{"id":2411,"date":"2023-08-30T14:27:03","date_gmt":"2023-08-30T05:27:03","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2411"},"modified":"2023-08-30T14:27:03","modified_gmt":"2023-08-30T05:27:03","slug":"%e6%9c%89%e7%97%9b%e6%80%a7%e3%81%ae%e7%b3%96%e5%b0%bf%e7%97%85%e6%80%a7%e7%a5%9e%e7%b5%8c%e9%9a%9c%e5%ae%b3%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e4%bd%b5%e7%94%a8%e8%96%ac%e7%89%a9%e7%99%82%e6%b3%95","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2411","title":{"rendered":"\u6709\u75db\u6027\u306e\u7cd6\u5c3f\u75c5\u6027\u795e\u7d4c\u969c\u5bb3\u306b\u5bfe\u3059\u308b\u4f75\u7528\u85ac\u7269\u7642\u6cd5"},"content":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059
\n\uff0d\u6587\u732e\u540d\uff0d
\n\u30fbTesfaye S, Sloan G, Petrie J, et al.
\n\u201cComparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial\u201d
\n\u30fbLancet. 2022;400(10353):680. Epub 2022 Aug 22.<\/p>\n

\uff0d\u8981\u7d04\uff0d
\nBackground\uff1a
\n\u7cd6\u5c3f\u75c5\u6027\u672b\u68a2\u795e\u7d4c\u969c\u5bb3\u6027\u75bc\u75db\uff08DPNP\uff09\u306f\u3001\u3088\u304f\u898b\u3089\u308c\u308b\u75c7\u72b6\u3067\u3001\u3057\u3070\u3057\u3070\u5f37\u3044\u82e6\u75db\u3092\u4f34\u3046\u3002\u307b\u3068\u3093\u3069\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u3001\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3001\u30ac\u30d0\u30da\u30f3\u30c1\u30f3\u304c\u3001DPNP\u306e\u93ae\u75db\u6cbb\u7642\u306e\u7b2c\u4e00\u9078\u629e\u85ac\u3068\u3057\u3066\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u304c\u3001\u3069\u308c\u304c\u6700\u826f\u304b\u3068\u304b\u3001\u4f75\u7528\u3059\u3079\u304d\u304b\u306b\u95a2\u3059\u308b\u6bd4\u8f03\u8a66\u9a13\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u307b\u3068\u3093\u3069\u306a\u3044\u3002\u305d\u3053\u3067\u3001DPNP \u306e\u6cbb\u7642\u306e\u305f\u3081\u306e\u7b2c\u4e00\u9078\u629e\u85ac\u306e\u3055\u307e\u3056\u307e\u306a\u7d44\u307f\u5408\u308f\u305b\u306e\u6709\u52b9\u6027\u3068\u5fcd\u5bb9\u6027\u3092\u8a55\u4fa1\u3059\u308b\u3053\u3068\u3092\u76ee\u7684\u3068\u3057\u305f\u3002<\/p>\n

Method\uff1a
\nOPTION-DM \u306f\u3001\u82f1\u56fd\u306e 13 \u306e\u30bb\u30f3\u30bf\u30fc\u306e\u591a\u65bd\u8a2d\u7121\u4f5c\u70ba\u5316\u4e8c\u91cd\u76f2\u691c\u30af\u30ed\u30b9\u30aa\u30fc\u30d0\u30fc\u8a66\u9a13\u3067\u30011\u65e5\u5e73\u5747\u75bc\u75db\u6570\u5024\u8a55\u4fa1\u5c3a\u5ea6 (NRS) \u304c 4 \u4ee5\u4e0a (\u5c3a\u5ea6\u306f 0 \uff5e 10) \u306e DPNP \u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f\u3082\u306e\u3067\u3042\u308b\u3002\u53c2\u52a0\u8005\u306f\u30e9\u30f3\u30c0\u30e0\u306b\u5272\u308a\u5f53\u3066\u3089\u308c (1:1:1:1:1:1)\u3001 6 \u307e\u305f\u306f 12\u4eba \u306e\u9806\u5217\u30d6\u30ed\u30c3\u30af\u3092\u4f7f\u7528\u3057\u3066\u3001\u30b5\u30a4\u30c8\u3054\u3068\u306b\u968e\u5c64\u5316\u3055\u308c\u305f\u6240\u5b9a\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u30b9\u30b1\u30b8\u30e5\u30fc\u30eb\u3067\u30013 \u3064\u306e\u6cbb\u7642\u7d4c\u8def\u306e6\u3064\u306e\u9806\u5e8f\u4ed8\u3051\u3089\u308c\u305f\u30b7\u30fc\u30b1\u30f3\u30b9\u306e\u3046\u3061\u306e1\u3064\u3092\u53d7\u3051\u308b\u3088\u3046\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u305f: \u3064\u307e\u308a\u3001\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u306b\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3092\u8ffd\u52a0(A-P)\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u306b\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u3092\u8ffd\u52a0(P-A)\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u306b\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3092\u8ffd\u52a0(D-P)\u306b\u3044\u305a\u308c\u304b\u3067\u3001\u5404\u7d4c\u8def\u306f 16 \u9031\u9593\u7d99\u7d9a\u3057\u305f\u3002\u5358\u5264\u7642\u6cd5\u306f 6 \u9031\u9593\u884c\u308f\u308c\u3001\u73fe\u5728\u306e\u81e8\u5e8a\u5b9f\u8df5\u3092\u53cd\u6620\u3057\u3066\u3001\u93ae\u75db\u304c\u5341\u5206\u3067\u306a\u3044\u5834\u5408 (NRS > 3)\u306b\u306f\u3001\u4f75\u7528\u7642\u6cd5\u304c\u8ffd\u52a0\u3055\u308c\u307e\u3057\u305f\u3002\u3044\u305a\u308c\u306e\u6cbb\u7642\u3082\u3001\u6700\u5927\u8010\u7528\u91cf (\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u306f75 mg\/day\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u306f120 mg\/day\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u306f600 mg\/day)\u307e\u3067\u6f38\u5897\u3057\u3066\u8abf\u6574\u3055\u308c\u305f\u3002primary outcome\u306f\u3001\u5404\u7d4c\u8def\u306e\u6700\u7d42\u9031\u306b\u304a\u3051\u308b 7 \u65e5\u9593\u3067\u306e1\u65e5\u3042\u305f\u308a\u306e\u5e73\u5747\u306e\u75db\u307f\u306e\u5dee\u3068\u3057\u305f\u3002\u3053\u306e\u8a66\u9a13\u306f\u3001ISRCTN\u3001ISRCTN17545443 \u306b\u767b\u9332\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

Results\uff1a
\n2017 \u5e74 11 \u6708 14 \u65e5\u304b\u3089 2019 \u5e74 7 \u6708 29 \u65e5\u307e\u3067\u306e\u9593\u306b\u3001252 \u4eba\u306e\u60a3\u8005\u304c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3055\u308c\u3001140 \u4eba\u306e\u60a3\u8005\u304c\u7121\u4f5c\u70ba\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u3001130 \u4eba\u304c\u6cbb\u7642\u7d4c\u8def\u3092\u958b\u59cb\u3057 (84 \u4eba\u304c\u5c11\u306a\u304f\u3068\u3082 2 \u3064\u306e\u7d4c\u8def\u3092\u5b8c\u4e86)\u3001primary outcome\u306b\u3064\u3044\u3066\u5206\u6790\u3055\u308c\u305f\u3002 16 \u9031\u76ee\u306e 7 \u65e5\u9593\u5e73\u5747 NRS \u30b9\u30b3\u30a2\u306f\u30013 \u3064\u306e\u7d4c\u8def\u3059\u3079\u3066\u306b\u304a\u3044\u3066\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u5e73\u5747 6.6 (SD 1.5) \u304b\u3089 16 \u9031\u76ee\u306e 3.3 (SD 1.8) \u306b\u6e1b\u5c11\u3057\u305f\u3002 \u5e73\u5747\u306e\u5dee\u306f\u3001D-P \u5bfe A-P \u3067 -0.1 (98.3%\u4fe1\u983c\u533a\u9593 -0.5 \u304b\u3089 0.3)\u3001P-A \u5bfe A-P \u3067 -0.1 (98.3%\u4fe1\u983c\u533a\u9593 -0.5 \u304b\u3089 0.3)\u30010. P-A \u5bfe D-P \u3067\u306f 0 (98.3%\u4fe1\u983c\u533a\u9593 \u20130.4 \uff5e 0.4) \u3067\u3042\u308b\u305f\u3081\u3001\u6709\u610f\u306a\u5dee\u306f\u306a\u304b\u3063\u305f\u3002 \u4f75\u7528\u7642\u6cd5\u3092\u53d7\u3051\u305f\u60a3\u8005\u306e\u5e73\u5747 NRS \u6e1b\u5c11\u306f\u3001\u5358\u5264\u7642\u6cd5\u3092\u7d9a\u3051\u305f\u60a3\u8005\u3088\u308a\u3082\u5927\u304d\u304b\u3063\u305f (1.0 [SD 1.3] vs 0.2 [1.5])\u3002 \u6709\u5bb3\u4e8b\u8c61\u306f\u5358\u5264\u7642\u6cd5\u3067\u306f\u4e88\u6e2c\u53ef\u80fd\u3060\u3063\u305f\u3002P-A \u7d4c\u8def\u3067\u306f\u3081\u307e\u3044\u3001D-P \u7d4c\u8def\u3067\u306f\u5410\u304d\u6c17\u3001A-P \u7d4c\u8def\u3067\u306f\u53e3\u6e07\u306e\u6709\u610f\u306a\u5897\u52a0\u304c\u89b3\u5bdf\u3055\u308c\u305f\u3002
\nBackground\uff1a
\n\u7cd6\u5c3f\u75c5\u6027\u672b\u68a2\u795e\u7d4c\u969c\u5bb3\u6027\u75bc\u75db\uff08DPNP\uff09\u306f\u3001\u3088\u304f\u898b\u3089\u308c\u308b\u75c7\u72b6\u3067\u3001\u3057\u3070\u3057\u3070\u5f37\u3044\u82e6\u75db\u3092\u4f34\u3046\u3002\u307b\u3068\u3093\u3069\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u3001\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3001\u30ac\u30d0\u30da\u30f3\u30c1\u30f3\u304c\u3001DPNP\u306e\u93ae\u75db\u6cbb\u7642\u306e\u7b2c\u4e00\u9078\u629e\u85ac\u3068\u3057\u3066\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u304c\u3001\u3069\u308c\u304c\u6700\u826f\u304b\u3068\u304b\u3001\u4f75\u7528\u3059\u3079\u304d\u304b\u306b\u95a2\u3059\u308b\u6bd4\u8f03\u8a66\u9a13\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u307b\u3068\u3093\u3069\u306a\u3044\u3002\u305d\u3053\u3067\u3001DPNP \u306e\u6cbb\u7642\u306e\u305f\u3081\u306e\u7b2c\u4e00\u9078\u629e\u85ac\u306e\u3055\u307e\u3056\u307e\u306a\u7d44\u307f\u5408\u308f\u305b\u306e\u6709\u52b9\u6027\u3068\u5fcd\u5bb9\u6027\u3092\u8a55\u4fa1\u3059\u308b\u3053\u3068\u3092\u76ee\u7684\u3068\u3057\u305f\u3002<\/p>\n

Method\uff1a
\nOPTION-DM \u306f\u3001\u82f1\u56fd\u306e 13 \u306e\u30bb\u30f3\u30bf\u30fc\u306e\u591a\u65bd\u8a2d\u7121\u4f5c\u70ba\u5316\u4e8c\u91cd\u76f2\u691c\u30af\u30ed\u30b9\u30aa\u30fc\u30d0\u30fc\u8a66\u9a13\u3067\u30011\u65e5\u5e73\u5747\u75bc\u75db\u6570\u5024\u8a55\u4fa1\u5c3a\u5ea6 (NRS) \u304c 4 \u4ee5\u4e0a (\u5c3a\u5ea6\u306f 0 \uff5e 10) \u306e DPNP \u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f\u3082\u306e\u3067\u3042\u308b\u3002\u53c2\u52a0\u8005\u306f\u30e9\u30f3\u30c0\u30e0\u306b\u5272\u308a\u5f53\u3066\u3089\u308c (1:1:1:1:1:1)\u3001 6 \u307e\u305f\u306f 12\u4eba \u306e\u9806\u5217\u30d6\u30ed\u30c3\u30af\u3092\u4f7f\u7528\u3057\u3066\u3001\u30b5\u30a4\u30c8\u3054\u3068\u306b\u968e\u5c64\u5316\u3055\u308c\u305f\u6240\u5b9a\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u30b9\u30b1\u30b8\u30e5\u30fc\u30eb\u3067\u30013 \u3064\u306e\u6cbb\u7642\u7d4c\u8def\u306e6\u3064\u306e\u9806\u5e8f\u4ed8\u3051\u3089\u308c\u305f\u30b7\u30fc\u30b1\u30f3\u30b9\u306e\u3046\u3061\u306e1\u3064\u3092\u53d7\u3051\u308b\u3088\u3046\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u305f: \u3064\u307e\u308a\u3001\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u306b\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3092\u8ffd\u52a0(A-P)\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u306b\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u3092\u8ffd\u52a0(P-A)\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u306b\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u3092\u8ffd\u52a0(D-P)\u306b\u3044\u305a\u308c\u304b\u3067\u3001\u5404\u7d4c\u8def\u306f 16 \u9031\u9593\u7d99\u7d9a\u3057\u305f\u3002\u5358\u5264\u7642\u6cd5\u306f 6 \u9031\u9593\u884c\u308f\u308c\u3001\u73fe\u5728\u306e\u81e8\u5e8a\u5b9f\u8df5\u3092\u53cd\u6620\u3057\u3066\u3001\u93ae\u75db\u304c\u5341\u5206\u3067\u306a\u3044\u5834\u5408 (NRS > 3)\u306b\u306f\u3001\u4f75\u7528\u7642\u6cd5\u304c\u8ffd\u52a0\u3055\u308c\u307e\u3057\u305f\u3002\u3044\u305a\u308c\u306e\u6cbb\u7642\u3082\u3001\u6700\u5927\u8010\u7528\u91cf (\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3\u306f75 mg\/day\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u306f120 mg\/day\u3001\u30d7\u30ec\u30ac\u30d0\u30ea\u30f3\u306f600 mg\/day)\u307e\u3067\u6f38\u5897\u3057\u3066\u8abf\u6574\u3055\u308c\u305f\u3002primary outcome\u306f\u3001\u5404\u7d4c\u8def\u306e\u6700\u7d42\u9031\u306b\u304a\u3051\u308b 7 \u65e5\u9593\u3067\u306e1\u65e5\u3042\u305f\u308a\u306e\u5e73\u5747\u306e\u75db\u307f\u306e\u5dee\u3068\u3057\u305f\u3002\u3053\u306e\u8a66\u9a13\u306f\u3001ISRCTN\u3001ISRCTN17545443 \u306b\u767b\u9332\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

Results\uff1a
\n2017 \u5e74 11 \u6708 14 \u65e5\u304b\u3089 2019 \u5e74 7 \u6708 29 \u65e5\u307e\u3067\u306e\u9593\u306b\u3001252 \u4eba\u306e\u60a3\u8005\u304c\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3055\u308c\u3001140 \u4eba\u306e\u60a3\u8005\u304c\u7121\u4f5c\u70ba\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u3001130 \u4eba\u304c\u6cbb\u7642\u7d4c\u8def\u3092\u958b\u59cb\u3057 (84 \u4eba\u304c\u5c11\u306a\u304f\u3068\u3082 2 \u3064\u306e\u7d4c\u8def\u3092\u5b8c\u4e86)\u3001primary outcome\u306b\u3064\u3044\u3066\u5206\u6790\u3055\u308c\u305f\u3002 16 \u9031\u76ee\u306e 7 \u65e5\u9593\u5e73\u5747 NRS \u30b9\u30b3\u30a2\u306f\u30013 \u3064\u306e\u7d4c\u8def\u3059\u3079\u3066\u306b\u304a\u3044\u3066\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u5e73\u5747 6.6 (SD 1.5) \u304b\u3089 16 \u9031\u76ee\u306e 3.3 (SD 1.8) \u306b\u6e1b\u5c11\u3057\u305f\u3002 \u5e73\u5747\u306e\u5dee\u306f\u3001D-P \u5bfe A-P \u3067 -0.1 (98.3%\u4fe1\u983c\u533a\u9593 -0.5 \u304b\u3089 0.3)\u3001P-A \u5bfe A-P \u3067 -0.1 (98.3%\u4fe1\u983c\u533a\u9593 -0.5 \u304b\u3089 0.3)\u30010. P-A \u5bfe D-P \u3067\u306f 0 (98.3%\u4fe1\u983c\u533a\u9593 \u20130.4 \uff5e 0.4) \u3067\u3042\u308b\u305f\u3081\u3001\u6709\u610f\u306a\u5dee\u306f\u306a\u304b\u3063\u305f\u3002 \u4f75\u7528\u7642\u6cd5\u3092\u53d7\u3051\u305f\u60a3\u8005\u306e\u5e73\u5747 NRS \u6e1b\u5c11\u306f\u3001\u5358\u5264\u7642\u6cd5\u3092\u7d9a\u3051\u305f\u60a3\u8005\u3088\u308a\u3082\u5927\u304d\u304b\u3063\u305f (1.0 [SD 1.3] vs 0.2 [1.5])\u3002 \u6709\u5bb3\u4e8b\u8c61\u306f\u5358\u5264\u7642\u6cd5\u3067\u306f\u4e88\u6e2c\u53ef\u80fd\u3060\u3063\u305f\u3002P-A \u7d4c\u8def\u3067\u306f\u3081\u307e\u3044\u3001D-P \u7d4c\u8def\u3067\u306f\u5410\u304d\u6c17\u3001A-P \u7d4c\u8def\u3067\u306f\u53e3\u6e07\u306e\u6709\u610f\u306a\u5897\u52a0\u304c\u89b3\u5bdf\u3055\u308c\u305f\u3002<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a> <\/p>\n

Discussion\uff1a\u4eca\u56de\u306e\u7814\u7a76\u306e\u9650\u754c\u3001\u6b8b\u3055\u308c\u305f\u8ab2\u984c\u306a\u3069\u3092\u8a18\u8f09\u3059\u308b\u3002
\n\u79c1\u305f\u3061\u306e\u77e5\u308b\u9650\u308a\u3001\u3053\u308c\u306f\u3053\u308c\u307e\u3067\u3067\u6700\u5927\u304b\u3064\u6700\u9577\u306e\u76f4\u63a5\u5bfe\u6c7a\u306e\u30af\u30ed\u30b9\u30aa\u30fc\u30d0\u30fc\u8a66\u9a13\u3067\u3042\u308b\u30023\u3064\u306e\u6cbb\u7642\u7d4c\u8def\u3068\u5358\u5264\u7642\u6cd5\u306e\u3059\u3079\u3066\u304c\u540c\u69d8\u306e\u93ae\u75db\u52b9\u679c\u3092\u6301\u3064\u3053\u3068\u3092\u793a\u3057\u305f\u3002\u4f75\u7528\u7642\u6cd5\u306f\u5fcd\u5bb9\u6027\u304c\u9ad8\u304f\u3001\u5358\u5264\u7642\u6cd5\u3067\u306f\u75bc\u75db\u7ba1\u7406\u304c\u4e0d\u5341\u5206\u306a\u60a3\u8005\u306e\u75bc\u75db\u304c\u6539\u5584\u3055\u308c\u305f\u3002
\n\u3000OPTION-DM \u306f\u5358\u5264\u7642\u6cd5\u3068\u4f75\u7528\u7642\u6cd5\u306e\u6bd4\u8f03\u3068\u3057\u3066\u8a2d\u8a08\u3055\u308c\u305f\u308f\u3051\u3067\u306f\u306a\u3044\u304c\u3001\u3053\u306e\u30c7\u30fc\u30bf\u306f\u3001DPNP \u60a3\u8005\u306b\u5bfe\u3059\u308b\u7b2c\u4e00\u9078\u629e\u85ac\u306e\u4f75\u7528\u7642\u6cd5\u3092\u63a8\u5968\u3059\u308b\u8aac\u5f97\u529b\u306e\u3042\u308b\u4e8b\u4f8b\u3092\u793a\u3057\u3066\u3044\u308b\u3002P-A \u7d4c\u8def\u306f TEAE \u306b\u3088\u308b\u4e2d\u65ad\u304c\u6700\u3082\u5c11\u306a\u304f\u3001\u3053\u308c\u3089\u306e\u7d50\u679c\u306f\u6c7a\u5b9a\u7684\u306a\u3082\u306e\u3067\u306f\u306a\u3044\u304c\u3001DPNP \u306e\u7b2c\u4e00\u9078\u629e\u6cbb\u7642\u3068\u3057\u3066 P-A \u7d4c\u8def\u304c\u6700\u826f\u306e\u9078\u629e\u3067\u3042\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3053\u3068\u3092\u793a\u5506\u3057\u3066\u3044\u308b\u3002
\n\u3000\u3053\u306e\u8a66\u9a13\u3067\u306f\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u304c\u5b58\u5728\u3057\u306a\u3044\u3053\u3068\u304c\u5236\u9650\u3068\u898b\u306a\u3055\u308c\u308b\u5834\u5408\u304c\u3042\u308b\u3002\u3057\u304b\u3057\u3001\u3053\u308c\u3089\u306e\u85ac\u306f\u4e16\u754c\u4e2d\u3067\u4e00\u822c\u7684\u306b\u4f7f\u7528\u3055\u308c\u3066\u304a\u308a\u3001\u73fe\u5728\u3001\u7121\u4f5c\u70ba\u5316\u30d7\u30e9\u30bb\u30dc\u5bfe\u7167\u8a66\u9a13\u304b\u3089\u5f97\u3089\u308c\u305f\u6709\u52b9\u6027\u306b\u95a2\u3059\u308b\u591a\u6570\u306e\u8a3c\u62e0\u306b\u57fa\u3065\u3044\u3066\u3001National Institute for Health and Care Excellence \u306a\u3069\u306e\u898f\u5236\u304a\u3088\u3073\u8aee\u554f\u6a5f\u95a2\u306b\u3088\u3063\u3066\u627f\u8a8d\u3055\u308c\u3066\u3044\u308b\u3002\u3055\u3089\u306b\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3092\u8ffd\u52a0\u3059\u308b\u3068\u3001\u3053\u306e\u3059\u3067\u306b\u9577\u304f\u53b3\u3057\u3044\u8a66\u9a13\u306e\u671f\u9593\u304c\u9577\u304f\u306a\u308a\u3001\u60a3\u8005\u304a\u3088\u3073\u5e02\u6c11\u53c2\u52a0\u30d1\u30cd\u30eb\u3068\u306e\u5354\u8b70\u306e\u5f8c\u3001\u502b\u7406\u7684\u306b\u6b63\u5f53\u3067\u306f\u306a\u3044\u3068\u611f\u3058\u305f\u3002\u5b9f\u969b\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3092\u542b\u307e\u306a\u3044\u5225\u306e\u30af\u30ed\u30b9\u30aa\u30fc\u30d0\u30fc\u4f75\u7528\u8a66\u9a13\u3067\u306f\u3001\u5358\u5264\u7642\u6cd5\u3068\u4f75\u7528\u7642\u6cd5\u306e\u4e21\u65b9\u3067NRS\u306e\u75db\u307f\u304c\u540c\u7a0b\u5ea6\u306b\u6e1b\u5c11\u3059\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u305f\u3002
\n\u3000\u3082\u30461\u3064\u306e\u5236\u9650\u306f\u30013\u3064\u306e\u7d4c\u8def\u3059\u3079\u3066\u306e\u4e3b\u8981\u306a\u7d50\u679c\u30c7\u30fc\u30bf\u3092\u63d0\u4f9b\u3059\u308b\u60a3\u8005\u306f59\uff05\u306b\u904e\u304e\u305a\u3001\u5c11\u306a\u304f\u3068\u30822\u3064\u306e\u7d4c\u8def\u3092\u5b8c\u4e86\u3059\u308b\u60a3\u8005\u306f64\uff05\u3068\u3001\u6bd4\u8f03\u7684drop-out\u304c\u591a\u3044\u3053\u3068\u3067\u3042\u308b\u3002\u3053\u306e\u4e3b\u306a\u7406\u7531\u306f\u3001\u9577\u3044\u7814\u7a76\u671f\u9593 (51 \u9031\u9593) \u3067\u3042\u308a\u3001\u60a3\u8005\u306e\u6642\u9593\u306b\u5bfe\u3059\u308b\u304b\u306a\u308a\u306e\u8981\u6c42 (\u4f8b\u3048\u3070\u3001\u5e74\u6b21\u4f11\u6687\u306e\u5ef6\u671f\u306a\u3069) \u3067\u3042\u3063\u305f\u3002\u305d\u308c\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001\u6b20\u640d\u30c7\u30fc\u30bf (\u7406\u7531\u306b\u3088\u308b\u6b20\u640d\u3092\u542b\u3080) \u306e\u5f71\u97ff\u306b\u95a2\u3059\u308b\u611f\u5ea6\u5206\u6790\u306f\u3001\u3053\u308c\u304c\u30d0\u30a4\u30a2\u30b9\u3092\u5f15\u304d\u8d77\u3053\u3059\u306e\u3067\u306f\u306a\u304f\u3001\u4e3b\u306b\u5dee\u306e\u7cbe\u5ea6\u306b\u5f71\u97ff\u3092\u4e0e\u3048\u305f\u3053\u3068\u3092\u793a\u5506\u3057\u3066\u3044\u308b\u3002\u3055\u3089\u306b\u3001\u6cbb\u7642\u7d4c\u8def\u9593\u306e\u30a6\u30a9\u30c3\u30b7\u30e5\u30a2\u30a6\u30c8\u671f\u9593\u3092\u9577\u304f\u3059\u308b\u3053\u3068 (\u4f8b\u3048\u3070 2 \u9031\u9593) \u304c\u671b\u307e\u3057\u3044\u3068\u601d\u308f\u308c\u305f\u304c\u3001\u3053\u306e\u9577\u304f\u3066\u8981\u6c42\u306e\u591a\u3044\u8a66\u9a13\u3067\u306f\u3053\u308c\u306f\u975e\u502b\u7406\u7684\u3067\u3042\u308a\u3001\u5bb3\u3084\u3055\u3089\u306b\u5927\u304d\u306a\u7814\u7a76\u306e\u4e2d\u6b62\u306b\u3064\u306a\u304c\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3068\u611f\u3058\u305f\u3002\u6700\u5f8c\u306b\u3001\u3053\u306e\u7814\u7a76\u306f\u3001\u30ad\u30e3\u30ea\u30fc\u30aa\u30fc\u30d0\u30fc\u52b9\u679c\u3092\u691c\u51fa\u3059\u308b\u7d71\u8a08\u7684\u306a\u691c\u51fa\u529b\u3092\u5099\u3048\u3066\u3044\u307e\u305b\u3093\u3067\u3057\u305f\u304c\u300116 \u9031\u9593\u3068\u3044\u3046\u9577\u3044\u6cbb\u7642\u671f\u9593\u306e\u7d42\u4e86\u6642\u306b\u3001\u3053\u308c\u304c\u4e3b\u8981\u306a\u7d50\u679c\u306b\u5f71\u97ff\u3092\u4e0e\u3048\u305f\u53ef\u80fd\u6027\u306f\u4f4e\u3044\u3002<\/p>\n

\u9078\u3093\u3060\u8ad6\u6587\u304c\u7814\u7a76\u8ad6\u6587\u3067\u306f\u306a\u3044\u5834\u5408\u3001introduction\u3001discussion\u306b\u6e96\u3058\u305f\u5185\u5bb9\u3092\u542b\u3081\u308b\u3088\u3046\u306b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112022\u5e7410\u67085\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059 \uff0d\u6587\u732e\u540d\uff0d \u30fbTesfaye S, Sloan G, Petrie J, et al … \u7d9a\u304d\u3092\u8aad\u3080 \u6709\u75db\u6027\u306e\u7cd6\u5c3f\u75c5\u6027\u795e\u7d4c\u969c\u5bb3\u306b\u5bfe\u3059\u308b\u4f75\u7528\u85ac\u7269\u7642\u6cd5<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33,17],"tags":[],"class_list":["post-2411","post","type-post","status-publish","format-standard","hentry","category-whats-new","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2411","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2411"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2411\/revisions"}],"predecessor-version":[{"id":2418,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2411\/revisions\/2418"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2411"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2411"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}