272 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 表 1 Variables Value Age, yr Sex Male 81 Female 12 Height, cm Body weight, kg 6
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1 2012 年 12 月 271 第 22 回日本呼吸ケア リハビリテーション学会学術集会 ( 福井 ) 奨励賞 受賞報告 特発性肺線維症における呼吸困難感, 運動 耐容能,QOL を含む多面的評価の重要性 要旨 IPF QOL IPF modified MRC modified MRC 6 SpO 2 modified MRC IPF IPF 6 QOL IPF QOL は じ め に QOL 1 2 スコアは 患者の 予後を予測する 1 modified MRC IPF IPF retrospective IPF 2000 ATS/ERS HRCT FVC L FVC Dl CO ml/min/mmhg Dl CO mmhg IPF
2 272 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 表 1 Variables Value Age, yr Sex Male 81 Female 12 Height, cm Body weight, kg BMI Smoking status Current 15 Former 59 Never 19 Baseline pulmonary function testing FVC, L FVC, pred FEV 1, L FEV 1, pred Dl CO, ml min mmhg Dl CO, pred Baseline arterial blood gas values, mmhg PaCO 2, mmhg ph MMRC score Six min walk test at baseline Walk distance, m , Borg n 93 except for Dl CO,, PaCO 2, ph n 90, respec tively and 6 min walk test variables 92. Continuous vari ables are expressed as mean values standard deviations. BMI: body mass index; FVC: forced vital capacity; FEV 1 : forced expiratory volume in 1 second; Dl CO : diffusion ca pacity of carbon monoxide; : partial pressure of oxy gen; PaCO 2 : partial pressure of carbon dioxide; MMRC: modified MRC; SpO 2 : arterial oxygen saturation measured by pulse oximetry. 1 2 FVC Dl CO modified MRC 6 SpO 2 Borg stepwise modified MRC 6 SpO 2 3 表 2 Univariate cox proportional hazard model Variables Hazard ratio p value Age Smoking status Current Former BMI FVC, pred Dl CO, pred , mmhg MMRC Walk distance, m , Borg n 93 except for Dl CO and n 90, respectively. Hazard ratios in smoking status are to never smokers. The walk dis tance, lowest SpO 2, and Borg are variables of 6 min walk test. BMI: body mass index; FVC: forced vital capacity; Dl CO : diffu sion capacity of carbon monoxide; : partial pressure of ox ygen; MMRC: modified MRC: SpO 2 : arterial oxygen saturation measured by pulse oximetry; CI: confidence interval 1 表 3 Stepwise multivariate cox proportional-hazard model の結果 Variables Hazard ratio p value MMRC , n 87, because patients for whom all data were available were included in the analysis. Forty six of these 87 patients 52.9 died during the observation period. Variables that were signifi cant in univariate analysis were included in the analysis. Vari ables eliminated were FVC predicted, Dl CO predicted,, and walk distance and the Borg scale at 6 min walk test. is a 6 min walk test variable. MMRC: modified MRC; SpO 2 : arterial oxygen saturation mea sured by pulse oximetry; CI: confidence interval 1 modified MRC 6 SpO 2 IPF 1 modified MRC Kaplan-Meier survival curves modified MRC COPD 5 IPF University of California San Diego Shortness of Breath Questionnaire SOBQ modified MRC
3 2012 年 12 月 (ml/min) 2000 Probability of Survival MMRC 3 MMRC 2 MMRC 0, Months 図 1 IPF modified MRC Kaplan Meier 1 VO 2 max r=0.62, p< (Nm) 大腿四頭筋筋力 患者では大腿四頭筋筋力が低下しており 運動耐容能低下の重要な説明因子である 3 41 IPF cardiopulmonary exercise test: CPX Cybex II 35 6 VC L VC DLco ml/min/ mmhg DLco CPX V 4 O 2 max ml/min V 4 O 2 max AT ml/min AT quadriceps force: QF handgrip force: HF HF 3219 N HF 9457 QF 8728 Nm QF 6515 V 4 O 2 max VC TLC DLco PEmax QF VE/V 4 CO 2 slope stepwise VC QF VE/V 4 CO 2 slope QF IPF AT VC DLco QF QF QF V 4 O 2 max 2 COPD IPF IPF 図 2 IPF 3 に対する呼吸リハビリテーションは 有効である 4 IPF FVC L FVC Dl CO mmhg 9 6 FVC L FVC Dl CO mmhg m St. George s Respiratory Questionnaire SGRQ QOL total -6.1 BDI 4 3 6
4 274 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 (m) P<0.05 (m) NS 分間歩行距離 baseline after the program 100 baseline after the program 図 3 IPF 6 4 表 4 Difference between groups in change from baseline FVC L N.S. FEV 1 L N.S. Dl CO N.S. mmhg N.S. PaCO 2 mmhg N.S. 6MWD m BDI score N.S. SGRQ score Symptoms N.S. Activity N.S. Impacts N.S. Total FVC: forced vital capacity; FEV 1 : forced expiratory volume in 1 second; Dl CO : diffusion capacity of carbon monoxide; : partial pressure of oxygen; PaCO 2 : partial pressure of carbon di oxide; 6MWD: 6 min walk distance; BDI: baseline dyspnea in dex; SGRQ: St. George s Respiratory Questionnaire 4 p まとめ IPF QOL IPF COPD IPF 5 weak yes m m IPF 6 QOL 受賞にあたっての感想とこれからの抱負 IPF QOL COPD IPF
5 2012 年 12 月 275 Multidisciplinary evaluation including dyspnea, exercise capacity, and health-related quality of life in idiopathic pulmonary fibrosis Osamu Nishiyama Department of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine 文献 1 Nishiyama, O., Taniguchi, H., Kondoh, Y., et al: A simple assessment of dyspnea as a prognostic indicator in idiopathbic pulmonary fibrosis. Eur Respir J, 36: , American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. Am J Respir Crit Care Med, 161: , Nishiyama, O., Taniguchi, H., Kondoh, Y., et al: Quadriceps weakness is related to exercise capacity in idiopathic pulmonary fibrosis. Chest, 127: , Nishiyama, O., Kondoh, Y., Kimura, T., et al: The effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology, 13: , Raghu, G., Collard, H.R., Egan, J.J., et al: An official ATS/ERS/ JRS/ALAT statement: idiopathic pulmonary fibrosis: evidencebased guidelines for diagnosis and management. Am J Respir Crit Care Med, 183: , 2011.
2010 年 6 月 25 表 身体所見 134 cm 31 kg /60 mmhg 83/ ,
24 シンポジウム Ⅲ 要旨 NPPV NPPV 緒 IPF 4 5 1 IPF 2004 2 QOL 179 10 現 10 18 2008 10 言 状 3.4 8.3 76.2 41 37.2 13.6 3 1 症 例 呈 示症例 患者 61 主訴 既往歴 30 45 家族歴 喫煙歴 飲酒歴 職歴 現病歴 13 NSIP 15 1 HOT 15 7 2010 年 6 月 25 表 1 1998
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運動負荷試験としての 6 分間歩行試験の特徴 和賀大 坂本はるか < 要約 > 6 分間歩行試験 (6-minute walk test; 6MWT) は,COPD 患者において, 一定の速度で歩く定量負荷試験であり, この歩行試験の負荷量は最大負荷量の約 90% に相当すると報告されている. そこ
運動負荷試験としての 6 分間歩行試験の特徴 和賀大 坂本はるか < 要約 > 6 分間歩行試験 (6-minute walk test; 6MWT) は,COPD 患者において, 一定の速度で歩く定量負荷試験であり, この歩行試験の負荷量は最大負荷量の約 90% に相当すると報告されている そこで, 6MWT は一定負荷試験であるか, 高負荷運動であるかを検証するため, 研究 1 は, 高齢者 22
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