{"id":852,"date":"2015-08-13T14:58:37","date_gmt":"2015-08-13T05:58:37","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=852"},"modified":"2015-09-10T16:29:42","modified_gmt":"2015-09-10T07:29:42","slug":"%e3%80%90ebm%e3%81%ae%e5%ad%a6%e3%81%b3%e3%80%91%e5%b8%af%e7%8a%b6%e7%96%b1%e7%96%b9%e3%81%ab%e5%af%be%e3%81%99%e3%82%8bpsl","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=852","title":{"rendered":"\u3010EBM\u306e\u5b66\u3073\u3011\u5e2f\u72b6\u75b1\u75b9\u306b\u5bfe\u3059\u308bPSL"},"content":{"rendered":"

STEP1\u3000\u81e8\u5e8a\u60a3\u8005\u306b\u5373\u3057\u305fPI(E)CO<\/strong>
\n\u3010\u8a55\u4fa1\u3092\u884c\u3063\u305f\u65e5\u4ed8\u3011
\n\u30002015\/08\/12
\n\u3010\u81e8\u5e8a\u72b6\u6cc1\u306e\u30b5\u30de\u30ea\u30fc\u3011
\n\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u3067\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f35 mg\/day\u3001\u74b0\u8ef8\u690e\u4e9c\u8131\u81fc\u306b\u3088\u308b\u75bc\u75db\u3067\u30c8\u30e9\u30e0\u30bb\u30c3\u30c8\u5185\u670d\u4e2d\u306e70\u4ee3\u7537\u6027\u3002\u9ad8\u9f62\u8005\u4f4f\u5b85\u306b\u72ec\u5c45\u3067ADL\u306f\u30d9\u30c3\u30c9\u4e0a\u751f\u6d3b\u3001\u5f53\u9662\u5b9a\u671f\u8a2a\u554f\u8a3a\u7642\u4e2d\u3002\u524d\u80f8\u90e8\u5de6\u5074\u306b\u75bc\u75db\u3092\u4f34\u308f\u306a\u3044\u6c34\u75b1\u30fb\u767a\u8d64\u51fa\u73fe\u3057\u3001\u5e2f\u72b6\u75b1\u75b9\u3068\u8a3a\u65ad\u3057\u305f\u304c\u3001\u767a\u75b9\u51fa\u73fe\u304b\u3089\u7d0480\u6642\u9593\u306872\u6642\u9593\u3092\u904e\u304e\u3066\u3044\u305f\u305f\u3081\u6297\u30a6\u30a4\u30eb\u30b9\u85ac\u306e\u9069\u5fdc\u306f\u306a\u304f\u3001\u7121\u6cbb\u7642\u7d4c\u904e\u89b3\u5bdf\u3068\u3057\u305f\u3002\u8a2a\u554f\u770b\u8b77\u5e2b\u306b\u5831\u544a\u3059\u308b\u3068\u3001\u5e2f\u72b6\u75b1\u75b9\u5f8c\u795e\u7d4c\u75db\uff08PHN\uff09\u4e88\u9632\u306e\u305f\u3081\u4f55\u304b\u3067\u304d\u306a\u3044\u304b\u3068\u76f8\u8ac7\u3092\u53d7\u3051\u305f\u3002\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u3067\u5e2f\u72b6\u75b1\u75b9\u6cbb\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u6982\u8981\u3092\u307f\u308b\u3068\u3001PHN\u4e88\u9632\u306b\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f360 mg\/day\u5185\u670d7\u65e5\u9593\uff08\u4ee5\u5f8c\u6f38\u6e1b\uff09\u3092\u884c\u3046\u3053\u3068\u304c\u3042\u308b\u3088\u3046\u3060\u3063\u305f\u3002\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u306bPHN\u4e88\u9632\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u3069\u308c\u307b\u3069\u3042\u308b\u306e\u304b\u7591\u554f\u306b\u611f\u3058\u3001\u6587\u732e\u3092\u691c\u7d22\u3057\u305f\u3002
\n\u3000\u3000P\uff1b\u5e2f\u72b6\u75b1\u75b9\u6025\u6027\u671f\u306e\u60a3\u8005
\n\u3000\u3000I(E)\uff1b\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u5185\u670d
\n\u3000\u3000C\uff1b\u30d7\u30e9\u30bb\u30dc\u5185\u670d
\n\u3000\u3000O\uff1bPHN\u306e\u51fa\u73fe\u3092\u6291\u5236\u3059\u308b\u304b<\/p>\n

STEP2\u3000\u691c\u7d22\u3057\u3066\u898b\u3064\u3051\u305f\u6587\u732e\u306e\u540d\u524d<\/strong>
\n\u3010\u898b\u3064\u3051\u305f\u8ad6\u6587\u3011
\n\u3000Wood MJ, Johnson RW, Mckendrick MW, Taylor J, Mandal BK, Crooks J.
\nA randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. New England Journal of
\nMedicine 1994;330(13):896-900.<\/p>\n

STEP3\u3000\u8ad6\u6587\u306e\u8a55\u4fa1<\/strong>
\nSTEP3-1\u3000\u8ad6\u6587\u306ePECO\u306f\u60a3\u8005\u306ePECO\u3068\u5408\u81f4\u3059\u308b\u304b\uff1f<\/strong>
\n\u3000P\uff1b\u514d\u75ab\u6291\u5236\u72b6\u614b\u306b\u306a\u304418\u6b73\u4ee5\u4e0a\u306e\u6210\u4eba\uff08\u5404\u5bfe\u7167\u7fa4\u306e\u5e73\u5747\u5e74\u9f62\u306f60\u6b73\u524d\u5f8c\uff09\u3067\u3001\u767a\u75b9\u51fa\u73fe\u304b\u308972\u6642\u9593\u4ee5\u5185
\n\u3000\u3000\u3000\u306e\u4e2d\u7b49\u5ea6\u4ee5\u4e0a\u306e\u75bc\u75db\u3092\u4f34\u3046\u5e2f\u72b6\u75b1\u75b9\u6025\u6027\u671f\u306e\u60a3\u8005
\n\u3000I(E)\uff1b\u30a2\u30b7\u30af\u30ed\u30d3\u30eb\uff0b\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f340mg\/day\u5185\u670d7\u65e5\u9593or 21\u65e5\u9593
\n\u3000C\uff1b\u30a2\u30b7\u30af\u30ed\u30d3\u30eb\uff0b\u30d7\u30e9\u30bb\u30dc\u5185\u670d
\n\u3000O\uff1b\u75bc\u75db\u304c\u5b8c\u5168\u6d88\u5931\u3059\u308b\u307e\u3067\u306e\u671f\u9593\u3092\u77ed\u7e2e\u3059\u308b\u304b
\n\u3000\u3000\u3000\uff086\u304b\u6708\u5f8c\u307e\u3067\u75bc\u75db\u3092\u30d5\u30a9\u30ed\u30fc\u3057\u3001PHN\u306e\u91cd\u75c7\u5ea6\u3068\u3057\u3066\u8a55\u4fa1\uff09
\n\u3000\u2192\u60a3\u8005\u306ePECO\u3068\u3000(\u5408\u81f4\u3059\u308b\u3000\u30fb\u3000\u591a\u5c11\u7570\u306a\u308b\u304cOK<\/strong>\u3000\u30fb\u3000\u5927\u304d\u304f\u7570\u306a\u308b\u305f\u3081\u4e0d\u9069\u5207)<\/p>\n

STEP3-2\u3000\u8ad6\u6587\u306e\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u306e\u8a55\u4fa1\uff1b\u5185\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1<\/strong>
\n\u2460\u7814\u7a76\u65b9\u6cd5\u304cRCT\u306b\u306a\u3063\u3066\u3044\u308b\u304b\uff1f\u96a0\u853d\u5316\u3068\u76f2\u691c\u5316\u306f\u3055\u308c\u3066\u3044\u308b\u304b\uff1f
\n\u3000\u2192\u30e9\u30f3\u30c0\u30e0\u5272\u308a\u4ed8\u3051\u304c\u3000\uff08\u3000\u3055\u308c\u3066\u3044\u308b<\/strong>\u3000\u30fb\u3000\u3000\u3055\u308c\u3066\u3044\u306a\u3044\u3000\uff09
\n\u3000\u2192\u96a0\u853d\u5316\u304c\u3000\u3000\u3000\u3000\u3000\u3000\uff08\u3000\u3055\u308c\u3066\u3044\u308b<\/strong>\u3000\u30fb\u3000\u3000\u3055\u308c\u3066\u3044\u306a\u3044\u3000\uff09
\n\u3000\u2192\u76f2\u691c\u5316\u304c\u3000\u3000\u3000\u3000\u3000\u3000\uff08\u3000\u3055\u308c\u3066\u3044\u308b<\/strong>\u3000\u30fb\u3000\u3000\u3055\u308c\u3066\u3044\u306a\u3044\u3000\uff09
\n\u3000\u5b9f\u969b\u306eTable\u3067\u4ecb\u5165\u7fa4\u3068\u5bfe\u7167\u7fa4\u306f\u540c\u3058\u3088\u3046\u306a\u96c6\u56e3\u306b\u306a\u3063\u3066\u3044\u308b\u304b\uff1f
\n\u3000\u2192\uff08\u3000\u306a\u3063\u3066\u3044\u308b<\/strong>\u3000\u30fb\u3000\u306a\u3063\u3066\u3044\u306a\u3044\uff1b\u3069\u3046\u7570\u306a\u308b\u304b\uff1f\uff09
\n\u2461\u89e3\u6790\u65b9\u6cd5\u306fITT(intention to treat)\u304b\uff1f
\n\u3000\u2192ITT\u304c\u3000\uff08\u3055\u308c\u3066\u3044\u308b\u3000\u3000\u30fb\u3000\u3000\u3055\u308c\u3066\u3044\u306a\u3044<\/strong>\uff09\u3000\uff08intention to treat\u306e\u8a18\u8f09\u306a\u3057\uff09<\/p>\n

STEP3-3\u3000\u8ad6\u6587\u3067\u898b\u3044\u3060\u3055\u308c\u305f\u7d50\u679c\u306e\u8a55\u4fa1<\/strong>
\n\u3000Outcome\u306b\u3064\u3044\u3066\u3001\u4ee5\u4e0b\u306e\u5024\u3092\u78ba\u8a8d\u3059\u308b
\n\u3010\u2460\u6cbb\u7642\u52b9\u679c\u306e\u6709\u7121\uff1b P\u5024\u3092\u78ba\u8a8d\u3059\u308b\u3011
\n\u3000P=0.74
\n\u3010\u2461\u6cbb\u7642\u52b9\u679c\u306e\u5927\u304d\u3055\uff1b\u6bd4\u306e\u6307\u6a19\u3068\u5dee\u306e\u6307\u6a19\u3092\u78ba\u8a8d\u3059\u308b\u3011
\n\u3000\u30fbRR(\u3042\u308b\u3044\u306fHR\u30fbOR)\u3092\u78ba\u8a8d\u3059\u308b
\n\u3000\u3000\u30b3\u30c3\u30af\u30b9\u6bd4\u4f8b\u30cf\u30b6\u30fc\u30c9\u5206\u6790\u3000HR = 1.043
\n\u3000\u30fbARR\u3068NNT\u3092\u8a08\u7b97\u3059\u308b
\n\u00a0\u3000 Outcome\u304c\u300c\u65e5\u6570\u300d\u306a\u306e\u3067\u8a08\u7b97\u4e0d\u53ef\uff1f
\n\u3010\u2462\u6cbb\u7642\u52b9\u679c\u306e\u3086\u3089\u304e\uff1b\u4fe1\u983c\u533a\u9593\u3092\u78ba\u8a8d\u3059\u308b\u3011
\n\u3000HR\u306e95%\u4fe1\u983c\u533a\u9593\uff1a0.81-1.34<\/p>\n

STEP4\u3000\u60a3\u8005\u3078\u306e\u9069\u5fdc<\/strong>
\n\u3010\u2460\u8ad6\u6587\u306e\u60a3\u8005\u3068\u3001\u76ee\u306e\u524d\u306e\u60a3\u8005\u304c\u3001\u7d50\u679c\u304c\u9069\u5fdc\u3067\u304d\u306a\u3044\u307b\u3069\u7570\u306a\u3063\u3066\u3044\u306a\u3044\u304b\uff1f\u3011
\n\u3000\u5e74\u9f62\u304c\u8ad6\u6587\u306e\u5bfe\u7167\u7fa4\u3088\u308a\u9ad8\u9f62\u3067\u3042\u308a\u3001\u3082\u3068\u3082\u3068\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u3067\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u9577\u671f\u5185\u670d\u4e2d\u3067\u3042\u308b\u305f\u3081\u3001\u514d\u75ab\u6291\u5236\u72b6\u614b\u3067\u3042\u308b\u70b9\u304c\u7570\u306a\u308b\u3002\u307e\u305f\u3001\u767a\u75b9\u51fa\u73fe\u304b\u308972\u6642\u9593\u3092\u308f\u305a\u304b\u306b\u8d85\u3048\u3066\u3044\u308b\u70b9\u3001\u30c8\u30e9\u30e0\u30bb\u30c3\u30c8\u5185\u670d\u4e2d\u3067\u75bc\u75db\u3092\u4f34\u3063\u3066\u3044\u306a\u3044\u70b9\uff08\u30de\u30b9\u30af\u3055\u308c\u3066\u3044\u308b\u53ef\u80fd\u6027\u3042\u308a\uff09\u3067\u3082\u7570\u306a\u308b\u3002\u3057\u304b\u3057\u306a\u304c\u3089\u3001\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u3092\u8ffd\u52a0\u6295\u4e0e\u306ePHN\u4e88\u9632\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u304c\u4f4e\u3044\u3068\u3044\u3046\u3053\u3068\u3092\u78ba\u8a8d\u3059\u308b\u306b\u306f\u3001\u5f53\u8ad6\u6587\u3067\u6982\u306d\u554f\u984c\u306f\u306a\u3044\u3068\u601d\u308f\u308c\u308b\u3002\uff08\u3042\u308b\u3044\u306f\u3001\u82e5\u5e74\u8005\u3088\u308a\u9ad8\u9f62\u8005\u306e\u65b9\u304cPHN\u306e\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u306e\u3067\u3001\u5bfe\u7167\u7fa4\u3092\u9ad8\u9f62\u8005\u306b\u9650\u5b9a\u3059\u308c\u3070\u3001\u9055\u3063\u305f\u7d50\u8ad6\u306b\u81f3\u308b\u306e\u304b\u3082\u3057\u308c\u306a\u3044\uff09
\n\u3010\u2461\u6cbb\u7642\u305d\u306e\u3082\u306e\u306f\u5fe0\u5b9f\u306b\u5b9f\u884c\u53ef\u80fd\u304b\uff1f\u3011
\n\u3000\u5b9f\u884c\u53ef\u80fd
\n\u3010\u2462\u91cd\u8981\u306a\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u30b3\u30b9\u30c8\u3084\u5bb3\u3092\u542b\u3081\u3066\u5168\u3066\u8a55\u4fa1\u3055\u308c\u305f\u304b\uff1f \u3011
\n\u3000\u526f\u4f5c\u7528\u3082\u8a55\u4fa1\u3055\u308c\u3066\u3044\u308b\u3002\u5f53\u8ad6\u6587\u306f\u3001\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u6295\u4e0e\u306fPHN\u306e\u91cd\u75c7\u5ea6\u306b\u5f71\u97ff\u3092\u4e0e\u3048\u305a\u3001\u526f\u4f5c\u7528\u51fa\u73fe\u306e\u53ef\u80fd\u6027\u3082\u3042\u308b\u305f\u3081\u3001\u63a8\u5968\u3057\u306a\u3044\u3068\u7d50\u8ad6\u3057\u3066\u3044\u308b\u3002
\n\u3010\u2463\u60a3\u8005\u306e\u8003\u3048\u30fb\u55dc\u597d\u306f\u3069\u3046\u306a\u306e\u304b\uff1f\u3011
\n\u3000\u75bc\u75db\u3082\u306a\u3044\u305f\u3081\u3001\u767a\u75b9\u306e\u51fa\u73fe\u3092\u307e\u308b\u3067\u6c17\u306b\u7559\u3081\u3066\u3044\u306a\u3044\u3002\u7121\u6cbb\u7642\u7d4c\u904e\u89b3\u5bdf\u306e\u65b9\u91dd\u3067\u3001\u4f55\u306e\u62b5\u6297\u3082\u306a\u304f\u5408\u610f\u3057\u3066\u3044\u308b\u3002\u4e0a\u8a18\u2462\u3068\u4f75\u305b\u3066\u3001\u672c\u75c7\u4f8b\u306b\u30d7\u30ec\u30c9\u30cb\u30be\u30ed\u30f3\u8ffd\u52a0\u6295\u4e0e\u3059\u308b\u7406\u7531\u306f\u306a\u3044\u3068\u8003\u3048\u308b\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

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