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1 136ﾑ ｧ ｧ9 2010; 22 (4): ﾞ fiapple ﾇ fi ｸ ｦ ｧ90ｹ ｹ ｧ9 0ｹ ｹ 閨0ｹ ｹ ｧ902090ｹ ｧ9 0ｹ0* 09. ﾞ. 6ｾ ｦﾐ apple0803 閨02090ｹ ｧ ｦ ｸ702 6ｧ ｧ9 0ｸ7016ｧ fi0ｹ0 020ｷ307 0ｸ7apple ｧ9020ｷ ｷ ｧ ｧ ｧ80ｹ fi ｸ ｦ0. ﾇ apple ｧ80ｹ ｧ fi090ｷ3 閨 ｹ ｸ ｷ ｸ ｧ fi ｷ307 0ｸ7apple ｧ9020ｷ307 0ｸ7applefi 00010ｷ ｧ ｸ ｸ apple fi ｸ7 020ｷ307 0ｸ7apple ｧ90ｷ apple apple ｸ702086ｦ007. 縺 閨 fi ｸ7046ｧ ｸ70ｹ apple ｦ apple03 閨 apple020ｷ ｦ000 02, applefi 00 fi02000ｹ ｸ7030ｸ700 閨 ｧ , ｧ /6ｧ apple ｧ /6ｧ ｧ ｧ907090ｹ ｦ0 >1,5 mg/dl. O ｦ ｹ ｸ7apple ｧ9apple ｧ8 閨 fi ｹ0 020ｷ307 00standard ｦ004000ｷ307 applefi apple ｧ8 ｨB fi0209, ｸ7apple ｦ ｸ fi ｹ ｷ ｧ O fi0ｹ0 0403fi07080ｹ0 apple ｧ80ｹ ｧ ｦ ｹ0 0403fi07080ｹ0 6 70ｸ704036ｧ80ｹ ｧ9 0ｹ0 006ｧ ｧ80ｹ0 04apple080ｸ7 06fi ｹ ｦ 閨 fi apple066 56ｧ90ｷ ｷ ｦ ｹ ｧ9 0ｹ0, 09 00apple066 56ｧ90ｷ ｷ ｸ ｷ ｧ ﾞ ｧ9 0ｸ7apple ｯfi fi0206 apple ｧ ｧ90ｹ0 apple ｸ ｸ ｦ007 00fi ｸ700, 09 00apple066 56ｧ90ｷ ｷ ｸ ｷ fi0706, 006ｧ ｧ ｸ70ｹ ｧ90ｹ ｷ ｷ3 020ｷ ｧ O06 026ｦ ｹ ｧ9000ｹ ｸ7 020ｷ ｧ ｹ0, apple 閨0ｹ0 00apple06apple 閨0ｹ0. 6ｾ46ｧ gold standard ｹ apple006ｧ9 0ｹ ｹ0 0403fi0706 0ｹ ｧ80ｹ0 07fi04080ｸ ｦ ｧ9080ｸ ｸ70ｹ0 0ｸ7apple00036ｧ ｹ ｧ90ｹ ｷ303006ｧ apple ｧ fi ｸ 閨 ｹ : 閨 , 00apple06apple 閨0ｹ0, ｷ300 閨 ｧ8apple02000ｹ0, 036ｧ ｧ80ｹ0, fi ｸ ｦ0. 6ﾑ ｷ3096ｧ fi ｦ 006ｧ800 縺 fi ｧ ﾞ 閨 , 2 ｦ 006ｧ ｧ9 0ｹ fi ｸ704090ｹ ｦ0 0ｸ802086ｦ ｧ9080ｸ7, ﾞ036ｧ807 * ﾇ fiapple apple ｧ9 00 閨03080ｹ ｹ ｧ9 0ｹ0 apple080ｸ7 apple apple08066ｧ applefi ｾ ｧ908 Necker 02080ｸ ｦ0, fi ｷ307 apple ｷ ｹ fi ｸ704090ｹ ｦ ｧ90ｹ ｷ3 020ｷ ﾇ 040ｸ ｧ ｧ9 apple 03080ｸ O ｧ908 Bichat-Claude Bernard ｧ apple03 6ｧ90406 applefi ｹ apple ｦ0 06apple ｹ ｧ80ｹ0 applefi apple ｧ Denis Diderot - Paris VI. 1

2 13M.A. 6ｾ4O03ｦﾐ ﾒｦﾐ ﾞ03, ｦﾐ O 6ﾑ8ｦ ﾇ6ｾ4 6ﾑ ｧ o03o096ｧ9 22, 2010 ｦ ｸ702 6ｧ9 0403fi0706 閨04080ｸ707 0ｸ ｧ ｧ90ｹ fi ｧ8 07fi ｦ ｧ9080ｸ7. ﾒ ｧ ｧ ｹ0 00 閨03000ｹ0 00 0ｹ ｦ0080ｸ apple00036ｧ ｹ ｧ80ｹ ｧ80ｹ ｧ9 0ｹ0. ｦ 08 50% apple00036ｧ9apple080ｸ7 020ｷ apple080ｸ ｧ apple03fi ｷ ｧ80ｹ ｹ0, 006ｧ ｷ3 020ｷ , 閨0408 fi ｧ9 0ｹ 閨 fi O ｧ90ｹ ｷ3 020ｷ apple ｦ ｧ apple080ｸ7 0ｸ ｦ ｸ70300fi , ｹ0 07 apple020ｸ70900 閨07000ｹ ｹ fi % 020ｷ apple080ｸ7 0ｸ7apple ｧ ｷ ｧ ｧ ｷ3 020ｷ ﾇ fi ｸ ｦ ｷ303006ｧ apple006ｧ ｹ fi ｹ0 0403fi0706 0ｹ ｧ80ｹ0 07fi04080ｸ7, 06fi0206 apple 閨 apple 036ｧ ｦ apple066 56ｧ90ｷ ｦ apple0806fi ｨB0ｷ36ｧ80ｹ 閨 ｷ ｧ O fi0ｹ0 020ｷ apple080ｸ7 00apple06030ｸ700086ｦ ｸ702086ｦ007 0ｸ ｸ ｹ0. 6ｾ402060ｹ0 ﾇ09 ﾞ ｧ ｧ80ｹ 閨07 00fi ｸ700 00apple ｦ fi fi ﾑ ｦ ｷ ｹ0 036ｧ ｹ0 6ｧ % ｦ , applefi 閨0ｷ30ｹ 閨 閨 fi0708 6ｦ ,2% 020ｷ 閨070ｷ , apple080ｸ7 閨 ｸ70ｹ ｸ7apple086 76ｧ ｸ70ｹ0 036ｧ8apple02000ｹ ｸ70300fi 0ｸ702fi 0ｸ7apple ｧ fi ｧ , ｹ 閨0ｹ ｸ7 2010, 03 6ｧ 閨 ｧ90ｹ0, fiapple0ｷ30ｹ ｸ ｧ ﾇ fi ｸ ｦ0 0ｸ7apple ｧ9apple ｸ70ｹ ｷ300 閨07080ｸ70ｹ apple 03006ｧ90ｹ ｯ fi03 02 apple 閨0702, ｸ apple ｧ8 apple ｧ9 020ｷ apple080ｸ ｹ0 036ｧ ｹ ｧ80ｹ0 076ｧ802080ｸ ｹ0 0700fi ｹ 閨0ｹ ｹ06. ｦ ｹ0 ﾇ09 ﾞ 閨07 apple fi 00fi03060ｹ % 020ｷ apple ｧ9 0ｹ ｷ3 020ｷ apple fi ｸ70ｹ 閨07080ｸ70ｹ ｧ ｧ80ｹ fi ｸ ,7. ｦ 08 6ｧ ｧ904040ｸ apple ｦ ｧ ｹ ｹ0 apple080ｸ7 apple03080ｷ303086ｦ fi ｸ70409, fiapple0ｷ30ｹ0 09 罍 03036ｧ9 8. ﾞ0ｸ702fi ｧ90ｷ30ｹ fi ｦ00ｹ0 03fi09080ｸ70ｹ0: ｨC 08apple 閨 ｸ ｷ apple06020ｸ7046ｧ9 020ｷ 閨02030ｷ307 apple080ｸ7 閨04080ｸ ｧ apple03fi ｷ ｧ90ｷ ｸ ｷ307. ｦ ｦ applefi apple ｹ0 fi02000ｹ0 apple080ｸ7 apple ｦ0apple02080ｸ 閨040ｷ ｹ ｦ0 0ｸ7026ｧ80ｹ0, 6ｧ fi ｸ70ｹ ｧ9 0ｸ7apple086 76ｧ ｸ70ｹ0 036ｧ8apple02000ｹ04,9,10. ｨC O06 0ｸ7apple00036ｧ ｹ0 閨04080ｸ fi apple fi apple066 56ｧ90ｷ304090ｹ01. ｨC O ｷ300 閨 ｧ90ｹ0 閨04080ｸ ｦ ｧ907 0ｸ ｸ 閨 ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ0, 02080ｸ apple ｧ ｧ8 apple00036ｧ fi ｸ70409, fi0ｹ0 03fi090ｷ ｧ9 0ｹ 閨03080ｸ7 03fi090ｷ3 apple fi ｷ ｸ ｷ307, fiapple0ｷ30ｹ ｧ802090ｹ ｷ ｧ8030ｸ ,7. ｨC ｧ ｧ9 apple ｦ ｷ ｧ ｷ30ｹ apple006ｧ ｹ ｧ80ｹ0 07fi04080ｸ ｦ ｧ9080ｸ7, 06fi0206 apple ｧ9 006ｧ ｷ304026ｧ apple000ｸ ｧ8 00 閨 , apple080ｸ7 apple 03 閨 apple ｧ8 00apple066 56ｧ90ｷ fi ｸ7apple03fi ｧ907 0ｸ ,7. O 閨0ｹ 閨0ｹ0 020ｷ ｸ702 6ｧ9-0ｷ fi070ｷ ｹ0 036ｧ ｹ fi ｸ ｦ ｸ70ｹ 閨 ｹ0 03fi09080ｸ70ｹ0, ｸ7-02 6ｧ9 0403fi fi ｹ0 ﾇ09 ﾞ fi ﾑ80ｸ70306apple09, fi0ｹ0 020ｷ ｹ0 036ｧ ｹ0 0ｸ ｸ7-036ｧ90ｷ30ｹ0 applefi ｷ3 020ｷ ,12. ﾞ07026ｧ , fi 030ｸ70300fi 0ｸ apple fi 020ｷ ｷ3 020ｷ apple080ｸ 閨 fi 00fi ｸ O ｷ300 閨 ｧ90ｹ ｷ3apple6ｧ9- ｨB apple06020ｸ704060ｹ ｷ ｧ , 00apple06- ｨB086ｦ007, 006ｧ ｧ ｧ apple06030ｸ ｦ ｦ ﾑ ｧ 閨07 006ｦ : 09fi040ｷ fi070ｷ ｧ ｷ303086ｦ ｷ30ｹ ｷ300 閨 ｧ90ｹ0; 6ｾ402060ｹ 閨0ｹ ｹ ｧ9 0ｹ ｸ7 ｯ90, ｷ3-00 閨 ｷ303086ｦ ｧ90ｹ ｷ3 020ｷ ｾ400 0ｸ702086ｦ00ｹ0 閨 apple00036ｧ ｹ0 ﾇ09 ﾞ ﾑ80ｸ70306apple09 ( ｧ9 020ｸ7036ｧ90ｷ30ｹ0) 0806 apple ｹ ｦ ｹ ｦ0 13,14. ﾞapplefi apple apple ｧ9 06 apple fi 閨 ｷ ｸ ｧ ｦ ｦ apple 閨 fi , apple006ｧ fi ｸ apple ｦ ｹ ｧ9000ｹ0. 030ｷ30ｹ ｦ ｧ90ｹ ｦ apple 閨 ｧ ｦ ｧ9 0ｹ ｷ3 020ｷ 閨 ｦ ﾞ0ｸ702fi ｧ fi0206, ｧ8- apple02090ｹ apple , ｸ703096ｧ ｸ ｦ ｹ ｸ70ｹ0 apple ｷ300 閨07080ｸ70ｹ0 006ｧ ｧ ｸ703096ｧ ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ ｸ ｸ apple 閨 閨07090ｹ ｹ0 6ｦ ｹ ｸ7 00 閨04080ｸ7 fi03080ｸ7 ｨB0ｷ36ｧ80ｹ ｸ707 6ｧ902000ｹ ｹ0, apple apple ｦ ｦ ｹ apple 03006ｧ90ｹ ｷ3 020ｷ ｾ46ｧ8-2

3 136ﾑ ｧ ｧ9 22, apple03 閨0807 apple apple ｦ ｷ3 020ｷ ,6,8,14,15, apple ｹ0 040ｸ7070ｸ7apple ｸ704000ｹ 閨0ｹ ｹ apple fi0ｹ0 fi0206, ｦ ｹ ｧ9 0ｹ ｸ7 036ｧ8apple0209, 0ｸ ｧ907-0ｸ707080ｹ ｹ0 0700apple ｹ ｸ ｦ ｹ ｷ30ｹ apple ｦ00ｹ0, ｧ ｧ 閨 fi ｧ9 fi ｧ ｧ9. O apple ｹ0 apple080ｸ7 apple03 鐶pple apple applefi fi ｸ fi0ｹ ｷ300 閨07080ｸ7 02fi00080ｸ7, 03 apple03 鐶pple ｧ ｸ ｧ ｹ0 0ｸ709006ｧ9-0ｹ ｸ ｸ707036ｧ802000ｹ ｹ0 ｨB0ｷ36ｧ80ｹ ｸ ｧ ｸ fi ｧ fi ｧ9 0ｹ0, apple086ｧ ｧ902070ｸ fi ｸ70409, apple080ｸ7 apple ｦ ｦ apple0806fi ｨB0ｷ36ｧ80ｹ01,16. 6ﾑ8apple06apple ｹ ｸ70ｹ0 0ｸ7apple086 76ｧ ｸ70ｹ0 036ｧ8apple02000ｹ0 applefi ｧ ｧ ﾑ86ｧ ｸ707fi fi ｧ90ｹ0 0ｸ7applefi ｧ8 apple ｸ8026ｧ apple080ｸ ｧ ｧ ｧ ｧ80ｹ0 閨04080ｸ707 0ｸ7apple ｧ apple036ｧ80309 apple ｸ fi 閨 ﾑ8apple0800 閨070ｷ30ｹ0 閨04080ｸ apple ｧ ｹ0 040ｸ 閨0ｹ ｹ0, fiapple0ｷ30ｹ ｧ9 07fi04080ｹ0, apple086ｧ9-000ｹ ｷ3apple6ｧ ｸ ｧ8 00apple ｾ402060ｹ0 ﾇ09 ﾞ apple ｹ0 6ﾑ80ｸ7030ｷ3apple 0ｸ802 閨0ｹ ｹ0, fiapple0ｷ30ｹ0 apple 罍 03036ｧ9, apple080ｸ ｧ ｧ fi ｧ90ｹ0 0ｸ7applefi 00010ｷ ｧ ｧ90ｹ0 apple080ｸ ｧ apple fi fi ｧ80ｹ0 07fi04080ｸ7, apple ｦ apple03fi fi0706 0ｹ ｹ0 6ｧ8 apple ｸ8026ｧ80ｹ ｹ0 (apple ｧ9). ｦﾌ ｧ90ｷ30ｹ0, 0ｸ702fi fiｨB apple08036ｦ0 apple 閨 ｧ apple03080ｹ apple 03fi ｸ7036ｧ90ｷ30ｹ ｦ ｹ0 applefi ｨB ｹ0 fi02000ｹ0. ｦ ｸ ｧ apple6ｧ904090ｹ0 030ｸ 閨07 0ｷ30ｹ0 apple03080ｹ apple ｧ ｸ70ｹ 閨04080ｸ707 0ｸ7apple ｧ ｹ0 0ｸ ｧ90ｹ0 00apple ｹ ｹ ｷ ｧ80ｹ ｹ fi 046ｦ (00apple ｹ0 0203apple). 6ｾ40ｸ70700apple060ｹ0, ｧ90ｹ ｹ0 036ｧ ｹ ｧ ｦ ｧ applefi 0ｸ702086ｦ00ｹ0 apple080ｸ7 006ｧ apple , 06fi ｧ apple036ｧ8030ｷ30ｹ0 030ｸ 閨 apple ｧ ｸ70ｹ0. 040ｸ704020ｸ704060ｹ0 fi000ｷ30ｹ0 02 apple ｧ ｸ ｸ applefi fi ｧ80ｹ0, apple080ｸ ｸ ｧ ｹ ｹ0 020ｷ ｾ ｹ ｧ80ｹ0, apple086ｧ908 0ｸ ｧ ｸ70ｹ0, ｷ300 閨 ｧ90ｹ0 00apple ｦ apple 閨030ｷ apple ｧ apple080ｸ7 apple ｧ ｧ8 09 0ｸ7apple , 006ｧ apple fi METAMO6ｾ4016ﾑ8086ｾ4 ﾇ 036ﾑ80206O08 6ｾ46ﾑ8 ﾇ ｦﾐ ﾒｦﾐ03096ﾑ803O086ｾ4 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ4 apple ｸ707 apple 閨 ｹ ｧ90402, 040ｷ3036ｧ90ｹ0 apple ｸ703086ｦ007 1,12,17. 6ｾ402060ｹ0 ﾇ09 ﾞ 00 閨 , % applefi 02080ｸ70ｹ 閨07080ｸ70ｹ ｧ ｧ fi ｧ80ｹ ｷ3 020ｷ % 07070ｷ3 020ｷ ｾ402080ｸ70ｹ ｧ90ｹ ｷ3 020ｷ , ｧ8 apple07070ｷ3 applefi fi ｸ ｧ apple fi ｸ7 50%, ｧ fi ｸ ｸ702fi 1,4. 縺 fi0908 0ｸ702fi, 046ｧ apple 閨 fi ｸ704090ｹ ｸ70ｹ ｷ300 閨07080ｸ70ｹ ｧ90ｹ0 fi ｸ707 02fi07 070ｷ3036ｧ ｦ ｸ704fi apple03fi020ｸ7apple0803 (gold standard) 02090ｹ apple006ｧ9 0ｹ ｹ0 0403fi0706 0ｹ ｧ80ｹ0 0700apple ｹ ｸ70ｹ ｧ90ｹ0 0ｸ702086ｦ00ｹ ｷ303006ｧ apple ｧ8 (preemptive) fi ｸ70409, applefi apple ｧ8 (040ｸ 閨 apple6ｧ ｸ7 apple 03fi ｹ0) applefi ｨB fi0209. ﾞ08086ｦ0 0ｸ fi0ｹ0 020ｷ307 0ｸ7apple ｧ90ｷ ｷ300 閨070ｷ apple 閨07090ｹ ｹ0 閨 ｹ ｷ307, fi07080ｹ ｧ80ｹ0 020ｷ ｧ ｸ applefi08000ｸ 縺 ｧ fi0ｹ ｸ70308apple08066ｧ ｹ fi04080ｹ ｹ0 閨 ｹ fi ｸ704090ｹ ｸ70ｹ ｧ90ｹ0 apple080ｸ7 040ｸ ｸ ｹ0 apple030800apple0803 閨 ｹ0, 006ｧ apple ｧ fi ｹ ｸ ｷ307. ﾞ0ｸ702fi ｧ90ｷ30ｹ ｦ ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ apple08036ｦ0 apple fi ｸ70ｹ0 0ｸ7apple00036ｧ ｹ 閨0ｹ ｸ ｷ307 6ﾑ86ｧ fi0ｹ0 fi ｸ70ｹ ｷ300 閨07080ｸ70ｹ0, ｦ ｹ0 applefi ｨB ｹ0 fi02000ｹ0 006ｧ ｹ0. O ｹ ｦ004000ｷ307 fi000ｷ30ｹ0 apple030804apple 03086ｦ ｹ0 040ｸ704026ｧ807080ｸ ｹ0 0ｸ ｸ707, 020ｸ7036ｧ90ｷ30ｹ ｹ0 ﾇ09 ﾞ, ﾑ80ｸ70306apple ｸ703086ｦ ｦ ｸ70ｹ0 030ｸ ｦ00ｹ0. 6ｾ402060ｹ0 ﾇ09 ﾞ ｧ ｦ ｹ ｦ0 applefi ｨB ｹ0 fi02000ｹ0 0ｸ7016ｧ applefi 20% % ｸ70ｹ0 036ｧ8apple02000ｹ ｷ3 020ｷ applefi 2% % ｧ8apple02000ｹ ｷ3 020ｷ ｦ 閨07 006ｧ apple08036ｦ0 apple ｹ ｧ9000ｹ ｷ3 020ｷ ﾞ0ｸ702fi 閨00 閨 ｸ fi ｹ 閨0ｹ 閨0ｹ0 apple ｹ ｦ0 040ｸ , ｧ ｧ90ｹ apple06030ｸ700086ｦ apple ｸ fi applefi apple 閨0ｹ ｸ70ｹ0 apple03fi040ｷ3apple 閨04080ｸ apple0ｷ3036ｧ ｸ70ｹ0 0ｸ ｦ00ｹ ｦ007080ｸ70ｹ0 ｨC ｸ70ｹ apple ｸ70ｹ0ｨc ｹ ｧ80ｹ0. 6ﾑ86ｧ apple6ｧ904090ｹ0 apple08036ｦ0 040ｸ 閨 閨0708, fi ｹ 閨 ｹ apple06030ｸ700086ｦ apple 閨03080ｸ 閨 fi 02080ｸ70ｹ apple ｸ ｧ ｸ70ｹ ｹ0/ ｦ ｹ ｧ9 0ｹ06. 6ﾑ ｸ7, ｹ ｹ ｧ9000ｹ ｸ7apple ｸ ｸ7076ｧ8030ｷ30ｹ0 0ｸ7apple086 76ｧ fi02000ｹ ｸ ｧ90ｹ0, 3

4 13M.A. 6ｾ4O03ｦﾐ ﾒｦﾐ ﾞ03, ｦﾐ O 6ﾑ8ｦ ﾇ6ｾ4 6ﾑ ｧ o03o096ｧ9 22, apple 閨03080ｸ 閨 fi 02080ｸ70ｹ0, ｧ8 6ｦ apple ｦ ｧ ｸ7 fi0209. ﾞ applefi07 apple03 鐶pple ｨB ｧ ｦ0 09 apple09096ｧ8 020ｷ ｸ ｷ ｸ70ｹ ｷ300 閨07080ｸ70ｹ ｧ90ｹ , 02fi ｹ0 ﾇ09 ﾞ fi ﾑ80ｸ70306apple09, apple ｦ applefi ｧ9 0ｹ apple03 閨 ｦ applefi apple020ｷ ｦ00ｹ0 fi02000ｹ0 apple080ｸ ｧ ｧ ｧ9ｨB ｷ30ｹ0 00 apple ｹ0 fi02000ｹ ｸ7030ｸ700 閨 ｧ O ｧ9 apple080ｸ7 apple0308 閨 applefi 0ｸ702086ｦ00ｹ ｧ9ｨB ｷ30ｹ ｧ fi fi02000ｹ ｷ3 6ｧ fi02000ｹ ｦ , apple080ｸ7 fi000ｷ30ｹ0 040ｸ ｸ707 2 applefi ｧ80ｹ ｧ80306 : 6ｦ ｧ90709 apple07070ｷ3 applefi 132,6 00mol/L (6ｧ8 1,5 mg/dl) 6ｦ ｹ0 applefi fi fi 00apple000604fi ｦ fi ｧ80ｹ0 0ｸ7apple 閨 ｹ04. ｦ ｧ apple ｧ ｧ apple , apple.04. apple fi apple 閨070ｷ307 04apple ｷ307 6ｧ fi0ｹ0 6ｧ9070ｷ304090ｹ ｸ ｸ ｦ0 6ｧ fi0ｹ ｸ ｾ402060ｹ0 ﾇ09 ﾞ ｧ9 0ｸ702086ｧ9 6ｧ ｧ fi ｧ80ｹ0 020ｷ ｧ ｾ ﾑ80ｸ70306apple09 6ｧ ｧ ｹ ｧ9000ｹ0 fi ｧ8- apple0209, ｧ90ｹ ｹ0 6ｧ9 06 0ｹ ｹ ｧ9 0ｹ0 (apple ｧ9 apple020ｷ ｷ3 020ｷ ｧ ｧ8apple02000ｹ ｧ90ｷ30ｹ ｷ3 020ｷ307 65). 0903fi apple03fi old for old03. ﾇ ｸ fi HLA ｹ0 0ｸ7apple ｯ fi apple ｧ8 0ｸ7026ｧ8, ｧ apple080ｸ apple ｧ9apple apple03 閨0807, 0ｸ7apple ｸ707 apple fi ｦ 閨 fi07080ｹ ｧ80ｹ ｧ ﾑ808 ｯ fi ｦ ｧ ｷ300 閨 ｧ90ｹ0, 閨04080ｸ ｹ0 6ｧ ｹ0 apple fi ｹ ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ ｸ703086ｦ ｷ303006ｧ fi0206 閨04080ｸ ｦ fi ｧ80ｹ0 applefi fi03000ｹ ｹ ｹ ｹ , 08086ｦ0 0ｸ7apple ｧ ｸ ｷ ｧ9 00apple 鐶pple fi ｸ70ｹ ｧ8 000ｸ ｧ9. 6ﾑ8apple06apple03 閨0807, 0ｸ7applefi 閨07000ｹ0 apple030800apple0803 閨 ｹ fi03 00fi ｸ700 閨 apple 03fi apple066 56ｧ90ｷ ｦ apple080ｸ7 6ｧ ｹ0 040ｸ 閨07000ｹ ｧ9000ｹ0, apple 閨 ｧ80ｹ0 040ｸ fi ｹ HLA. O ｦ ｹ ｸ7apple ｦ007 0ｷ30ｹ0 apple03080ｹ ｧ8 閨 fi ｹ 閨 ｷ ｧ ｦ apple ｧ ｧ90ｷ30ｹ 閨 ｹ ｦ ｹ0 apple080ｸ7 apple apple ｦ applefi apple fi standard ｧ ｧ8 applefi ｨB fi ﾑ8apple6ｧ904090ｹ0, fi ｹ0 020ｷ ｦ004000ｷ ｧ ｦ fi090ｷ3 apple fi ｷ307 00apple06apple ( ｷ307, ｸ apple06apple ) apple6ｧ ｹ ｧ9 0ｹ0, fi 0ｸ7apple 閨 ｹ0, ｧ ｧ907090ｹ ｦ0 >1,5 mg/dl fi fi 00apple000604fi ｷ30ｹ ｧ ｸ712,19,20. O06 apple fi ｹ ｹ ｧ80ｹ0 閨 ｹ0 006ｧ ｸ 閨07000ｹ0: ｨC fi02 07 apple03fi apple fi ｸ70409 ( ｧ fi ｹ0 00apple6ｧ9 00apple fi ｸ704090ｹ0) ｨC fi ｸ fi ｹ0 006ｧ fi07080ｹ0 6 70ｸ704036ｧ80ｹ ｧ9 0ｹ0 ｨC 0008 ｯ fi ｸ7apple ｸ fi0ｹ ｸ ｦ ｹ ｸ 閨0ｹ0 00apple ｹ0 ｨC fi ｸ fi ｸ703096ｧ fi ｸ ﾑ fi07080ｹ0 6 70ｸ704036ｧ80ｹ ｧ9 0ｹ0 閨 ｧ ｸ70ｹ ｦ00ｹ ｦ00ｹ ｷ ｦ ｹ ｧ9 0ｹ0 0208apple0803 閨 ｹ0, ｹ ｸ ｦ ｹ0 applefi apple 閨 fi ｸ704036ｧ80ｹ ｧ9 0ｹ0 00apple ｦ ｷ303086ｦ007, 08applefi ｦ ｸ ｧ80ｹ0 00apple6ｧ ｹ ｧ9 0ｹ ｸ7 fi ﾞ016ｧ9ｨB applefi fiapple08 09 fi ｧ ｷ3apple6ｧ9ｨB ｷ30ｹ0 00apple006ｧ909080ｸ704 0ｷ30ｹ0 apple03080ｹ fi ﾑ8apple066 56ｧ90ｷ ｦ00ｹ ｦ ｹ0 6ｾ400 fi03080ｸ70ｹ ｸ70ｹ ｧ90ｹ0, 02fi ｸ70ｹ ｷ300 閨07080ｸ70ｹ0, 0ｸ apple fi apple066 56ｧ90ｷ304090ｹ fi ｸ ｦ ｷ3036ｧ90ｹ ｧ80209, ｧ9ｨB080ｸ fi0706, ｧ fi0706. O ｧ90ｹ0 020ｷ ｧ9ｨB080ｸ ,3 0403fi0706, ｧ90ｹ ｧ9 0ｹ ,8 0403fi ｧ90ｹ ｧ9ｨB080ｸ apple06apple03 閨 fi0708 ｨB0ｷ36ｧ80ｹ013. 6ｾ402080ｸ70ｹ ｸ700 閨07080ｸ70ｹ ｷ3 020ｷ , 0208 apple fi apple066 56ｧ90ｷ304090ｹ0 06apple ｨB ( applefi 3, ,6 0403fi0706 ) 閨 apple fi ｸ apple080ｸ7 00 閨07080ｸ ｧ ｧ80ｹ02,13. ﾞ02fi ｧ90ｹ ｷ3 020ｷ307 75, 閨04080ｸ ｦ apple fi apple066 56ｧ90ｷ304090ｹ0: 5,9 閨 , ｷ apple080ｸ7 00 閨07080ｸ ｷ ｧ ﾞ 閨 ｸ70ｹ ｧ90ｹ ｹ0 036ｧ ｹ0 閨04080ｸ % fi ｧ907 0ｸ ｸ7, apple apple080ｸ ｦ fi ｸ70ｹ ｦ00ｹ ｸ70ｹ ｦ00ｹ ｧ90ｹ015. ｦﾌ ｧ90ｷ30ｹ0, fiapple0ｷ30ｹ 閨 , ｹ ｦ ｹ ｧ9000ｹ fi ｧ ｦ , fiapple0ｷ30ｹ ｦ fi apple ｸ70400fi. ﾇ fi ｷ ｸ700 閨070ｷ307 fi030ｷ ｷ ｧ ,8%, ｸ70ｹ ｸ700 閨07080ｸ70ｹ ｷ3 020ｷ ｧ ,4%. 6ｾ46ｦ000080ｷ 閨 ｸ ｹ0 4

5 136ﾑ ｧ ｧ9 22, 2010 ﾇ09 ﾞ, ｧ fi ｸ70ｹ ｸ ｸ70ｹ ｧ / ｧ90ｹ0 ｨC 閨 ｧ907 0ｸ70708, ｸ70ｹ ｷ3 020ｷ ｧ / ｧ90ｹ0 ｨC 閨 ｧ907 0ｸ ｦ 閨 ｧ apple 閨 apple080ｸ 閨 ｹ 閨0ｹ0 (registries) 02fi ｷ307 ﾇ09 ﾞ, fi ｹ ｧ9 0ｹ0, ｹ ｹ0 apple fi ｹ ｦ ｹ ｷ300 閨070ｷ ﾑ80ｸ70306apple09, ｦ apple066 56ｧ90ｷ ｷ ｸ ｷ307: 0007 apple ｧ apple066 56ｧ90ｷ ｹ0 020ｷ ｸ ｷ ｧ90ｹ ｷ3 020ｷ ｧ90ｹ ｾ402080ｸ70ｹ0 0ｸ7apple00036ｧ ｹ ｧ90ｹ ｷ3 020ｷ apple066 56ｧ90ｷ ｷ ｸ ｷ307 6ｧ ｦ applefi apple066 56ｧ90ｷ ｷ ｸ ｷ ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ ｷ3 020ｷ ﾞ0ｸ702fi apple08 fi 閨 ｧ ｧ ｷ307 0ｸ7apple ｧ9020ｷ307 apple03080ｹ fi ｸ ｾ46ｦ000080ｷ apple ｸ , 09 00apple066 56ｧ90ｷ ｷ ｸ700 閨070ｷ apple ｹ ｧ9 0ｹ0, 09 00apple066 56ｧ90ｷ30409 fi000ｷ30ｹ0 020ｷ ｸ ｷ ｧ O ｹ ｧ9 0ｹ ｧ90ｹ0 閨04080ｸ ｦ apple fi apple ｸ ｸ ｦ007 00fi ｸ700, apple apple ｦ fi090ｷ3 apple ｹ ｹ ｸ703096ｧ9 0ｹ ｸ ｦ ｹ0. 09 閨 ｧ9 020ｷ , 09 00apple066 56ｧ90ｷ fi ｧ % ｸ70ｹ ｧ90ｹ % ｦ , ｹ0 apple03080ｹ ｸ70ｹ ｧ90ｹ ｷ3 020ｷ , 09 00apple066 56ｧ90ｷ fi 閨 % ｧ % fi ｸ ｦ 閨03080ｹ0, ｸ70ｹ ｧ90ｹ ｧ9 0ｹ ｷ3 020ｷ apple080ｸ ｦ fi applefi apple fi0209, 09 00apple066 56ｧ90ｷ ｸ70ｹ ｧ90ｹ 閨 % fi % fi ｦ % fi ﾞ02fi0009 apple 閨 ｧ apple ｦ 閨 閨 ｹ ｷ ｧ80ｹ ｹ0: ｦ 060ｹ0 6ｦ008 apple ｹ ｹ ｹ fi ｸ704090ｹ ｧ907 0ｸ707080ｹ ｸ7 006ｧ ｦ ｹ ｸ70ｹ ｸ700 閨07080ｸ70ｹ0 040ｸ ｸ70ｹ fi ｸ70ｹ apple ｸ fi ｹ0 閨0ｷ30ｹ 閨03 ( 3 ｨｮ 006ｧ807000ｹ0). ﾇ apple fi apple066 56ｧ90ｷ304090ｹ fi ｸ ｸ7026ｧ ｹ ｹ , applefi 02080ｸ70ｹ ｧ807000ｹ0 apple00036ｧ9apple080ｸ apple fi ｧ907 0ｸ707080ｹ ｸ ｹ ｧ9000ｹ ｦ % fi ｷ ｸ700 閨070ｷ ｧ apple08036ｦ fi METAMO6ｾ4016ﾑ8086ｾ4 ﾇ 036ﾑ80206O08 6ｾ46ﾑ8 ﾇ ｦﾐ ﾒｦﾐ03096ﾑ803O086ｾ4 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ ｹ fi ｹ0 020ｷ apple080ｸ7 apple 閨07080ｸ (23,2%), ｹ ｹ fi ｹ0 020ｷ apple080ｸ ｧ ｧ ｧ80ｹ fi ｸ700 (10%) 13. ﾞapple 閨 ｹ 閨04080ｸ704 0ｹ0 apple ｧ80ｹ ｹ ｦ ｹ0 020ｷ ｷ3-00 閨070ｷ ｾ402060ｹ0 apple ｹ ｦ ｹ ｸ7 apple ｹ0 00old for old 閨 ｧ9 縺 ｧ , 09 08apple086ｧ9 apple 閨 ｧ8apple02000ｹ ｷ3 020ｷ apple080ｸ7 閨 ｦ00ｹ0 applefi apple ｹ0 fi02000ｹ ｧ9 0ｹ0 6ｧ904090ｹ0 6ｧ ｦ ｹ0 020ｷ , fi ｸ ｧ80ｹ ｧ9 0ｹ0 apple00036ｧ9apple080ｸ7 11 0ｷ apple apple066 56ｧ90ｷ % fi % fi0706, apple066 56ｧ90ｷ ｷ ｸ ｷ307 6ｧ % ｸ70ｹ ｧ807000ｹ % ｸ70ｹ ｧ807000ｹ022. 6ｾ402 00apple apple 閨 ｸ ｹ0 ﾇ09 ﾞ, 09 00apple066 56ｧ90ｷ ｸ ｦ ｹ fi ｧ % ｧ90ｹ % ｧ90ｹ ﾞ07 fi000ｷ30ｹ ｧ9 0ｸ7apple ｯ fi fi0206 apple ｧ ｧ90ｹ0 apple ｸ ｸ ｦ ｦ000 02, 02 apple 閨 apple066 56ｧ90ｷ ｷ ｸ ｸ ｷ ｧ ｦ ｸ apple 閨 ｧ fi apple066 56ｧ90ｷ ｷ ｸ ｷ ｧ ｧ ｧ8 apple fi ｦ ｸ70ｹ ｷ300 閨07080ｸ70ｹ0 applefi fi, ｸ70ｹ0 0700fi ｸ70ｹ ｧ90ｹ ｸ7apple ｧ9ｨB ,8% fi ,1% fi fi ｹ0 006ｧ apple ｹ 罍 ｧ9. 6ｾ46ｦ000080ｷ 閨 ｹ0 Agence de Biomｨｦdecine, 09 00apple066 56ｧ90ｷ ｸ ｦ ｹ ｷ3 020ｷ , 006ｧ ｯ 03046ｧ applefi ｧ 陦 : fi ,5% 閨 ,4% ｸ70ｹ ｧ90ｹ ｧ9 0ｹ ﾑ ｦ ｹ0, ｧ9 0ｸ7apple ｯ fi fi0ｹ0 020ｷ apple080ｸ7 apple006 56ｧ90ｷ ｸ ｦ007 00fi ｸ700, 09 00apple066 56ｧ90ｷ ｸ ｦ ｹ fi- 0706, 006ｧ ｧ ｸ70ｹ ｧ90ｹ ｷ3 020ｷ ｸ70ｹ ｧ90ｹ 閨 % ( ｷ 閨070ｷ307 DIVAT * 2003) 8. 6ｾ apple 閨 apple080ｸ apple ｦ ｦ00ｹ ｦ00ｹ ｦ ｦ ｧ ｧ ｧ8apple0209, applefi ｦ apple066 56ｧ90ｷ ｷ ｸ ｷ307. ｦ apple 閨 ｷ ｦ004000ｷ307 0ｸ ｧ fi0009 applefi030ｸ 閨 ｷ30ｹ0 08 6ｧ fi0206 apple ｹ ｦ ｹ0 0ｸ702 閨0ｹ apple000306apple ｹ * DIVAT (Donnｨｦes Informatique Validｨｦes en Transplantation): Toulouse, Nancy, Nantes, Paris Necker. 5

6 13M.A. 6ｾ4O03ｦﾐ ﾒｦﾐ ﾞ03, ｦﾐ O 6ﾑ8ｦ ﾇ6ｾ4 6ﾑ ｧ o03o096ｧ9 22, 2010 apple ｷ 閨 ｧ8030ｸ ﾞ ｧ apple006ｧ9 ｦ apple080ｸ apple ｦ ｧ fi ｸ ｧ ｧ90ｹ ｹ ｸ7036ｧ907090ｹ0 (020ｸ apple08036ｧ90709, tacrolimus), ｧ90ｹ ｹ0 apple030ｷ302000ｹ107090ｹ0 mtor (sirolimus, everolimus), ｧ90ｹ ｹ0 046ｦ ｹ0 020ｷ307 apple080ｸ ( ｨB apple036ｧ90709, 000ｸ fi 08016ｦ0) ｷ 閨 ｷ307 0ｸ7apple 閨0ｷ ｹ ｸ7026ｧ907090ｹ0 2 (IL-2). 6ｾ40ｸ7076ｧ8030ｷ30ｹ0, 046ｧ ｧ ｧ8 apple ｷ ｧ apple006ｧ9 (induction) 閨 ｷ307 0ｸ7apple 閨0ｷ ｹ0 IL ｸ707 0ｸ7 0400fi 陦 02090ｹ ｸ7036ｧ907090ｹ0, 000ｸ fi 08016ｦ ｧ ｧ8 0ｸ7026ｧ apple fi ｧ9 0ｹ0 applefi ｹ0 閨04080ｸ ｷ303006ｧ % 020ｷ ｸ700 閨070ｷ ｸ7apple ｸ 閨07 046ｧ applefi 07 陦 apple030ｷ302fi ｸ70ｹ ｸ700 閨07080ｸ70ｹ ｹ ｧ9 0ｹ0. K ｦ fi ｧ90ｹ0 0ｸ702086ｧ ｸ ｷ ｧ apple006ｧ ｷ , ｧ 閨0ｹ0 fi ｹ0, 000ｸ fi 08016ｦ ｸ apple08036ｧ ｧ8 tacrolimus 8. O ｷ300 閨 ｦ ｸ fi 00fi ｸ apple086ｧ908 閨 ｸ 閨 ｸ ｧ ｸ70ｹ ｧ90ｹ ｹ ｸ7036ｧ907090ｹ0 03fi090ｷ ｹ0 apple ｦ ｹ0 applefi 0ｸ702086ｦ00ｹ ｦ004apple 04090ｹ apple 03080ｸ ｨB080ｸ fi ｹ 閨0ｹ ｹ ｸ 閨0709 閨 ｹ ｸ703096ｧ9 0ｹ ｸ ｦ ｹ0. 6ﾑ86ｧ applefi ｧ ｸ ｦ007 apple030ｷ302fi ｧ80ｹ0 apple080ｸ apple ｸ ｧ90ｹ ｹ ｸ7036ｧ907090ｹ0 086ｦ ｧ8, ｧ ｸ707 02fi07. O ｧ90ｹ ｹ0 apple030ｷ302000ｹ107090ｹ0 mtor apple08066ｧ ｸ7 000ｸ ｦ 閨080ｹ ｸ707 0ｸ7 0400fi ｧ ｸ apple08036ｧ ｾ402060ｹ ｦ ｹ0 020ｷ307 0ｸ7apple ｧ9-020ｷ ｧ apple030804apple ｧ804080ｸ ｸ70ｹ ｦ00ｹ ｧ90ｹ ｹ ｸ7036ｧ907090ｹ0, 06fi 閨04080ｸ fi020902, 0007 apple ｦ007 0ｸ7- apple 閨 ｸ ｦ apple020ｸ apple ｷ307. ｦ 00 閨 閨07 040ｸ ｧ907080ｸ ｷ 閨0ｷ ｹ ｸ7036ｧ ｹ ｧ90ｹ ｹ0 mtor ｧ ｹ fi ｸ704090ｹ ｧ , 閨02000ｹ0 006ｧ ｸ7fi ｹ ｧ fi ｧ ｸ707 02fi apple ｦ ｷ300 閨07000ｹ0 fi ｹ0 0ｸ ｦ ｧ fiapple ﾑ8apple06apple 閨0ｹ ｹ0 O ｸ700 閨 ｹ ｧ9 0ｹ0 閨04080ｸ ｧ ｸ ｧ ｹ ｹ ｸ7036ｧ90ｷ30ｹ CMV ｸ70ｹ0 006ｦ ｹ O06 0ｸ 閨07000ｹ ｹ0 applefi CMV 閨04080ｸ707 apple ｧ9 020ｸ7036ｧ90ｷ30ｹ apple006ｧ ｸ fi 08016ｦ0 36,37. ｦ ｸ702fi fi000ｷ30ｹ0 006ｧ apple08036ｦ ｧ90ｷ ｹ0 040ｸ7-0407fi ｹ ｹ0 applefi ｹ ｧ90ｷ ｹ0 00apple ｧ90ｷ304090ｹ ｸ ｦ ｹ ｷ fiｨB apple03 閨0807 apple ｸ ｧ ｸ806026ｧ apple006ｧ9 apple080ｸ7 閨 apple0703 apple08036ｦ ｹ ｹ0 applefi CMV 8. O06 0ｸ7apple00036ｧ ｹ0 apple 03080ｸ ｨB080ｸ707 00apple6ｧ904090ｹ0 040ｸ70407 閨0ｹ ｹ0 applefi 0003apple ｸ8086ｦ00ｹ0. 6ｾ 閨0209 apple ｧ /41 (17%) ｸ700 閨07080ｸ70ｹ ｷ3 020ｷ ﾇ 00apple6ｧ9apple020ｷ ｷ ｷ307 applefi pneumocystis carinii 閨 ｧ % ｹ 閨02000ｹ035,40, ｧ ｧ apple ｸ ｧ80ｹ apple006ｧ9 0ｹ0 006ｧ ｧ apple ｧ8. 6ｾ 閨 ｸ700 閨070ｷ ｷ3 020ｷ apple ｧ ｹ0 apple ｦ ｹ ｹ0 applefi CMV (0%), apple 閨0ｹ ｹ0, apple07000ｸ ｧ8 04apple ｧ ｷ apple07000ｸ 閨0ｹ ｹ0 applefi pneumocystis 0400 apple % 07026ｧ O ｹ ｸ7 07 apple07000ｸ ｦ0 apple ｦ apple fi 50-61% 8, ｹ ｸ7 apple00apple ｦ apple ｧ903 apple % 8,40. O06 080ｸ ｹ0 apple ｦ apple fi 30-70%, ｧ ｸ7apple00036ｧ ｹ ｹ ｷ3 020ｷ , ｸ7apple ｧ9 apple ,35,40. 6ｾ40ｸ ｹ0 000ｸ7036ｦ % 020ｷ ｷ apple ｦ ｨB6ｧ apple ｦ ｧ ｸ % 020ｷ ｸ700 閨070ｷ ｷ3 020ｷ ｾ46ｧ apple 閨 ｧ apple apple ｧ8 090ｷ3096ｧ ｸ7 CMV ｹ0 pneumocystis carinii ｸ70ｹ0 apple ｸ70ｹ ｧ807000ｹ0 applefi fi ｸ70409, 09 08apple086ｧ ｧ apple ｧ9 閨0ｷ30ｹ0 閨 fi0708 applefi fi ｸ70409, ｹ 閨 ｷ ｸ7026ｧ8020ｷ ｸ 閨07 006ｧ apple ﾞapple ｦ ｦ ｧ ｸ ｸ70ｹ0 0ｸ7apple00036ｧ ｹ ｸ700 閨07080ｸ70ｹ0 03fi090ｷ 閨 ｹ ｸ ｦ ｸ70ｹ0 040ｸ704026ｧ ｹ0. 6ﾑ86ｧ apple08036ｦ0 040ｸ70407fi ｸ702086ｦ00ｹ0 (9-12%) ｦ ｸ70ｹ0 6

7 136ﾑ ｧ ｧ9 22, ｸ7apple fi ｸ70ｹ (1-4%) 41,42. ｦ apple ｸ7 閨 ｹ0 apple ｦ apple fi 5,7%, apple ｸ applefi apple , apple080ｸ7 閨04080ｸ ｸ ｧ8 00apple6ｧ9apple020ｷ ,6% (apple 04 閨080ｹ 閨03080ｸ7, apple 陦 02080ｹ0, 080ｸ70308 fi04080ｸ7 026ｦ ｹ0, ｷ ｹ0 apple030ｷ30208apple 03086ｦ00ｹ ｧ9 0ｹ0) 41. O06 apple 閨0ｹ ｹ0 apple03 鐶pple ｨB ｦ apple ｸ703086ｦ apple fi ｸ ﾒ apple ｸ fi 閨 ｧ90ｹ0 apple03 鐶pple ｸ apple apple03080ｹ ｦ0030ｸ ｷ307 fi09020ｷ307, apple 閨0ｹ ｹ0, ｧ9, 閨 ｸ7 apple , fiapple apple 38. ﾒ 閨0ｹ0 00apple06apple 閨0ｹ0 O 閨0ｹ0 00apple06apple 閨0ｹ0 006ｧ apple6ｧ904090ｹ0 040ｸ70407 閨0ｹ0, fiapple0ｷ30ｹ fi03000ｹ ｷ ｹ ｧ9000ｹ0 020ｷ ｸ700 閨070ｷ307. 6ﾑ80ｸ7036ｦ % 020ｷ ｷ ｧ807 applefi fi ｸ ｧ8apple02000ｹ ｷ3 6ｧ ｷ3 020ｷ ,43,44. 6ｾ402080ｸ70ｹ ｸ700 閨07080ｸ70ｹ ｷ3 020ｷ ｧ fi ｧ ｸ7apple006ｦ0030ｸ % 020ｷ ｷ O06 040ｸ70407fi ｹ0 00apple06apple 閨0ｹ0 040ｸ7076ｧ ｦ0 閨 ｸ ｧ9080ｸ7/ ｧ9 07fi0408, ｧ8 0700apple , 03030ｸ703006ｧ9000ｹ ｸ7036ｧ90ｷ30ｹ apple06026ｧ ｸ7096ｧ 陦 08080ｹ0 0ｸ7apple ｧ9 0ｹ0, 0ｸ7apple 閨 , apple000604fi ｹ08. ﾇ ｧ8 0303fi006 50ｷ ｸ ｦ ｹ ｧ apple % 020ｷ ｸ ｷ O08006ｧ apple 閨0ｹ ｹ ｸ7 fi0209, ｸ 閨0ｹ0 00apple06apple 閨0ｹ fi ｹ0 020ｸ apple08036ｧ907090ｹ08,40. O06 040ｸ707 鐶pple ｹ0 006ｧ fi ｹ0, fiapple0ｷ30ｹ0 006ｧ ｸ707fi090208, apple 閨0ｹ ｦ ｹ08. O06 0ｸ7apple00036ｧ ｹ ｸ700 閨 閨04080ｸ ｸ 閨 ｷ300 閨 fi apple ｧ80ｹ ｹ0 07 閨000ｹ0 040ｸ707036ｧ802000ｹ ｸ ｦ ｸ70ｹ035. ﾇ ｧ ｹ ｧ80ｹ ｸ70ｹ0 apple03 鐶pple ｧ apple ｧ ｧ fiapple ｦ ｸ 閨07090ｹ ｧ9 0ｹ fi fi ｧ ｧ apple ｧ8 apple00036ｧ O0ｸ 閨0ｹ0 / ｸ 閨0ｹ0 00apple06apple 閨0ｹ0 6ｾ40ｸ7076ｧ8030ｷ30ｹ0 040ｸ7076ｧ ｸ7apple ｧ ｸ7 apple ｧ8 040ｷ3036ｧ90ｹ0 apple ｧ8, 080ｸ , ｧ803000ｹ0, 026ｧ803000ｹ ｧ / ｸ ｧ8. 6ｾ ｧ ｸ 閨0ｹ0 00apple06apple 閨0ｹ ｧ9ｨB ｸ70407fi ,5% 39, apple 閨0ｹ ｹ0 applefi ｧ ｸ70407fi ,6% 41. ﾇ 0ｸ7apple ｧ ｸ7 apple ｧ apple08036ｦ0 040ｸ704076ｧ8, apple ｦ % 020ｷ , apple ｧ8 apple apple ｧ % 020ｷ ｧ803000ｹ ｧ803000ｹ ｧ9ｨB ｧ apple % % 07026ｧ , ｹ0 apple03080ｹ ｧ9 0409, ｸ7apple ｸ 閨07 fi ｧ ｧ apple06046ｧ ｹ ｸ70ｹ0 040ｸ700apple020ｷ ｦ00ｹ ｸ700 閨07080ｸ70ｹ08,45,46. 6ﾑ ｦ ｹ0, 00apple ｧ9 07 apple 閨 閨0ｹ ｹ047,48, 08applefi ｸ703006ｧ ｸ707 閨 ｸ ｧ8 8. 6ｾ ｹ ｧ802090ｹ ｧ ｸ70407fi ,6-30% ｸ70ｹ0 0ｸ7apple00036ｧ ｹ ｸ700 閨07080ｸ70ｹ035,41, 0400 陦 08080ｹ ｹ ｧ9 0ｹ ｸ ｧ80ｹ0 090ｷ3096ｧ80ｹ ｧ ｧ90ｹ ｹ ｸ7036ｧ907090ｹ0, 020ｸ7036ｧ90ｷ30ｹ tacrolimus ｸ apple08036ｧ ﾞ ｧ9 METAMO6ｾ4016ﾑ8086ｾ4 ﾇ 036ﾑ80206O08 6ｾ46ﾑ8 ﾇ ｦﾐ ﾒｦﾐ03096ﾑ803O086ｾ4 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ ｧ /3-2/3 020ｷ ｸ ｷ ｧ apple08030ｸ7apple ｧ8. ﾞapple08 6ｧ 閨 ｧ803080ｸ7, , 020ｸ7036ｧ90ｷ30ｹ0, ｧ8 07fi ｧ9080ｸ7 3 6ｧ8 apple0608 apple ｷ 閨07080ｸ749. O ｧ8 07fi04080ｹ0 6ｾ402080ｸ70ｹ0 0ｸ7apple00036ｧ ｹ ｸ700 閨07080ｸ70ｹ0, fiapple0ｷ30ｹ ｷ ｸ70ｹ ｸ700 閨07080ｸ70ｹ0 fi030ｷ ｷ , 006ｧ ｸ7076ｧ803090ｹ0 09 閨 ｧ907090ｹ0 D, 0906 ｯ 0ｸ702fi ｧ apple006ｧ9 0ｸ7apple ｹ08,50, apple080ｸ7 00apple ｧ ｧ ｧ90ｷ ｸ7 000ｸ apple ｦ00ｹ0 0ｸ7apple0003apple ｸ ｦ0 51. ﾇ 閨 ｧ907090ｹ0 D 閨 apple ｧ apple020ｸ ｧ9070ｷ fi ｸ ﾞ 閨0ｹ0 / ｸ 閨0ｹ0 00apple06apple 閨0ｹ0 ﾇ ｧ9 applefi ｧ fi ｸ704076ｧ ｸ70ｹ ｷ300 閨07080ｸ70ｹ ｸ700 閨07080ｸ70ｹ0 fi ｸ70ｹ0 0700fi ｸ70ｹ0 03fi090ｷ 閨 ｹ ｹ ｧ80ｹ0 apple ｹ apple ｷ 閨 ｧ9 53, apple ｧ apple fi 19,7% ｧ9000ｹ ｷ3 020ｷ ,42, % ｧ90ｹ ｷ3 020ｷ 閨 apple ｦ0 28% ｸ70ｹ ｧ90ｹ ｧ9 0ｹ ﾑ ｦ ｹ0, ｧ907 0ｸ707080ｹ0 006ｧ apple ｸ7apple fi0ｹ0, 02fi ｷ3 020ｷ ,54. 6ｾ46ｦ000080ｷ ｹ0 6ﾑ80ｸ7030ｷ3apple 0ｸ802 閨0ｹ0 ﾒ 02000ｸ7030ｸ707026ｧ ｹ ｧ9000ｹ0 (EBPG, 7