{"created":"2023-06-20T15:52:50.285387+00:00","id":7180,"links":{},"metadata":{"_buckets":{"deposit":"2b70a559-1179-413b-8175-d45f028f39b3"},"_deposit":{"created_by":22,"id":"7180","owners":[22],"pid":{"revision_id":0,"type":"depid","value":"7180"},"status":"published"},"_oai":{"id":"oai:redcross.repo.nii.ac.jp:00007180","sets":["100:90:221"]},"author_link":["6412","18190","6403","6409","25677","6445","6402"],"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2014-12","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"11","bibliographicPageStart":"2","bibliographicVolumeNumber":"35","bibliographic_titles":[{"bibliographic_title":"京都第二赤十字病院医学雑誌 "},{"bibliographic_title":"Medical journal of Kyoto Second Red Cross Hospital","bibliographic_titleLang":"en"}]}]},"item_10001_description_5":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"京都第二赤十字病院小児科に川崎病として1978年4月から2014年6月までに入院し、急性期の治療を行った1,109例(男児650例、女児459例)の治療成績に関する検討を行った。治療プロトコールから4期に分類した。第I期(1978.4～1984.3)は心エコー検査機器がなく病初期の冠動脈評価が出来なかった時期で164例。第II期(1984.4～1994.3)はアスピリン治療を主体とした時期で197例。第III期(1994.4～2003.12)はγグロブリン療法(γ-gl)を行うも、1日用量が統一されなかった時期で212例。第IV期(2004.1～2014.6)は初回投与量を2g/kgとして使用している時期で516例である。γグロブリン療法を行うようになった第III期以降は冠動脈障害を残す割合は著減し、1ヵ月を過ぎても拡大や瘤を残す症例の割合(表3)は第I期が4.3%、第II期が8.1%、第III期が0.9%、第IV期が1%であった。第I期の初回の評価が回復期を過ぎて行っている症例が含まれていることからその割合は第II期と変わらないと考えられる。第III期、第IV期の治療成績は川崎病全国調査成績(拡大1.75%、瘤0.72%、巨大瘤0.018%)からみても極めて優れているもので、巨大瘤はいない。現在、当院で行っている治療プロトコール(表2)は日本小児循環器学会のガイドラインや世界標準とは少し異なっている。γ-glの投与開始時期は少なくとも発症後第5病日まで待つべきである。次に、γ-glの投与時間は24時間以内ではなく、32-36時間かけることである。再投与は原則1回とし、第10病日以内に投与する。アスピリンはγ-gl投与中は併用しない。再投与でも効果がない場合は経過をみることである。結論的にいえば、γ-glの投与の仕方を工夫すれば、血漿交換療法、副腎皮質ホルモン剤、免疫抑制剤、抗TNFα剤の必要性はほとんどないと考える。また、γ-glとアスピリン剤の併用はすべきではない。","subitem_description_type":"Abstract"}]},"item_10001_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{},{}],"names":[{"name":"Kiyosawa, Nobuyuki"}]}]},"item_10001_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"京都第二赤十字病院"}]},"item_10001_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00357778","subitem_source_identifier_type":"NCID"}]},"item_10001_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0389-4908","subitem_source_identifier_type":"ISSN"}]},"item_10001_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"清沢, 伸幸"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"小林, 奈歩"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"木村, 学"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"東道, 公人"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"藤井, 法子"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"大前, 禎毅"}],"nameIdentifiers":[{},{}]},{"creatorNames":[{"creatorName":"長村, 敏生"}],"nameIdentifiers":[{},{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2015-03-21"}],"displaytype":"simple","filename":"MJKSRCH35_2.PDF","filesize":[{"value":"450.4 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"kyo2_000044","url":"https://redcross.repo.nii.ac.jp/record/7180/files/MJKSRCH35_2.PDF"},"version_id":"87008645-c877-4c2d-88e9-d9aa26445956"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"川索病","subitem_subject_scheme":"Other"},{"subitem_subject":"小児","subitem_subject_scheme":"Other"},{"subitem_subject":"超音波検査","subitem_subject_scheme":"Other"},{"subitem_subject":"冠動脈後遺症","subitem_subject_scheme":"Other"},{"subitem_subject":"アスピリン","subitem_subject_scheme":"Other"},{"subitem_subject":"γグロブリン","subitem_subject_scheme":"Other"},{"subitem_subject":"Kawasaki disease","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Sequelae of coronary artery","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Echocardiography","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Aspirin","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Gamma-Globulins","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"京都第二赤十字病院小児科における川崎病急性期治療結果について","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"京都第二赤十字病院小児科における川崎病急性期治療結果について"},{"subitem_title":"Treatment results of acute phase of Kawasaki disease in Japanese Red Cross Kyoto Daini Hospital","subitem_title_language":"en"}]},"item_type_id":"10001","owner":"22","path":["221"],"pubdate":{"attribute_name":"公開日","attribute_value":"2015-03-21"},"publish_date":"2015-03-21","publish_status":"0","recid":"7180","relation_version_is_last":true,"title":["京都第二赤十字病院小児科における川崎病急性期治療結果について"],"weko_creator_id":"22","weko_shared_id":-1},"updated":"2023-06-20T20:15:32.665313+00:00"}