39：2052-2058，2008

7）Furie KL, Kasner SE, Adams RJ, et al：Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke　42：227-276，2011

8）Bokura H, Saika R, Yamaguchi T, et al：Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals. Stroke　42：1867-1871，2011

9）Yaghi S, Moon YP, Mora-McLaughlin C, et al：Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study. Stroke　46：1488-1493，2015

10）Montaner J, Perea-Gainza M, Delgado P, et al：Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke　39：2280-2287，2008

11）Kilarski LL, Achterberg S, Devan WJ, et al：Meta-analysis in more than 17,900 cases of ischemic stroke reveals a novel association at 12q24.12. Neurology　83：678-685，2014

12）Miyatake S, Miyake N, Touho H, et al：Homozygous c.14576G＞A variant of RNF213 predicts early-onset and severe form of moyamoya disease. Neurology　78：803-810，2012

13）Kumai Y, Kamouchi M, Hata J, et al：Proteinuria and clinical outcomes after ischemic stroke. Neurology　78：1909-1915，2012

14）Ago T, Matsuo R, Hata J, et al：Insulin resistance and clinical outcomes after acute ischemic stroke. Neurology　90：e1470-e1477，2018

15）Wilcox R, Bousser MG, Betteridge DJ, et al：Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke: results from PROactive (PROspective pioglitAzone Clinical Trial In macroVascular Events 04). Stroke　38：865-873，2007