{"id":3005,"date":"2026-06-10T14:03:33","date_gmt":"2026-06-10T05:03:33","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=3005"},"modified":"2026-06-10T14:03:33","modified_gmt":"2026-06-10T05:03:33","slug":"%e9%9b%a3%e6%b2%bb%e6%80%a7%e6%85%a2%e6%80%a7%e5%89%af%e9%bc%bb%e8%85%94%e7%82%8e%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e3%83%9e%e3%82%af%e3%83%ad%e3%83%a9%e3%82%a4%e3%83%89%e9%95%b7%e6%9c%9f%e7%99%82","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=3005","title":{"rendered":"\u96e3\u6cbb\u6027\u6162\u6027\u526f\u9f3b\u8154\u708e\u306b\u5bfe\u3059\u308b\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u9577\u671f\u7642\u6cd5 VS \u9f3b\u5185\u8996\u93e1\u624b\u8853 VS \u30d7\u30e9\u30bb\u30dc\u306e\u6cbb\u7642\u6210\u7e3e\u3092\u6bd4\u3079\u308b\u3068\uff1f"},"content":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d<br \/>\nC Philpott et al.The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps (MACRO): a pragmatic, multicentre, three-arm, randomised, placebo-controlled phase 4 trial. Lancet.2025;406(10506):926-939.<\/p>\n<p>\uff0d\u8981\u7d04\uff0d<br \/>\n<strong>1. Introduction<\/strong><br \/>\n\u3000\u6162\u6027\u526f\u9f3b\u8154\u708e\uff08Chronic Rhinosinusitis: CRS\uff09\u306f\u3001\u6210\u4eba\u306e\u7d049%\u304c\u7f79\u60a3\u3057\u3066\u3044\u308b\u3068\u63a8\u5b9a\u3055\u308c\u308b\u975e\u5e38\u306b\u4e00\u822c\u7684\u306a\u6162\u6027\u75be\u60a3\u3067\u3042\u308b\u3002\u526f\u9f3b\u8154\u708e\u306e\u75c7\u72b6\u306f\u5358\u306a\u308b\u5c40\u6240\u306e\u4e0d\u5feb\u611f\u306b\u7559\u307e\u3089\u305a\u3001\u60a3\u8005\u306e\u5065\u5eb7\u95a2\u9023QOL\u3092\u8457\u3057\u304f\u4f4e\u4e0b\u3055\u305b\u308b\u3002\u5148\u884c\u7814\u7a76\u306b\u304a\u3044\u3066\u3001\u91cd\u75c7CRS\u60a3\u8005\u306b\u304a\u3051\u308bQOL\u306e\u4f4e\u4e0b\u5ea6\u306f\u3001\u72ed\u5fc3\u75c7\u3084\u6162\u6027\u9589\u585e\u6027\u80ba\u75be\u60a3\uff08COPD\uff09\u306a\u3069\u306e\u6df1\u523b\u306a\u6162\u6027\u75be\u60a3\u3068\u540c\u7b49\u3001\u3042\u308b\u3044\u306f\u305d\u308c\u4ee5\u4e0a\u3067\u3042\u308b\u3053\u3068\u304c\u5831\u544a\u3055\u308c\u3066\u304a\u308a\u3001\u793e\u4f1a\u7d4c\u6e08\u7684\u306a\u75be\u75c5\u8ca0\u8377\uff08disease burden\uff09\u304c\u6975\u3081\u3066\u5927\u304d\u3044\u3002<br \/>\n\u3000\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u304a\u3088\u3073\u8033\u9f3b\u54bd\u5589\u79d1\u306b\u304a\u3051\u308b\u6a19\u6e96\u7684\u306a\u521d\u671f\u6cbb\u7642\u3068\u3057\u3066\u3001\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u6e96\u62e0\u3057\u305f\u5185\u79d1\u7684\u6cbb\u7642\uff08\u5c40\u6240\u30b9\u30c6\u30ed\u30a4\u30c9\u70b9\u9f3b\u85ac\u306e\u9577\u671f\u7684\u4f7f\u7528\u3001\u304a\u3088\u3073\u751f\u7406\u98df\u5869\u6c34\u306b\u3088\u308b\u9f3b\u6d17\u6d44\uff09\u304c\u884c\u308f\u308c\u308b\u3002\u3057\u304b\u3057\u3001\u3053\u308c\u3089\u306e\u9069\u5207\u306a\u521d\u671f\u6cbb\u7642\u3092\u5c3d\u304f\u3057\u3066\u3082\u306a\u304a\u75c7\u72b6\u304c\u6b8b\u5b58\u3059\u308b\u300c\u6cbb\u7642\u62b5\u6297\u6027\u300d\u306e\u60a3\u8005\u304c\u5168\u4f53\u306e\u7d043\u5206\u306e1\u5b58\u5728\u3059\u308b\u3053\u3068\u304c\u5927\u304d\u306a\u81e8\u5e8a\u7684\u8ab2\u984c\u3067\u3042\u3063\u305f\u3002<br \/>\n\u3000\u3053\u306e\u3088\u3046\u306a\u521d\u671f\u6cbb\u7642\u62b5\u6297\u6027\u4f8b\u306b\u5bfe\u3059\u308b\u30bb\u30ab\u30f3\u30c9\u30e9\u30a4\u30f3\u3068\u3057\u3066\u3001\u5b9f\u81e8\u5e8a\u3067\u306f\u4e3b\u306b\u4ee5\u4e0b\u306e2\u3064\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u304c\u5e83\u304f\u9078\u629e\u3055\u308c\u3066\u304d\u305f\u3002<br \/>\n\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u7cfb\u6297\u83cc\u85ac\u306e\u5c11\u91cf\u9577\u671f\u6295\u4e0e\uff1a\u4e3b\u306b\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u306a\u3069\u304c\u7528\u3044\u3089\u308c\u3001\u6297\u83cc\u4f5c\u7528\u306b\u52a0\u3048\u3066\u6297\u708e\u75c7\u4f5c\u7528\u30fb\u514d\u75ab\u5909\u8abf\u4f5c\u7528\u3092\u671f\u5f85\u3057\u30663\u30f6\u6708\u7a0b\u5ea6\u6295\u4e0e\u3055\u308c\u308b\u3002\u4e00\u5b9a\u306e\u6539\u5584\u3092\u793a\u3059\u4e2d\u7b49\u5ea6\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u3042\u308b\u3082\u306e\u306e\u3001\u30d7\u30e9\u30bb\u30dc\u3068\u306e\u53b3\u5bc6\u306a\u6bd4\u8f03\u3084\u4e0a\u4e57\u305b\u52b9\u679c\u306e\u691c\u8a3c\u306f\u4e0d\u5341\u5206\u3067\u3042\u3063\u305f\u3002<br \/>\n\u5185\u8996\u93e1\u4e0b\u526f\u9f3b\u8154\u624b\u8853\uff08Endoscopic Sinus Surgery: ESS\uff09\uff1a\u5916\u79d1\u7684\u306b\u526f\u9f3b\u8154\u3092\u958b\u7a93\u3057\u3001\u63db\u6c17\u3068\u6392\u6cc4\u3092\u6539\u5584\u3055\u305b\u308b\u3002\u3057\u304b\u3057\u3001\u5185\u79d1\u7684\u6cbb\u7642\u3068\u76f4\u63a5\u6bd4\u8f03\u3057\u305f\u9ad8\u54c1\u8cea\u306a\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\uff08RCT\uff09\u306e\u30c7\u30fc\u30bf\u304c\u4e0d\u8db3\u3057\u3066\u3044\u305f\u305f\u3081\u3001\u52b9\u679c\u306e\u78ba\u5b9f\u6027\u306b\u7591\u554f\u304c\u6b8b\u3055\u308c\u3066\u3044\u305f\u3002<br \/>\n\u3053\u308c\u30892\u3064\u306e\u4e3b\u8981\u306a\u6cbb\u7642\u9078\u629e\u80a2\uff08ESS\u3068\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u9577\u671f\u6295\u4e0e\uff09\u3092\u76f4\u63a5\u6bd4\u8f03\uff08Head-to-Head\uff09\u3057\u305f\u9ad8\u54c1\u8cea\u306a\u8a66\u9a13\u306f\u904e\u53bb\u306b\u5b58\u5728\u3057\u306a\u304b\u3063\u305f\u3002<br \/>\n\u3000\u672c\u7814\u7a76\uff08MACRO\u8a66\u9a13\uff09\u306f\u3001\u9069\u5207\u306a\u521d\u671f\u5185\u79d1\u6cbb\u7642\u3092\u884c\u3063\u305f\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u75c7\u72b6\u304c\u6b8b\u5b58\u3059\u308b\u6210\u4ebaCRS\u60a3\u8005\u3092\u5bfe\u8c61\u306b\u3001\u5185\u8996\u93e1\u4e0b\u526f\u9f3b\u8154\u624b\u8853\uff08ESS\uff09\u3068\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u9577\u671f\u5c11\u91cf\u6295\u4e0e\u306e\u81e8\u5e8a\u7684\u6709\u52b9\u6027\u304a\u3088\u3073\u5b89\u5168\u6027\u3092\u76f4\u63a5\u6bd4\u8f03\u3059\u308b\u3053\u3068\u3092\u76ee\u7684\u3068\u3057\u305f\u3002<\/p>\n<p><strong>2. Method<\/strong><br \/>\n2.1 \u8a66\u9a13\u30c7\u30b6\u30a4\u30f3<br \/>\n\u82f1\u56fd\u56fd\u5185\u306e17\u306e\u533b\u7642\u6a5f\u95a2\uff08\u4e3b\u3068\u3057\u30662\u6b21\u30fb3\u6b21\u533b\u7642\u6a5f\u95a2\u306e\u8033\u9f3b\u54bd\u5589\u79d1\u5916\u6765\uff09\u306b\u304a\u3044\u3066\u5b9f\u65bd\u3055\u308c\u305f\u3001\u5b9f\u7528\u7684\uff08Pragmatic\uff09\u30013\u7fa4\u4e26\u884c\u3001\u591a\u65bd\u8a2d\u5171\u540c\u306e\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\uff08RCT\uff09\u3067\u3042\u308b\u3002\u53b3\u683c\u306b\u7d71\u5236\u3055\u308c\u305f\u5b9f\u9a13\u74b0\u5883\u3067\u306f\u306a\u304f\u3001\u5b9f\u81e8\u5e8a\u306b\u5373\u3057\u305f\u74b0\u5883\u4e0b\u3067\u306e\u6709\u52b9\u6027\u3092\u8a55\u4fa1\u3059\u308b\u8a2d\u8a08\uff08\u30d7\u30e9\u30b0\u30de\u30c6\u30a3\u30c3\u30af\u30fb\u30c8\u30e9\u30a4\u30a2\u30eb\uff09\u304c\u63a1\u7528\u3055\u308c\u305f\u3002<br \/>\n2.2 \u5bfe\u8c61\u60a3\u8005<br \/>\n<strong>\u7d44\u307f\u5165\u308c\u57fa\u6e96\uff1a<\/strong><br \/>\n18\u6b73\u4ee5\u4e0a\u306e\u6210\u4eba\u3002<br \/>\n\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u9069\u5408\u3057\u305f\u9069\u5207\u306a\u521d\u671f\u5185\u79d1\u6cbb\u7642\uff08\u5c40\u6240\u30b9\u30c6\u30ed\u30a4\u30c9\u70b9\u9f3b\u3001\u9f3b\u6d17\u6d44\uff09\u3092\u6700\u4f4e6\u9031\u9593\u4ee5\u4e0a\u7d99\u7d9a\u3057\u3066\u3082\u75c7\u72b6\u304c\u6b8b\u5b58\u3059\u308bCRS\u3002<br \/>\n\u9f3b\u526f\u9f3b\u8154\u75c7\u72b6\u8a55\u4fa1\u8cea\u554f\u7968\uff08SNOT-22\uff09\u30b9\u30b3\u30a2\u304c20\u70b9\u4ee5\u4e0a\uff08\u4e2d\u7b49\u75c7\u4ee5\u4e0a\uff09\u3002<br \/>\nCT\u691c\u67fb\u306b\u304a\u3044\u3066Lund-Mackay\u30b9\u30b3\u30a2\u304c4\u70b9\u4ee5\u4e0a\u3067\u3042\u308a\u3001\u5ba2\u89b3\u7684\u306b\u526f\u9f3b\u8154\u75c5\u5909\u304c\u78ba\u8a8d\u3055\u308c\u3066\u3044\u308b\u3002<br \/>\n<strong>\u9664\u5916\u57fa\u6e96\uff1a<\/strong><br \/>\n\u904e\u53bb12\u30f6\u6708\u4ee5\u5185\u306b3\u9031\u9593\u3092\u8d85\u3048\u308b\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u7cfb\u6297\u83cc\u85ac\u306e\u4f7f\u7528\u6b74\u304c\u3042\u308b\u3002<br \/>\n\u904e\u53bb6\u30f6\u6708\u4ee5\u5185\u306b\u526f\u9f3b\u8154\u624b\u8853\u306e\u65e2\u5f80\u304c\u3042\u308b\u3002<br \/>\n\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u4e0d\u826f\u306e\u91cd\u75c7\u5598\u606f\u3001\u514d\u75ab\u4e0d\u5168\u75c7\u3001\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u306b\u5bfe\u3059\u308b\u7981\u5fcc\uff08QT\u5ef6\u9577\u306a\u3069\uff09\u3092\u6709\u3059\u308b\u3002<br \/>\n2.3 \u4ecb\u5165\u5185\u5bb9\uff08\u30e9\u30f3\u30c0\u30e0\u5316\u3068\u5272\u308a\u4ed8\u3051\uff09<br \/>\n\u9069\u683c\u57fa\u6e96\u3092\u6e80\u305f\u3057\u305f\u53c2\u52a0\u8005\u306f\u3001\u30a6\u30a7\u30d6\u30d9\u30fc\u30b9\u306e\u30b7\u30b9\u30c6\u30e0\u3092\u7528\u3044\u30661:1:1\u306e\u5272\u5408\u3067\u4ee5\u4e0b\u306e3\u7fa4\u306b\u30e9\u30f3\u30c0\u30e0\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\u305f\u3002\u5168\u7fa4\u306b\u304a\u3044\u3066\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u6cbb\u7642\u3068\u3057\u3066\u300c\u6a19\u6e96\u5185\u79d1\u6cbb\u7642\uff08\u30e2\u30e1\u30bf\u30be\u30f3\u306a\u3069\u306e\u5c40\u6240\u30b9\u30c6\u30ed\u30a4\u30c9\u70b9\u9f3b\u85ac\u304a\u3088\u3073\u751f\u7406\u98df\u5869\u6c34\u306b\u3088\u308b\u9f3b\u6d17\u6d44\uff09\u300d\u304c\u7d99\u7d9a\u3057\u3066\u4f75\u7528\u3055\u308c\u305f\u3002<br \/>\n<strong>ESS\u7fa4\uff08\u624b\u8853\u6cbb\u7642\u7fa4\uff09<\/strong>\uff1a\u30e9\u30f3\u30c0\u30e0\u5316\u304b\u30896\u9031\u9593\u4ee5\u5185\u306b\u5185\u8996\u93e1\u4e0b\u526f\u9f3b\u8154\u624b\u8853\u3092\u5b9f\u65bd\u3002\u5177\u4f53\u7684\u306a\u8853\u5f0f\uff08\u524d\u982d\u6d1e\u30fb\u4e0a\u984e\u6d1e\u30fb\u7be9\u9aa8\u6d1e\u306e\u958b\u7a93\u306a\u3069\uff09\u306e\u7bc4\u56f2\u306f\u3001\u62c5\u5f53\u5916\u79d1\u533b\u306e\u81e8\u5e8a\u7684\u5224\u65ad\u306b\u4e00\u4efb\u3055\u308c\u305f\u3002<br \/>\n<strong>CLAR\u7fa4\uff08\u6297\u83cc\u85ac\u6cbb\u7642\u7fa4\uff09<\/strong>\uff1a\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u3092\u8a0812\u9031\u9593\u6295\u4e0e\u3002\u30b9\u30b1\u30b8\u30e5\u30fc\u30eb\u306f\u6700\u521d\u306e2\u9031\u9593\u304c250mg\u30921\u65e52\u56de\u3001\u305d\u306e\u5f8c\u306e10\u9031\u9593\u306f250mg\u30921\u65e51\u56de\uff08\u5b9f\u81e8\u5e8a\u306b\u304a\u3051\u308b\u6a19\u6e96\u7684\u306a\u5c11\u91cf\u9577\u671f\u6295\u4e0e\u30d7\u30ed\u30c8\u30b3\u30eb\uff09\u3002<br \/>\n<strong>PLA\u7fa4\uff08\u30d7\u30e9\u30bb\u30dc\u5bfe\u7167\u7fa4\uff09<\/strong>\uff1a\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u3068\u5916\u898b\u30fb\u5473\u304c\u8b58\u5225\u4e0d\u80fd\u306a\u30d7\u30e9\u30bb\u30dc\u3092\u540c\u69d8\u306e\u30b9\u30b1\u30b8\u30e5\u30fc\u30eb\u306712\u9031\u9593\u670d\u7528\u3002<br \/>\n2.4 \u76f2\u691c\u5316<br \/>\nCLAR\u7fa4\u3068PLA\u7fa4\u306e\u9593\u306f\u3001\u60a3\u8005\u304a\u3088\u3073\u81e8\u5e8a\u533b\u306b\u5bfe\u3057\u3066\u53b3\u5bc6\u306a\u4e8c\u91cd\u76f2\u691c\uff08Double-blind\uff09\u3055\u308c\u305f\u3002\u4e00\u65b9\u3001ESS\u7fa4\u306b\u3064\u3044\u3066\u306f\u3001\u507d\u624b\u8853\u306e\u5b9f\u65bd\u304c\u502b\u7406\u7684\u30fb\u5b9f\u7528\u7684\u306b\u56f0\u96e3\u3067\u3042\u308b\u305f\u3081\u3001\u975e\u76f2\u691c\uff08Open-label\uff09\u30c7\u30b6\u30a4\u30f3\u3068\u3055\u308c\u305f\u3002<br \/>\n2.5 \u8a55\u4fa1\u9805\u76ee\u3068\u7d71\u8a08\u89e3\u6790<br \/>\n<strong>\u4e3b\u8981\u8a55\u4fa1\u9805\u76ee\uff08Primary Outcome\uff09<\/strong>\uff1a<br \/>\n<strong>\u30e9\u30f3\u30c0\u30e0\u5316\u304b\u30896\u30f6\u6708\u6642\u70b9\u306b\u304a\u3051\u308bSNOT-22\uff08Sino-Nasal Outcome Test-22\uff09\u306e\u5408\u8a08\u30b9\u30b3\u30a2<\/strong>\u3002SNOT-22\u306fCRS\u7279\u7570\u7684\u306aQOL\u8cea\u554f\u7968\u3067\u3042\u308a\u300122\u306e\u75c7\u72b6\u9805\u76ee\uff08\u9f3b\u75c7\u72b6\u3001\u7761\u7720\u3001\u8033\u30fb\u9854\u9762\u75c7\u72b6\u3001\u5fc3\u7406\u7684\u5f71\u97ff\u306a\u3069\uff09\u3092\u54040\u70b9\uff08\u554f\u984c\u306a\u3057\uff09\u304b\u30895\u70b9\uff08\u6700\u60aa\uff09\u306e6\u6bb5\u968e\u3067\u8a55\u4fa1\u3059\u308b\uff08\u7dcf\u8a080\u301c110\u70b9\uff09\u3002\u30b9\u30b3\u30a2\u304c\u4f4e\u3044\u307b\u3069QOL\u304c\u826f\u597d\u3067\u3042\u308b\u3053\u3068\u3092\u793a\u3059\u3002\u4e8b\u524d\u306b\u8a2d\u5b9a\u3055\u308c\u305f\u81e8\u5e8a\u7684\u306b\u610f\u5473\u306e\u3042\u308b\u6700\u5c0f\u306e\u5dee\uff08MCID: Minimal Clinically Important Difference\uff09\u306f8.9\u70b9\u3067\u3042\u308b\u3002<br \/>\n\u89e3\u6790\u624b\u6cd5\uff1a<br \/>\n\u4e3b\u8981\u89e3\u6790\u306f\u3001ITT\u89e3\u6790\u304c\u884c\u308f\u308c\u305f\u3002\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u30b9\u30b3\u30a2\u3084\u65bd\u8a2d\u7b49\u3092\u8abf\u6574\u3057\u305f\u7dda\u5f62\u6df7\u5408\u30e2\u30c7\u30eb\u3092\u7528\u3044\u3066\u3001\u5404\u7fa4\u9593\u306e\u5e73\u5747\u5dee\u304a\u3088\u307395%\u4fe1\u983c\u533a\u9593\uff08CI\uff09\u3092\u7b97\u51fa\u3057\u305f\u3002<\/p>\n<p><strong>3. Results<\/strong><br \/>\n3.1 \u5bfe\u8c61\u60a3\u8005\u306e\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u7279\u6027<br \/>\n\u8a08514\u540d\u306e\u60a3\u8005\u304c\u30e9\u30f3\u30c0\u30e0\u5316\u3055\u308c\u305f\uff08ESS\u7fa4: 171\u540d\u3001CLAR\u7fa4: 172\u540d\u3001PLA\u7fa4: 171\u540d\uff09\u3002\u53c2\u52a0\u8005\u306e\u5168\u4f53\u7684\u306a\u80cc\u666f\u30c7\u30fc\u30bf\u306f\u5404\u7fa4\u9593\u3067\u306e\u80cc\u666f\u56e0\u5b50\u306e\u4e0d\u5747\u8861\u306f\u8a8d\u3081\u3089\u308c\u306a\u304b\u3063\u305f\u3002<\/p>\n<p>\u767b\u9332\u60a3\u8005\u306e80%\u304c\u300c\u9f3b\u30dd\u30ea\u30fc\u30d7\u3092\u4f34\u3046\u6162\u6027\u526f\u9f3b\u8154\u708e\uff08CRSwNP\uff09\u300d\u3067\u3042\u308a\u3001\u7d044\u5272\u306b\u5598\u606f\u306e\u5408\u4f75\u3084\u624b\u8853\u65e2\u5f80\u304c\u3042\u308b\u306a\u3069\u3001\u96e3\u6cbb\u6027\u304b\u3064\u6bd4\u8f03\u7684\u91cd\u75c7\u5ea6\u306e\u9ad8\u3044\u96c6\u56e3\u3092\u53cd\u6620\u3057\u3066\u3044\u305f\u3002<br \/>\n\u6cbb\u7642\u9075\u5b88\u7387\uff08\u30a2\u30c9\u30d2\u30a2\u30e9\u30f3\u30b9\uff09\u306b\u95a2\u3057\u3066\u3001CLAR\u7fa4\u304a\u3088\u3073PLA\u7fa4\u306e\u7d0498%\u304c\u4e88\u5b9a\u3055\u308c\u305f\u30d7\u30ed\u30c8\u30b3\u30eb\u901a\u308a\u306b\u6295\u85ac\u3092\u5b8c\u4e86\u3057\u305f\u3002ESS\u7fa4\u306b\u304a\u3044\u3066\u306f\u3001\u5272\u308a\u4ed8\u3051\u3089\u308c\u305f\u60a3\u8005\u306e87%\u304c6\u30f6\u6708\u306e\u8ffd\u8de1\u671f\u9593\u5185\u306b\u4e88\u5b9a\u901a\u308a\u624b\u8853\u3092\u5b8c\u4e86\u3057\u305f\u3002<\/p>\n<p>3.2 \u4e3b\u8981\u8a55\u4fa1\u9805\u76ee\uff086\u30f6\u6708\u6642\u70b9\u306eSNOT-22\u30b9\u30b3\u30a2\uff09\u306e\u7d50\u679c<br \/>\n\u30e9\u30f3\u30c0\u30e0\u5316\u304b\u30896\u30f6\u6708\u6642\u70b9\u306b\u304a\u3051\u308b\u5404\u7fa4\u306eSNOT-22\u5e73\u5747\u30b9\u30b3\u30a2\u304a\u3088\u3073\u7fa4\u9593\u6bd4\u8f03\u306e\u7d50\u679c\u306f\u4ee5\u4e0b\u306e\u901a\u308a\u3067\u3042\u3063\u305f\u3002<br \/>\n<strong>\u30d7\u30e9\u30bb\u30dc\uff08PLA\uff09\u7fa4\uff1a46.8\u70b9<br \/>\n\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\uff08CLAR\uff09\u7fa4\uff1a42.8\u70b9<br \/>\n\u5185\u8996\u93e1\u4e0b\u526f\u9f3b\u8154\u624b\u8853\uff08ESS\uff09\u7fa4\uff1a24.3\u70b9<\/strong><\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/df6ed6933dcf4596759d258da86ea80e.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/df6ed6933dcf4596759d258da86ea80e-300x170.png\" alt=\"\" width=\"300\" height=\"170\" class=\"alignnone size-medium wp-image-3006\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/df6ed6933dcf4596759d258da86ea80e-300x170.png 300w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/df6ed6933dcf4596759d258da86ea80e.png 602w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>\u4e3b\u8981\u306a\u7fa4\u9593\u5bfe\u6bd4\uff08\u8abf\u6574\u5f8c\u5e73\u5747\u5dee\uff09\uff1a<br \/>\n<strong>\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u7fa4 vs \u30d7\u30e9\u30bb\u30dc\u7fa4<\/strong>\uff1a<br \/>\n\u8abf\u6574\u5f8c\u5e73\u5747\u5dee\u306f -3.11\u70b9\uff0895%CI: -7.50 to 1.28\u3001p=0.17\uff09\u3067\u3042\u3063\u305f\u3002\u3053\u306e\u7d50\u679c\u306f\u7d71\u8a08\u5b66\u7684\u306a\u6709\u610f\u5dee\u3092\u793a\u3055\u305a\u3001\u3055\u3089\u306b\u81e8\u5e8a\u7684\u610f\u5473\u306e\u3042\u308b\u5dee\u306e\u57fa\u6e96\uff08MCID: 8.9\u70b9\uff09\u3092\u5927\u304d\u304f\u4e0b\u56de\u3063\u305f\u3002\u3059\u306a\u308f\u3061\u3001\u6a19\u6e96\u7684\u306a\u5185\u79d1\u6cbb\u7642\u306b\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u3092\u9577\u671f\u4e0a\u4e57\u305b\u3059\u308b\u52b9\u679c\u306f\u3001\u30d7\u30e9\u30bb\u30dc\u3092\u4e0a\u4e57\u305b\u3057\u305f\u5834\u5408\u3068\u660e\u78ba\u306a\u5dee\u7570\u304c\u306a\u3044\u3053\u3068\u304c\u5b9f\u8a3c\u3055\u308c\u305f\u3002<br \/>\n<strong>\u624b\u8853\uff08ESS\uff09\u7fa4 vs \u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u7fa4<\/strong>\uff1a<br \/>\n\u8abf\u6574\u5f8c\u5e73\u5747\u5dee\u306f -18.13\u70b9\uff0895%CI: -22.50 to -13.76\u3001p<0.0001\uff09\u3067\u3042\u3063\u305f\u3002\u7d71\u8a08\u5b66\u7684\u306b\u6975\u3081\u3066\u9ad8\u5ea6\u306a\u6709\u610f\u5dee\u304c\u8a8d\u3081\u3089\u308c\u3001\u304b\u3064MCID\uff088.9\u70b9\uff09\u306e2\u500d\u3092\u8d85\u3048\u308b\u5927\u5e45\u306aQOL\u6539\u5584\u52b9\u679c\u304c\u624b\u8853\u306b\u3088\u3063\u3066\u3082\u305f\u3089\u3055\u308c\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u305f\u3002\n3.3 \u75c7\u72b6\u306e\u6642\u7cfb\u5217\u63a8\u79fb\n\u8ffd\u8de1\u671f\u9593\u4e2d\u306e\u6642\u7cfb\u5217\u8a55\u4fa1\u306b\u304a\u3044\u3066\u3001ESS\u7fa4\u3067\u306f\u624b\u8853\u5b9f\u65bd\u76f4\u5f8c\u306e\u300c6\u9031\u9593\u6642\u70b9\u300d\u3067\u3059\u3067\u306bSNOT-22\u30b9\u30b3\u30a2\u306e\u5927\u5e45\u306a\u4f4e\u4e0b\u304c\u8a8d\u3081\u3089\u308c\u3001\u305d\u306e\u6539\u5584\u52b9\u679c\u306f3\u30f6\u6708\u5f8c\u30016\u30f6\u6708\u5f8c\u3078\u3068\u8ffd\u8de1\u304c\u9032\u3080\u306b\u3064\u308c\u3066\u3055\u3089\u306b\u62e1\u5927\u30fb\u7dad\u6301\u3055\u308c\u305f\u3002\u4e00\u65b9\u3067\u3001CLAR\u7fa4\u306e\u30b9\u30b3\u30a2\u63a8\u79fb\u306f\u3001\u3059\u3079\u3066\u306e\u8a55\u4fa1\u6642\u70b9\uff086\u9031\u30013\u30f6\u6708\u30016\u30f6\u6708\uff09\u306b\u304a\u3044\u3066PLA\u7fa4\u306e\u7de9\u3084\u304b\u306a\u6539\u5584\u8ecc\u8de1\u3068\u307b\u307c\u5b8c\u5168\u306b\u4e00\u81f4\u3057\u3066\u304a\u308a\u3001\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u6295\u4e0e\u306b\u3088\u308b\u8ffd\u52a0\u7684\u306a\u75c7\u72b6\u6539\u5584\u52b9\u679c\u306f\u78ba\u8a8d\u3055\u308c\u306a\u304b\u3063\u305f\u3002\n\n<a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/305bdaafa84dfff7abd6ecdf0efb9b28.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/305bdaafa84dfff7abd6ecdf0efb9b28-277x300.png\" alt=\"\" width=\"277\" height=\"300\" class=\"alignnone size-medium wp-image-3007\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/305bdaafa84dfff7abd6ecdf0efb9b28-277x300.png 277w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2026\/06\/305bdaafa84dfff7abd6ecdf0efb9b28.png 602w\" sizes=\"auto, (max-width: 277px) 100vw, 277px\" \/><\/a><\/p>\n<p><strong>4. Discussion<\/strong><br \/>\n4.1 \u4e3b\u8981\u306a\u77e5\u898b\u306e\u81e8\u5e8a\u7684\u610f\u7fa9<br \/>\nMACRO\u8a66\u9a13\u306e\u7d50\u679c\u306f\u3001\u521d\u671f\u5185\u79d1\u6cbb\u7642\u62b5\u6297\u6027\u306e\u6210\u4ebaCRS\u60a3\u8005\u306b\u5bfe\u3059\u308b\u4e8c\u6b21\u9078\u629e\u306e\u6a19\u6e96\u5316\u306b\u304a\u3044\u3066\u3001\u6975\u3081\u3066\u91cd\u8981\u306a\u77e5\u898b\u3092\u63d0\u4f9b\u3059\u308b\u3002\u9069\u5207\u306a\u521d\u671f\u6cbb\u7642\uff08\u30b9\u30c6\u30ed\u30a4\u30c9\u70b9\u9f3b\u3001\u9f3b\u6d17\u6d44\uff09\u3092\u884c\u3063\u3066\u3082\u75c7\u72b6\u304c\u6b8b\u308b\u4e2d\u7b49\u75c7\u4ee5\u4e0a\u306e\u75c7\u4f8b\u306b\u304a\u3044\u3066\u3001ESS\u306b\u3088\u308b\u5916\u79d1\u7684\u4ecb\u5165\u306f\u65e9\u671f\u304b\u3064\u5f37\u56fa\u306aQOL\u6539\u5584\u3092\u3082\u305f\u3089\u3059\u3002\u5bfe\u7167\u7684\u306b\u3001\u3053\u308c\u307e\u3067\u5b9f\u81e8\u5e8a\u3067\u5e83\u304f\u884c\u308f\u308c\u3066\u304d\u305f\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u6297\u83cc\u85ac\u306e\u30eb\u30fc\u30c1\u30f3\u306a\u5c11\u91cf\u9577\u671f\u6295\u4e0e\u306f\u3001\u30d7\u30e9\u30bb\u30dc\u3092\u8d85\u3048\u308b\u81e8\u5e8a\u7684\u30d9\u30cd\u30d5\u30a3\u30c3\u30c8\u3092\u3082\u305f\u3089\u3055\u306a\u3044\u3053\u3068\u304c\u660e\u3089\u304b\u306b\u306a\u3063\u305f\u3002\u3053\u308c\u306f\u3001\u6f2b\u7136\u3068\u3057\u305f\u6297\u83cc\u85ac\u9577\u671f\u6295\u4e0e\u304c\u3082\u305f\u3089\u3059\u8010\u6027\u83cc\u306e\u30ea\u30b9\u30af\u3084\u3001\u85ac\u5264\u7279\u6709\u306e\u526f\u4f5c\u7528\uff08\u6d88\u5316\u5668\u75c7\u72b6\u3001QT\u5ef6\u9577\u30ea\u30b9\u30af\u7b49\uff09\u3092\u9451\u307f\u308b\u3068\u3001\u305d\u306e\u4f7f\u7528\u3092\u5f37\u304f\u5236\u9650\u3059\u3079\u304d\u6839\u62e0\u3068\u306a\u308b\u3002<br \/>\n<strong>4.2 \u672c\u7814\u7a76\u306e\u9650\u754c\uff08Limitations\uff09<br \/>\n\u7279\u5b9a\u306e\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u306b\u304a\u3051\u308b\u691c\u51fa\u529b\u4e0d\u8db3\uff1a\u53c2\u52a0\u8005\u306e80%\u304c\u9f3b\u30dd\u30ea\u30fc\u30d7\u3092\u4f34\u3046\u6162\u6027\u526f\u9f3b\u8154\u708e\uff08CRSwNP\uff09\u3067\u3042\u3063\u305f\u3002<\/strong>\u75c5\u614b\u751f\u7406\u5b66\u7684\u306b\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u306f\u597d\u4e2d\u7403\u6027\u708e\u75c7\uff08\u975e2\u578b\u708e\u75c7\uff09\u304c\u4e3b\u4f53\u3068\u3055\u308c\u308b\u300c\u9f3b\u30dd\u30ea\u30fc\u30d7\u3092\u4f34\u308f\u306a\u3044\u6162\u6027\u526f\u9f3b\u8154\u708e\uff08CRSsNP\uff09\u300d\u306b\u6709\u52b9\u3067\u3042\u308b\u53ef\u80fd\u6027\u304c\u5f93\u6765\u6307\u6458\u3055\u308c\u3066\u3044\u305f\u304c\u3001\u672c\u8a66\u9a13\u306b\u304a\u3051\u308bCRSsNP\u60a3\u8005\u306f\u5168\u4f53\u306e20%\u306b\u904e\u304e\u305a\u3001\u3053\u306e\u30b5\u30d6\u30b0\u30eb\u30fc\u30d7\u306b\u304a\u3044\u3066\u52b9\u679c\u3092\u5b8c\u5168\u306b\u5426\u5b9a\u30fb\u8a55\u4fa1\u3059\u308b\u305f\u3081\u306e\u7d71\u8a08\u5b66\u7684\u691c\u51fa\u529b\u304c\u4e0d\u8db3\u3057\u3066\u3044\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002<br \/>\n<strong>ESS\u7fa4\u306b\u304a\u3051\u308b\u975e\u76f2\u691c\u5316\u306e\u30d0\u30a4\u30a2\u30b9\uff1a\u624b\u8853\u3068\u3044\u3046\u4ecb\u5165\u306e\u6027\u8cea\u4e0a\u3001\u507d\u624b\u8853\u3092\u884c\u3063\u3066\u3044\u306a\u3044\u3002<\/strong>\u305d\u306e\u305f\u3081\u3001\u60a3\u8005\u304c\u300c\u624b\u8853\u3092\u53d7\u3051\u305f\u300d\u3068\u3044\u3046\u8a8d\u8b58\u3092\u6301\u3064\u3053\u3068\u306b\u3088\u308b\u4e3b\u89b3\u7684\u306a\u30d7\u30e9\u30bb\u30dc\u52b9\u679c\u3001\u304a\u3088\u3073QOL\u8cea\u554f\u7968\uff08SNOT-22\uff09\u306e\u56de\u7b54\u306b\u304a\u3051\u308b\u8a55\u4fa1\u30d0\u30a4\u30a2\u30b9\u304c\u7d50\u679c\u3092\u4e00\u5b9a\u7a0b\u5ea6\u4fee\u98fe\u3057\u3066\u3044\u308b\u53ef\u80fd\u6027\u306f\u6392\u9664\u3067\u304d\u306a\u3044\u3002<br \/>\n<strong>\u4e00\u822c\u5316\u306e\u53ef\u80fd\u6027\uff08\u5bfe\u8c61\u96c6\u56e3\u306e\u9078\u629e\u30d0\u30a4\u30a2\u30b9\uff09\uff1a\u672c\u8a66\u9a13\u306f\u3001\u82f1\u56fd\u306e2\u6b21\u30fb3\u6b21\u533b\u7642\u6a5f\u95a2\uff08\u5c02\u9580\u5916\u6765\uff09\u306b\u7d39\u4ecb\u3055\u308c\u305f\u91cd\u75c7\u5ea6\u306e\u9ad8\u3044\u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u3066\u3044\u308b\u3002<\/strong>\u305d\u306e\u305f\u3081\u3001\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\uff08\u8a3a\u7642\u6240\u7b49\uff09\u3092\u521d\u3081\u3066\u53d7\u8a3a\u3057\u305f\u8efd\u75c7\u4f8b\u3084\u3001\u521d\u671f\u6cbb\u7642\u304c\u307e\u3060\u5341\u5206\u306b\u884c\u308f\u308c\u3066\u3044\u306a\u3044CRS\u60a3\u8005\u306b\u5bfe\u3057\u3066\u3001\u6700\u521d\u304b\u3089ESS\u3092\u30d5\u30a1\u30fc\u30b9\u30c8\u30e9\u30a4\u30f3\u3068\u3057\u3066\u63a8\u5968\u3059\u308b\u6839\u62e0\u3068\u306f\u306a\u3089\u306a\u3044\u3002<\/p>\n<p><strong>5. Conclusion<\/strong><br \/>\n\u9069\u5207\u306a\u521d\u671f\u5185\u79d1\u6cbb\u7642\uff08\u30b9\u30c6\u30ed\u30a4\u30c9\u70b9\u9f3b\u304a\u3088\u3073\u9f3b\u6d17\u6d44\u3092\u6700\u4f4e6\u9031\u9593\uff09\u3092\u884c\u3063\u3066\u3082\u75c7\u72b6\u304c\u6b8b\u5b58\u3059\u308b\u6210\u4eba\u6162\u6027\u526f\u9f3b\u8154\u708e\u306b\u304a\u3044\u3066\u3001\u5185\u8996\u93e1\u4e0b\u526f\u9f3b\u8154\u624b\u8853\uff08ESS\uff09\u306f\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u9577\u671f\u6295\u4e0e\u304a\u3088\u3073\u30d7\u30e9\u30bb\u30dc\u306b\u5bfe\u3057\u3066\u3001\u5287\u7684\u304b\u3064\u660e\u78ba\u306b\u512a\u308c\u305fQOL\u6539\u5584\uff08SNOT-22\u30b9\u30b3\u30a2\u306e\u6539\u5584\uff09\u3092\u3082\u305f\u3089\u3059\u3002\u4e00\u65b9\u3067\u3001\u30af\u30e9\u30ea\u30b9\u30ed\u30de\u30a4\u30b7\u30f3\u306e\u5c11\u91cf\u9577\u671f\u6295\u4e0e\u306f\u30d7\u30e9\u30bb\u30dc\u306b\u5bfe\u3059\u308b\u8ffd\u52a0\u52b9\u679c\u3092\u793a\u3055\u306a\u304b\u3063\u305f\u3002\u6cbb\u7642\u62b5\u6297\u6027\u306eCRS\u306b\u5bfe\u3057\u3066\u306f\u3001\u6f2b\u7136\u3068\u6297\u83cc\u85ac\u6295\u4e0e\u3092\u7d99\u7d9a\u3059\u308b\u306e\u3067\u306f\u306a\u304f\u3001\u9069\u5207\u306a\u30bf\u30a4\u30df\u30f3\u30b0\u3067\u5916\u79d1\u7684\u6cbb\u7642\uff08ESS\uff09\u3092\u63d0\u793a\u30fb\u8003\u616e\u3059\u308b\u3053\u3068\u304c\u3001QOL\u5411\u4e0a\u3068\u9069\u5207\u306a\u6297\u83cc\u85ac\u9069\u6b63\u4f7f\u7528\u306e\u89b3\u70b9\u304b\u3089\u5f37\u304f\u63a8\u5968\u3055\u308c\u308b\u3002<\/p>\n<p>\u3010\u958b\u50ac\u65e5\u30112026\u5e746\u670810\u65e5<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d C Philpott et al.The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=3005\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\u96e3\u6cbb\u6027\u6162\u6027\u526f\u9f3b\u8154\u708e\u306b\u5bfe\u3059\u308b\u30de\u30af\u30ed\u30e9\u30a4\u30c9\u9577\u671f\u7642\u6cd5 VS \u9f3b\u5185\u8996\u93e1\u624b\u8853 VS \u30d7\u30e9\u30bb\u30dc\u306e\u6cbb\u7642\u6210\u7e3e\u3092\u6bd4\u3079\u308b\u3068\uff1f<\/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":[23,17],"tags":[],"class_list":["post-3005","post","type-post","status-publish","format-standard","hentry","category-23","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/3005","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=3005"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/3005\/revisions"}],"predecessor-version":[{"id":3008,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/3005\/revisions\/3008"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3005"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3005"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}