n-3系脂肪散を強化した食事療法が有効と考えられた肺気腫の一例

An effective treatment for the advanced stages of chronic obstructive pulmonary disease (COPD) has not been established yet. We report our recent experience of one patient with pulmonary emphysema treated by dietary supplementation of n-3 fatty acid for two months. He presented improvements in clinical symptoms and pulmonary function, and suppression of leukotriene B(4) generation by peripheral leukocytes. We consequently suppose that dietary treatment with n-3 fatty acids (perilla seed oil) may offer benefits for the treatment of pulmonary emphysema by competitively inhiabiting the conversion of arachidonicacid to leukotrienes and prostanoids.今回我々は,肺気腫の症例に対してn-3系脂肪酸を強化した食事療法をおこない,臨床症状,呼吸機能検査所見ともに速やかに改善を認め,同時に白血球のロイコトリエンB4産生能が著明に減少した一例を経験したので報告する｡ 症例は67歳,男性｡主訴は労作時呼吸困難｡【第一回目入院】3カ月間入院し,薬物療法,温泉を用いた理学療法を行った｡自覚症状はやや改善が見られたが,呼吸機能検査所見の改善は得られなかった｡【第二回目入院】1年後に再入院｡n-3系脂肪酸強化食事療法も併用した｡自覚症状および,呼吸機能検査上,FVC,FEV1.0,PEFなどに改善を認めた｡n-3系脂肪酸はアラキドン酸代謝を通してロイコトリエン合成に関与すると推定されるが,経渦中に白血球のLTB4産生能の減少を認めた｡この症例は肺気腫に対するn-3系脂肪酸強化食 事療法の有用性が示唆され,病態を考える上でも興味深いと考えられた

Review Article Children with Chronic Granulomatous Disease

Patients with CGD are "experiments of nature." An abnormality of genetic coding of small part of a protein (cytochrome b) in the membrane of phagocytic cells results in abnormal oxidative metabolism of these cells. The metabolic defect is critical for production of reactive oxygen radicals, which are necessary for efficient intracellular killing of catalase-positive bacterial and fungal species within phagocytic vacuoles. Patients with CGD suffer recurrent severe and often lifethreatening infections with these same species of bacteria and fungi. Thus clinical evidence is provided for the importance of a normal oxidative response of phagocytic cells during the engulfment process for normal host defense against bacteria. Investigators, intrigued by this remarkable biochemical clinical correlation, have studied human granulocytes with the tools of modern molecular genetics. The abnormal gene has been located and defective-gene products have been identified in CGD patients. This knowledge has provided a basis for therapy of CGD patients with human recombinant interferon gamma, an immunomodulator which stimulates NADPH-oxidase activity in the abnormal granulocytes. Other treatment and replacement modalities are anticipated but most importantly these CGD patients have provided insights into the usually hidden mysteries of nature. We are very grateful to these patients as our teachers

<原著>培養軟骨細胞の分化機能発現と細胞増殖動態に関する実験的研究

The present study was undertaken to investigate the relationship among cell morphology, proliferation, and maturation of chondrocytes in primary cultures. Chondrocytes were isolated from the growth cartilages of the rat ribs and cultured for 6 days. In situ DNA cytofluorometry using an inverted epi-illumination cytofluorometer (Nikon P1-I) and 3H-thymidine autoradiography were carried out for the correlated analysis of cell morphology and proliferation. Cytoskeletal staining with fluorescent phalloidin and 35S-sulphate autoradiography were also performed. In addition, in situ hybridization to c-myc mRNA was carried out using DNA probe. According to the results obtained, the cultured chondrocytes were composed of mixed populations of large, polygonal cells and of small, round cells. The round cells showed a significantly higher 35S uptake than the polygonal cells. The cytoskeletal staining clearly revealed stress fibers in the cytoplasm of the polygonal cells, whereas only a fine filamentous structure was shown in the cytoplasm of the round cells. In situ DNA cytofluorometry clearly demonstrated that cell proliferative activity was high in the polygonal cells and low in the round cells. In addition, 3H-thymidine autoradiography with cumulative labeling method revealed that the polygonal cells were changing into the small, round cells. C myc mRNA signals were detected in the cytoplasm of over a half of the round cells, whereas no evidence of c-myc expression were found in the polygonal cells. From these results, it appears that as the shape of the cultured chondrocytes shifts from polygonal to round, the cell proliferative activity decreases in association with cell differentiation. It was also suggested that c-myc mRNA is amplified in the well differentiated round chondrocytes, and not in the proliferative polygonal cells.従来の培養軟骨細胞を用いた研究から, 軟骨細胞の形態と分化機能発現の聞には, 関連性のあることが示されている. 著者らは, 成長軟骨細胞の培養系において細胞形態, 機能が明らかに異なっている2種類の細胞が存在することを見いだした. 本研究では, この培養系を用い, 軟骨細胞の形態・細胞増殖動態・分化機能発現の3者の関連性を総合的に把握することを目的とした. このための方法論として, 細胞形態別増殖動態解析には, in situ DNA 顕微蛍光測光法と3_H-サイミジンオートラジオグラフィーを行い, 分化機能の検索には35_S オートラジオグラフィーを用いた. また, FITC-ファロイジン染色法により, 軟骨細胞の形態と細胞骨格の関係についても調べた. 更に, 本研究では, 悪性腫瘍以外に, 胎生期の細胞や分化途上の細胞にも出現し, 細胞の分化・増殖に深く関係があると考えられている c-myc 遺伝子の発現の有無を, in situ DNA- mRNA hybridization 法を用いて検索した. 実験には, ラット肋軟骨から分離・培養した成長軟骨細胞を用いた. 培養開始4 - 6日目頃の成長軟骨細胞は, 大型多角形の扁平な胞体を持ち, 大きな核を有する細胞(以下, 多角形細胞と略す)と, 比較的小型で類円形ないし球状の胞体と小さな核を有する細胞(以下, 円形細胞と略す)の2種類の細胞から構成されていた. in situ DNA 顕微蛍光測光法による細胞増殖動態解析の結果, 多角形細胞は, 活発な増殖性を示す2倍体細胞と少数の4倍体から構成されているのに対し, 円形細胞は, ほとんど増殖活性を持たない2倍体細胞から構成されていることが判った. 3_H-サイミジンの30分標識の結果から, 多角形細胞の標準率は11%, 円形細胞の標識率は0. 5%であり, その標識率の経時的変化はほとんど認められなかった. 3_H-サイミジンの持続標識実験の結果から, 多角形細胞が円形細胞に形態的に変化することが示唆された. また, 35_S オートラジオグラフィーより, 多角形細胞は, 軟骨基質の産生能が低く, 他方, 円形細胞では, 基質産生が亢進していることがわかった. FITC-ファロイジン染色によるアクチンの細胞内分布パタンを, 両細胞で比較したところ, 多角形細胞ではストレスファイバーがよく発達しているのに対し, 円形細胞には, 分断された線維性構造のみが観察された. 以上の結果をまとめると, 培養軟骨細胞の形態・増殖・分化の3者の間には, たがいに密接な関連が有り, 多角形細胞から円形細胞への形態変化に伴って, 増殖活性が低下し, 分化機能が発現されることが判明した. 次に, c-myc 遺伝子の発現の有無を in situ hybridization 法を用いて検索したところ, 円形細胞の過半数に, c-myc mRNA のシグナルが検出された. このことから, 軟骨細胞では, 分化機能発現と関連して c-myc 遺伝子が発現される可能性が示唆された

サーモグラフィーによる体表面温度の測定 3.体表面温度の回復率と末消血流量との相関

The body surface peripheral circulation in 12 cases,　including 9 patients with　diabetes mellitus who were suffering coldness, numbness or pain in their feet, and 3 healthy volunteers was examined using Laser-Doppler blood flowmetry. At the same time, the body surface temperature was estimated by thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio = [Total counts of thermography(Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). The recovery ratio and the blood flow were correlated, r=0.68, p<O.01. The peripheral circulation of 16 patients with diabetes mellitus was observed at three different conditions including, l)placed at room temperature at 20℃for 15 min, 2) submerged and warmed for 5 min in a hot bath at 36℃(i.e. hot loading), and 3) submerged and cooled for 5 min in a water bath at 20℃ (i.e. cold loading). Three different baseline temperatures, 26℃, 27℃ and 28 ℃, were used in processing the　thermographic results into pictures. The highest correlation (r=0.59, p=0.0002) was obtained under the condition of cold loading using a baseline temperature limitation of27℃.The difference ratio (%) of blood flow was calculated as the blood flow at cold loading divided by the blood flow at hot loading in these 16 patients. The difference　ratio of the blood flow and the recovery ratio of thermography were correlated, r=0.46, p<O.OOO1. We found a strong correlation between the results of Laser-Doppler blood flowmetry and one of thermographic methods used to monitor peripheral circulation in patients with diabetes mellitus. Cold loading using a baseline temperature limitation of 27℃ were recommended for further examinations. Patients with low blood flow as well as　with large differences in their peripheral circulation between cold loading and hot　loading had severe coldness in their body surface temperature. We showed the usefulness of the results of thermography, when quantified by picture processing using computer software, in relation with the results of Laser-Doppler blood flowmetry.末梢神経障害を有する糖尿病患者の末梢循環障害の程度を数量的に検討する目的で､下肢に冷感ならびにしびれ感または疼痛を訴える糖尿病患者9症例と健常ボランティア3例の計12例(平均年齢59歳)についてサーモグラフィーを用いて体表面温度を測定した｡更に,サーモグラフィーで得られた結果と末梢皮膚血流量をレーザードプラー血流計を用いて測定して得られた結果と比較した｡サーモグラフィーによる測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率= [冷水負荷後の特定温度27℃以 上の体表面温度のサーモグラフィーのPixelの総数]÷ [冷水負荷前の特定温度27℃以上の体表面温度のサーモグラフィーのPixelの総数]×100%で求めた｡レーザードプラ-血流計を用いて測定して得られた末梢血流量は左右それぞれ5カ所,計10カ所の測定値の平均で表示した｡その結果,末梢皮膚温度の回復率と末梢皮膚の血流量との問には正の相関関係(r=0.68,p<0.01)が認められた｡次に,末梢皮膚血流量について,室温20℃安静15分後,温水36℃浸水負荷10分後,冷水20℃浸水負荷30分後の異なる3条件について､またサーモグラフィーで得られた結果を,画像処理の過程で用いられた,26℃,27℃,28℃の3つの異なる特定温度との関連について検討を行なった｡対象は,下肢に冷感ならびにしびれ感または疼痛を訴える糖尿病患者16症例(平均年齢69歳,平均HbAIC9.6%)について測定した｡その結果,末梢皮膚 血流量は冷水20℃浸水負荷30分後に測定して得られた結果と,回復率は特定温度27℃で画像処理して得られた結果とが最も相関が高い(r=0.59,p=0.0002)ことが示された｡`次に,相関が高い条件は,室温20℃安静15分後に血流量を測定した場合(r=0.483,p=0.0002)であった｡そして温 水36℃浸水負荷10分後に測定して得られた結果とが最も相関関係が低い結果となった｡更に,冷水20℃浸水負荷30分後に測定して得られた結果を温水36℃浸水負荷10分後に測定して得られた結果で割った比を%で表示したところ回復率とこの比との間には正の相関関係(r=0.46,p<0.0001)が認められた｡このことから,温水36℃負荷時と,冷水20℃負荷時との差が大きい患者 において末梢皮膚温度の低下が著しいことが示された｡これまで悲観血的に測定されてきたサーモグラフィーによる末梢循環の数量的評価の試みは,レーザー血流計による結果と組み合わせることで,両者の間に正の相関関係が示されたことにより,今後,数量化された客観的評価を可能にした

サーモグラフィーによる体表面温度の測定 2.温水負荷の効果

The body surface temperature of 41 patients suffering coldness, numbness or pain in their feet was examined using thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio =[Total counts of thermography (Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). Three different baseline temperatures, 26℃. 27℃ and 28℃, were used in processing the thermographic results into pictures. The recovery ratio was susceptible to temperature, and we recommend a baseline temperature limitation of 27℃ for clinical study. A bi-modal distribution of recovery ratio was observed in 18 patients with diabetes mellitus. One group (6 subjects) had high recovery ratio between 80%-100%, and another group (10 subjects) had a low recovery ratio between 0%-19%. The results of thermography were also influenced by weather. To reduce the effect of outside temperature, we used pre-loading with hot water at 36℃ for 5 min (hot loading).　A large difference in　recovery ratio between presence and absence of hot loading was observed in 6 of the 30 subjects. The difference was over-estimated in more than 20% of recovery ratio without hot loading as compared with hot loading in these 6 subjects. The effect of drugs on peripheral circulation, such as beraprost sodium and sarpogrelate hydrochloride, was clear and quantified using thermography under these conditions of hot loading.下肢に冷感ならびにしびれ感または疼痛を訴える患者41症例についてサーモグラフィーを用いて体表面温度を測定した｡測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率=[冷水負荷後の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]÷[温水負荷前の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]× 100%で求めた｡サーモグラフィーで得られた結果と画像処理の過程で用いられた,26℃,27℃,28℃の3つの異なる特定温度T℃ との関連について検討を行なった｡その結果,回復率は特定温度T℃に影響を受けやすいことが明らかとなった｡下肢の体表面温度の低い臨床症例においては27℃の条件が適当と考えられた｡前述の41症例中の18症例の糖尿病患者について検討を行なった｡そのサーモグラフィーの結果は,比較的回復率の高い(80%～100%)群の6症例と比較的回復率の低い(0%～19%)群の10症例の2群に別れた｡わずかに残り2症例が20%から79%の間であった｡下肢の症状が気温の低い時期に出親しやすいためにサーモグラフィーの検査を冬期に行なう必要性が高まった｡しかし,天候の影響を受けやすいために冷水負荷前の測定領域の下肢が冷えすぎているために20℃の室温に15分間の安静時間では体表面温度が十分に暖まることが出来ず,27℃以上の領域として測定範囲全体を観察できない 問題に直面した｡この間温点を解決する手段として36℃の温水に5分間下肢を入れて暖める温水負荷を加えることにした｡そこで, 温水負荷を行なった症例30症例について,温水負荷を行なう前(室温)の回復率と温水負荷を行なった後の回復率について比較検討を行なったところ,20%にあたる6症例において温水負荷を行なわなかった場合に20%以上の回復率の過剰評価が認めら れた｡温水負荷を行なうことにより年間を通じて天候の影響を最小限にすることが可能となり,この結果,長期間の内服薬の末梢循環に及ぼす影響の測 定を行なった場合に,季節の影響を最小限にしてサーモグラフィーにより回復率を用いて数値化された測定結果を検討することが可能となった｡具体的に末梢循環の改善に薬効が有ると言われている薬剤であるベラプロストおよびサルポグレラートを3ヵ月間内服した場合の前後のサーモグラフィーで得られた回復率について検討を行なった｡その結果はベラプロストにおいては,6.9%から41.9%に上昇または回復率の6.1倍の上昇を認めた。サルポグレラートにおいては,1.9%から17.3%に上昇または回復率の9.1倍の上昇を認めた。以上より,温水負荷を加えたサーモグラフィーの測定結果の数値化は下肢に症状の有る患者の末梢循環の評価ならびに薬効の評価の比較に有用であることが表わされた

気管支喘息および慢性気管支炎患者における抗ヒトIgEによる好塩基球からのヒスタミン遊離

Histamine release from basophils induced by anti-IgE was studied in 8 patients with chronic bronchitis and 50 patients with bronchial asthma by analyzing doseresponse curves. As the result, there were no significant differences in maximum percent histamine release from basophils among three groups of healthy subjects (24.7± 14.2%), patients with chronic bronchitis (27.7±22.1%) and those with bronchial asthma (28.4±17.0%). In the patients with bronchial asthma, the maximum percent histamine release was higher in accordance with higher serum IgE levels, and low maximum percent release was observed in patients with intrinsic asthma (14.1±7.2%). Study of dose-response curves of anti-IgE-induced histamine release showed that a negative slope from E(2) to E(1) was observed in both healthy subjects and patients with chronic bronchitis. The majority of asthmatics with serum IgE levels of 501IU/ml or over showed a positive slope from E(2) to E(1).気管支喘息50例，慢性気管支炎8例を対象に，抗ヒトIgE添加時の好塩基球からのヒスタミン遊離を全血法により行ない，その臨床的評価について検討を加えた。抗ヒトIgE海底時のMax　％　histamine releaseの平均は，健康人24.7±14.2％，慢性気管支炎27.7±22.1％，気管支喘息28.4±17.0％であり，3者間に有意の差はみられなかった。すなわち，抗ヒトIgE添加により健康人や慢性気管支炎患者の好塩基球からも有意のヒスタミン遊離が見られた。気管支喘息のなかでは，内因性喘息症例においてヒスタミン遊離（14.1±7.2％）の低い傾向が見られた。Dose-response curveの検討では，健康人，慢性気管支炎症例では全例E（2）からE（1）へかけてのnegative slopeを示した。気管支喘息症例では，血清IgE値500IU/ml以下の症例ではnegative slopeを示す症例が多く，一方501IU/ml以上の症例ではpositive slopeを示す症例がより多く見られた

Analysis of Communication between Inpatient Children and Their Mothers - I -

We observed the communication between inpatient children and their mothers mainly at the scenes of "play", "drug administration", and "meal" and classified their communication state into 6 types to evaluate the mother-child relationship. The 6 types were such as, good response type (Type I), repair type (Type II) , good response discontinuation type (Type III), response setback type (Type IV), rejective ending type (Type V), rejectin type (Type VI). 1. Sixty-two communication scenes were evaluated in 10 mother-child pairs. 2. Concerning child\u27s words and behavior, attachment for their mothers was observed at 82.5% of the "play" scenes. However, both attachment and rejection were observed at similar percentages of "drug administration" or "meal" scenes . 3. Concerning mother\u27s responses, good responses were most frequently observed at play scenes (88.0%). At "meal" scenes, good responses, good response discontinuation, and rejection were observed. In "drug administration" scenes, no rejection was observed. 4. The mother-child communication was classified into 6 types according to mother\u27s responses. 5. Type I and II indicating good responses were most frequently observed (77.4% of the scenes) . Type V and VI indicating rejective responses were observed in 9.7% of the scenes. 6. In "play" and "drug administration" scenes, good com- munication types were frequently observed. In "meal" scenes, various types were present. 7. The frequency of the communication types indicating rejection was significantly lower in relatively aged mothers group than in young mothers. It is clinically important to clarify the association between mother-child communication types and the situation in which the mother and child are placed based on the results of this study. The participation-observation method used in this study is an effective method of evaluating the relationship between inpatient children and their mothers for appro- priate nursing support

BAL液中好中球増加をともなわないⅡ型喘息について

Clinical features of asthma patients with bronchiolar obstruction (type Ⅱ asthma) were studied in relation to the proportion of neutrophils in bronchoalveolar lavage (BAL) fluid. Of 13 subjects studied, 7 were accompanied with BAL neutrophilia (53.5%) (BALn(+)) and 6 were without BAL neutrophilia (3.5%) (BALn(-)). 1. The mean age was higher in BALn(-) (66.0 years) than in BALn(+) patients (55.0 years). 2. Bronchial reactivity to methacholine was slightly higher in BALn(-) patients than in those with BALn(+). 3. The value of FEV1.0% was significantly lower in BALn(+) patints than in those with BALn(-) (p<0.01). 4. The proportion of BAL lymphocytes was signicantly more decreased in BALn(+) patients compared to the proportion in those with BALn(-) (p<0.001). 5. the values of serum IgG, IgA, and IgM were not significantly different between BALn(+) and BALn(-) patients, however, the value of IgG was more decreased in BALn(+) patients than in those with BALn(-). These results suggest that two kinds of type Ⅱ asthma ; one is with BAL neutrophilia related to suppressed immunity, and another is without BAL neutrophilia in part due to aging.細気管支閉塞型(Ⅱ型)喘息の臨床的特徴が,BAL液中の好中球頻度との関連のもとに検討された｡対象13例のうち,7例がBAL液中好中球増加(平均好中球頻度;53.5%)をともなう症例(BALn(+))で,残りの6例はBAL液中好中球増加 をともなわない(3.5%)症例(BALn(-))であった｡1.平均年齢は,BALn(+)症例(55.0才)に比べ,BALn(-)症例(66.0才)でより高い傾向が見られた｡2.メサコリンに対する気道過敏性は,BALn(+)症例に比べBALn(-)症例でやや高い傾向が見られたが,両者間に有意の差は見られなかった｡3.FEV1.0%値は,BALn(-)症例に比べBALn(+)症例で有意に低い値を示した(P<0.05)｡4.BAL液中リンパ球頻度はBALn(+)症例でBALn(-)症例に比べ有意に低い値を示した(P<0.001)｡5.血清IgG,IgAおよびIgM値には両者間に有意の差は見られなかったが,IgG値はBALn(+)症例でより低い傾向が見られた｡これらの結果より,Ⅱ型喘息にはBAL液中好中球増加を示す症例と示さない症例の2種類があること,そして前者は免疫能の低下と,そして後者は加齢とある程度の関連があることが示唆された

Hepatitis in Children

115 patients (71 male and 44 female) with infectious hepatitis were hospitalized in Nagasaki University Hospital during 1974-1984. They were all the hospitalized patients in our pediatric department. The total patient was 8150 and that of hepatitis was 115, that is 1.4%. On the classification of hepatitis, infectious mononucleosis patients were the most. Next was HB hepatitis. HA hepatitis were less than we had expected. Generally in Japan, childrens HA hepatitis patients are less usual than HB hepatitis patients. Unknown etiology group patients who are in the early period and are not immunologically diagnosed. Two fluminant hepatits patients died. Transient liver disfunction group was probably the EB virus infection, because they were recovered soon. The neonatal hepatitis patients were examined by viral study but could not be diagnosed what they were. In Europe and America it is said that prognosis is not good, but in our cases it was very good and all were recovered completely as well as other cases in all over Japan. We used dialysable leukocyte extracte (DLE) to chronic HB hepatitis. In normal course of HB hepatits, most of immunologists consider as following ; HB virus infected hepatic cells have normal function but their surface markers are changed immunologically. Then killer cells attack the infected cells and break them. So HB virus are exposed to serum, and made inactivated by antibody. On the other hand cellular immunity may be implicated in the pathogenesis of chronic hepatitis and there may be depression of delayed cutaneous hypersensitivity and T cell function. So we used DLE in order to expect that it would work efficiently to normalize the cellular immumity. We used DLE for 7 patients with HB hepatitis (chronic type). After using DLE the liver functions were normalized in 6 patients. Seroconversion was recognized in 3 cases. HBs Ag disappeared in 3 cases. The period untill seroconversion occurred was rather long, between 2 and 4 years. We conclude DLE seems to be effective

気管支喘息患者における腰椎海綿骨骨塩量と脊椎圧迫骨折の臨床的特徴

Clinical risk factors associated with the development of osteoporosis and vertebral fractures were evaluated in patients with asthma in relation to sex, age, and dose of glucocorticoids (GC). In 75 asthmatic patients including 44 steroid-dependent asthma, the bone mineral density (BMD) of the lumber spines was measured by quantitative computed tomography (QCT). Thirty five patients of them were followed up with radiographs over a period of 0.5 to 4 years (average: 2.6±1.3 years). The BMD was significantly lower in older (p<O.01) or female (p<0.05) patients. All the five patients developing vertebral compression fractures were female and more than 64 y.o., and received systemic glucocorticoid (GC) therapy for more than 3 years with a lot of cumulative gramdosage of GC. No significant correlation was demonstrated between the BMD and the dose of systemic GC per day, but multiple regression analysis demonstrated a significant relationship (p<O.o1) between the BMD and lifetime cumulative gramdosage of GC. Multiple regression analysis also demonstrated significant relationships (p<O.01) between the BMD and clinical factors such as age and sex. These results indicates that the bone loss and vertebral fractures of patients with asthma are influenced by the patient's age, sex, and the lifetime cumulative GC dose.対象は気管支喘息75症例｡このうち44例はステロイド依存性難治症例であった｡35症例については,0.5年から4年間(平均:2.6±1.3年間)の経時的観察もおこなわれた｡これらの症例の骨塩量に影響を及ぼす因子について検討をおこなった｡高齢者,女性に有意な低骨塩量を認めた｡重回帰分析にて年齢,性別,経口副腎ステロイド投与総量などの項目に骨塩量と有意な関連が認められた｡また,35症例中5例に脊椎圧迫骨折が発生し,いずれも骨塩量が低く,高齢者,女性,長期ステロイド内服例であった｡これらのことから気管支喘息患者においては,女性,高齢者,長期ステロイド内服例に骨塩量減少や脊椎圧迫骨折のリスクが高いと考えられた｡また,ステロイド続発性骨粗鬆症の発生には,ステロイドの現在の一日内服量よりもこれまでの総積算内服量が重要と考えられた