{"id":785,"date":"2010-06-09T11:16:40","date_gmt":"2010-06-09T02:16:40","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=785"},"modified":"2015-08-07T11:17:03","modified_gmt":"2015-08-07T02:17:03","slug":"%ef%bd%9ebnp%e3%81%ab%e5%9f%ba%e3%81%a5%e3%81%84%e3%81%a6%e6%b2%bb%e7%99%82%e3%82%92%e8%a1%8c%e3%81%a3%e3%81%a6%e3%81%84%e3%81%8f%e3%81%93%e3%81%a8%e3%81%af%e5%bf%83%e4%b8%8d%e5%85%a8%e7%ae%a1","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=785","title":{"rendered":"\uff5eBNP\u306b\u57fa\u3065\u3044\u3066\u6cbb\u7642\u3092\u884c\u3063\u3066\u3044\u304f\u3053\u3068\u306f\u5fc3\u4e0d\u5168\u7ba1\u7406\u306b\u6709\u7528\u304b\uff1f\uff5e"},"content":{"rendered":"<p>\u3010\u6587\u732e\u3011<br \/>\nPfisterer M et al. BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial. JAMA. 2009 Jan 28;301(4):383-92.<\/p>\n<p>\u3010\u8981\u7d04\u3011<br \/>\n\u80cc\u666f<br \/>\n\u5fc3 \u4e0d\u5168\u306e\u6cbb\u7642\u306b\u304a\u3044\u3066\u3001Nt-BNP\u306b\u57fa\u3065\u3044\u3066\u884c\u3046\u6cbb\u7642\u304c\u75c7\u72b6\u306b\u57fa\u3065\u3044\u3066\u884c\u3046\u6cbb\u7642\u3088\u308a\u3082\u512a\u308c\u3066\u3044\u308b\u304b\u3069\u3046\u304b\u306f\u5b9a\u304b\u3067\u306f\u306a\u3044\u3002\u7a2e\u3005\u306e\u7814\u7a76\u304c\u3042\u308b\u3088\u3046\u3060\u304c\u3001\u3069\u308c \u3082\u30b5\u30a4\u30ba\u304c\u5c0f\u3055\u304b\u3063\u305f\u308a\u3001\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u671f\u9593\u304c\u4e0d\u5341\u5206\u3067\u3042\u3063\u305f\u308a\u3001\u8a73\u7d30\u304c\u8ad6\u6587\u306b\u8a18\u8f09\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\u308a\u3068\u554f\u984c\u304c\u3042\u3063\u305f\u3002<br \/>\n\u3055\u3089\u306b\u9ad8\u9f62\u8005\u306f\u5fc3\u4e0d\u5168\u306e\u75c7\u72b6\u3082\u9855\u5728\u5316\u3057\u306b\u304f\u304f\u3042\u3066\u306b\u306a\u3089\u306a\u3044\u3002\u305d\u308c\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u85ac\u306b\u5bfe\u3057\u3066\u306e\u6709\u5bb3\u4e8b\u8c61\u306a\u3069\u3082\u591a\u3044\u305f\u3081\u975e\u5e38\u306b\u6cbb\u7642\u304c\u96e3\u3057\u3044\u304c\u3001\u9ad8\u9f62\u8005\u306b\u5bfe\u3059\u308b\u5fc3\u4e0d\u5168\u7ba1\u7406\u306b\u5bfe\u3057\u3066\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u3082\u4e4f\u3057\u3044\u3002<\/p>\n<p>\u76ee\u7684<br \/>\n\u5fc3\u4e0d\u5168\u306b\u304a\u3044\u3066\u3001Nt-BNP\u306b\u57fa\u3065\u304f\u6cbb\u7642\u3068\u75c7\u72b6\u306b\u57fa\u3065\u304f\u6cbb\u7642\u306e\u7d50\u679c\u309218\u304b\u6708\u3067\u6bd4\u8f03\u3059\u308b\u3053\u3068\u3002<\/p>\n<p>\u30c7\u30b6\u30a4\u30f3\uff0c\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\uff0c\u60a3\u8005<br \/>\nrandomised controlled multicenter trial<br \/>\n\u5bfe\u8c61\u8005&#8230;\u53ce\u7e2e\u969c\u5bb3\u6027\u5fc3\u4e0d\u5168\uff08EF\uff1c45%\uff09\u3067\u3042\u308a\u3001NYHA2\u5ea6\u4ee5\u4e0a\u30671\u5e74\u4ee5\u5185\u306b\u5fc3\u4e0d\u5168\u3067\u5165\u9662\u6b74\u304c\u3042\u308a\u3001Nt-BNP\u304c\u6b63\u5e38\u4e0a\u9650\u306e2\u500d\u4ee5\u4e0a\u3067\u3042\u308b60\u6b73\u4ee5\u4e0a\u306e\u60a3\u8005499\u4eba\u3002Baseline\u306b\u5dee\u306f\u306a\u3044\u3002<br \/>\n\uff08\u5f37\u3044\u3066\u8a00\u3048\u3070\u3001\u5e74\u9f62\u5225\u306e\u6bd4\u8f03\u306775\u6b73\u4ee5\u4e0a\u306e\u307b\u3046\u304c<br \/>\n\u75c7\u72b6\u304c\u91cd\u75c7\u3067\u3042\u308a\u3001BNP\u3082\u9ad8\u5024\u3067\u3042\u308b\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001EF\u304c\u826f\u3044\u304f\u3089\u3044\uff09<br \/>\n\u8ffd\u8de1\u671f\u9593&#8230;18\u30ab\u6708<br \/>\n\u5834\u6240&#8230;\u30b9\u30a4\u30b9\u3068\u30c9\u30a4\u30c4\u306e15\u304b\u6240\u306e\u5916\u6765\u8a3a\u7642\u30bb\u30f3\u30bf\u30fc<br \/>\n\u671f\u9593&#8230;2003\u5e741\u6708~2008\u5e746\u6708<\/p>\n<p>\u4ecb\u5165<br \/>\nNYHA2\u5ea6\u4ee5\u4e0b\u306e\u75c7\u72b6\u306b\u6291\u3048\u308b\u3088\u3046\u306b\u6cbb\u7642\u3057\u3066\u3044\u304f\u7fa4\uff08\u75c7\u72b6\u306b\u57fa\u3065\u3044\u305f\u6cbb\u7642\u7fa4\uff09<br \/>\nBNP\u304c\u6b63\u5e38\u4e0a\u9650\u306e2\u500d\u4ee5\u5185\u3068NYHA2\u5ea6\u4ee5\u4e0b\u306b\u4fdd\u3064\u3088\u3046\u6cbb\u7642\u3057\u3066\u3044\u304f\u7fa4\uff08BNP\u306b\u57fa\u3065\u3044\u305f\u6cbb\u7642\u7fa4\uff09<br \/>\n\uff0875\u6b73\u672a\u6e80\u3067\u306f\u3000400pg\/ml\u4ee5\u4e0b\u300175\u6b73\u4ee5\u4e0a\u3067\u306f\u3001800pg\/ml\u4ee5\u4e0b\uff09<\/p>\n<p>\u7d50\u679c<br \/>\nPrimary end point<br \/>\n\u30fbHospital free survival\uff08\u5728\u5b85\u751f\u5b58\u7387\uff09\u306fBNP\u306b\u57fa\u3065\u304f\u5fc3\u4e0d\u5168\u6cbb\u7642\u7fa4\u3068\u75c7\u72b6\u306b\u57fa\u3065\u304f\u6cbb\u7642\u7fa4\u3068\u3067\u540c\u7b49\uff0841% vs 40%;HR,0.91[95% CI,0.72-1.14];P=0.39\uff09<br \/>\n\u30fb18\u304b\u6708\u306b\u308f\u305f\u308b\u8ffd\u8de1\u671f\u9593\u4e2d\u306eQOL\u6e2c\u5b9a\u57fa\u6e96\u306f\u6539\u5584\u3057\u305f\u304c\u30012\u7fa4\u9593\u306e\u6539\u5584\u306f\u540c\u7b49\u3067\u3042\u3063\u305f\u3002<br \/>\nSecondary end point<br \/>\n\u5168\u5e74\u9f62\u306b\u304a\u3051\u308b\u6bd4\u8f03<br \/>\n\u30fbHF Hospital free survival\uff08\u5fc3\u4e0d\u5168\u306b\u95a2\u3059\u308b\u5728\u5b85\u751f\u5b58\u7387\uff09\u3067\u4e21\u7fa4\u9593\u306b\u5dee\u304c\u3042\u3063\u305f<br \/>\n\uff0872% vs 62%;HR,0.68[95% CI,0.50-0.92];P=0.01\uff09<br \/>\n\u5e74\u9f62\u5225\uff0860-75\u6b73\u300175\u6b73\u4ee5\u4e0a\u306e2\u7fa4\uff09\u306b\u304a\u3051\u308b\u6bd4\u8f03\uff08Figure6,7.\uff09<br \/>\n\u30fb60~75\u6b73\u306b\u304a\u3044\u3066BNP\u306b\u57fa\u3065\u304f\u6cbb\u7642\u7fa4\u3067\u7d50\u679c\u304c\u6539\u5584\u3057\u305f\u304c\u300175\u6b73\u4ee5\u4e0a\u3067\u306f\u6539\u5584\u3057\u306a\u304b\u3063\u305f\u3002\uff08P<0.02\uff09\n\u3000\u3000\u7d50\u679c\u3068\u306f...\u5728\u5b85\u751f\u5b58\u7387\uff0c\u6b7b\u4ea1\u7387\u3001\u5fc3\u4e0d\u5168\u306b\u95a2\u3059\u308b\u5728\u5b85\u751f\u5b58\u7387\n\n\uff1c\u53c2\u8003\uff1e\n\u5fc3\u4e0d\u5168\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u7684\u4ecb\u5165\u7387\n\u3000Baseline1\u30ab\u67083\u304b\u67086\u304b\u6708\nsympton-guided group77%61%53%52%\nBNP-guided group86%95%91%90%\n\n\u3057\u304b\u3057\u3001\u75c7\u72b6\u306e\u6539\u5584\u3082\u3001BNP\u5024\u3082\u4e21\u7fa4\u3068\u3082\u6709\u610f\u5dee\u304c\u306a\u304b\u3063\u305f\u3002\uff08Figure3.\uff09\n\u75c7\u72b6\u306e\u7a0b\u5ea6\uff08NYHA\u5206\u985e\uff09\u3068BNP\u5024\u3068\u306e\u95a2\u4fc2\u6027\u306b\u3064\u3044\u3066Figure4.\u306b\u8a18\u8f09\u304c\u3042\u308b\u304c\u3001\u304b\u306a\u308a\u5e45\u304c\u3042\u308b\u3053\u3068\u304c\u5206\u304b\u308b\u3002\u3053\u308c\u306b\u3088\u308aBNP\u306b\u57fa\u3065\u304f\u6cbb\u7642\u7fa4\u3067\u306f\u85ac\u7269\u306e\u5229\u7528\u3055\u308c\u308b\u7387\u304c\u5897\u3048\u3066\u3057\u307e\u3046\u3053\u3068\u3092\u793a\u5506\u3059\u308b\u3002\n\n\u6709\u5bb3\u4e8b\u8c61\u306b\u95a2\u3057\u3066\n\u4e21\u7fa4\u9593\u306b\u6709\u610f\u5dee\u306a\u3057\u3002\uff08\u814e\u6a5f\u80fd\u969c\u5bb3\u3001\u4f4e\u8840\u5727\u3082\u6709\u610f\u5dee\u306a\u3057\u3002\uff09\n\u3000\u3057\u304b\u3057\u3001\u5e74\u9f62\u3092\u52a0\u5473\u3059\u308b\u3068\u3001\n75\u6b73\u4ee5\u4e0a\u306e\u60a3\u8005\u306710.5% vs 5.5%; P=0.12\n60-75\u6b73\u306e\u60a3\u8005\u30673.7% vs 4.9%; P=0.74\n\n\u7d50\u8ad6\nBNP\u306b\u57fa\u3065\u304f\u5fc3\u4e0d\u5168\u6cbb\u7642\u7fa4\u306f\u75c7\u72b6\u306b\u57fa\u3065\u304f\u6cbb\u7642\u7fa4\u3068\u6bd4\u8f03\u3057\u3001\u81e8\u5e8a\u7684\u306a\u30a2\u30a6\u30c8\u30ab\u30e0\u3084QOL\u3092\u6539\u5584\u3057\u306a\u304b\u3063\u305f\u3002\n\n\n\n\u3010\u958b\u50ac\u65e5\u3011\n\uff12\uff10\uff11\uff10\u5e74\uff16\u6708\uff19\u65e5\n<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u3010\u6587\u732e\u3011 Pfisterer M et al. BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs Standa &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=785\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\uff5eBNP\u306b\u57fa\u3065\u3044\u3066\u6cbb\u7642\u3092\u884c\u3063\u3066\u3044\u304f\u3053\u3068\u306f\u5fc3\u4e0d\u5168\u7ba1\u7406\u306b\u6709\u7528\u304b\uff1f\uff5e<\/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":[17],"tags":[],"class_list":["post-785","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/785","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=785"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/785\/revisions"}],"predecessor-version":[{"id":786,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/785\/revisions\/786"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=785"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=785"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=785"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}