http://hdl.handle.net/10564/1524 1998-06 2026-04-10T15:42:25Z http://hdl.handle.net/10564/452 タイトル: Transforming growth factor-βの免疫調節作用 : 特に免疫グロブリン産生に及ぼす影響 著者: 松為, 裕二 抄録: Transforming growth factor-β(TGF-β)は,間葉系細胞の増殖を促進するが,免疫 担当細胞の機能には一般に抑制的に働くことが知られている。ところで肝硬変,肺線維症など臓 器線維化を組織学的特徴とする疾患では,高免疫グロブリソ(Ig)血症が共通した特徴であり,ま た標的臓器においてTGF-βの発現亢進が明らかになってきている。そこで線維化臓器のTGF -β産生亢進が高Ig血症の成立に関与している可能性を想定した。まずTGF-βを添加してマ ウス脾細胞を培養すると,リンパ球増殖能,Ig産生能は短期培養では抑制的に働くが,長期培養 ではむしろ促進的に働いた。次に浸透圧ミニポンプを用いてTGF-βを持続的にマウス肝内に 注入すると,脾細胞の非特異的および特異的Ig産生の亢進を認めた。これらの成績は,肝での 長期におよぶTGF-β産生亢進が高Ig血症の成立に関与する可能性を示すと考えられた。; Transforming growth factor-β(TGF-β) is known to stimulate the prolif- eration of mesenchymal cells and exert suppressive effects on many immune responses including immunoglobulin (Ig) production of lymphocytes. Recently, the hyperexpression of TGF-β has been immunohistochemically proven in the livers and lungs in patients with liver cirrhosis and pulmonary fibrosis, respectively. However, the patients with these diseases commonly show hyper-, not hypo-, gammaglobulinemia as a characteristic humor- al finding. We made a hypothesis that the increased production of TGF-β in the organs undergoing fibrosis might play a role in the pathogenesis of hypergammaglobulinemia, and we investigated the effects of TGF-β on immune responses in in vitro and in vivo. TGF -β strikingly inhibited the proliferation responses, NK activity and polyclonal Ig production of murine splenocytes during the first 4 days of cultures. However, after a 5-day culture period, the addition of TGF-β in the culture enhanced all of these immune responses. Furthermore, continuous intrahepatic administration of TGF-β using osmotic minipump augmented polyclonal Ig production of spleen cells. In addition, an antigen-specific Ig production of spleen cells was also enhanced by the continuous injection of TGF-β follow- ing an intraperitoneal immunization of the antigen, sheep red blood cells. On the other hand, the intraperitoneal administration of TGF-β had no effect on either polyclonal or antigen- specific Ig production of spleen cells, suggesting that the augmented Ig productjon of spleen cells was not due to a direct effect of TGF-β on spleen cells. Although the precise mechanism of hypergammaglobulinemia in the patients with liver cirrhosis is unknown, the continuous production of TGF-β in the livers chronically affected with fibrosis is consid- ered to play an important role in the pathogenesis of hypergammaglobulinemia in those patients. 1998-06-29T15:00:00Z http://hdl.handle.net/10564/451 タイトル: NICU入院児のABRによる聴覚スクリーニングの有用性についての検討 著者: 畠, 史子 抄録: 1988～1995年の8年間に奈良県立医科大学附属病院NICUに入院したハイリスク新生児437例にABRによる聴覚スクリーニング検査を行い,51例(11.7%)が少なくとも一側のV波閾値が60dBnHL以上でABR異常を認めた。ABR異常の重要な因子は①人工呼吸管理10日以上,②脳障害,③頭頸部奇形,④PPHN,⑤妊娠中の非細菌性感染の各因子であった。初回ABRが正常で,後に難聴と診断された例は4例あり,それらの危険因子は10日以上の人工呼吸管理(HFO使用)およびPPHNであった。NICUに入院した新生児の聴覚スクリーニング検査は,①から⑤の危険因子を認めるような例には早期にABRを行い,1歳前後に全例にCORを行うことが最も効率よく,かつ難聴の見逃しが少ない方法ではないかと考えた。; During 1988-1995, 437 iofants in the neonatal intensive care unit (NICU) of Nara Medical University were screened by auditory brainstem response (ABR). Wave Ⅰ and wave Ⅴ shortened with increasing infant age．Changes in wave Ⅴ were more drastic than those in wave Ⅰ, Ⅰ-Ⅴ interpeak latency shortened with increasing infant age, which supports a maturation process of the brainstem. Changes in ABR wave latencies continue beyond the 120th conceptional week. Neurological prognosis for the infants who showed no responsen to ABR was significant- ly bad (X²test). Wave Ⅴ latencies of mentally retarded infants were significantly longer than those of normal infants at the 56th conceptional week. Fifty-one infants out of 437 (11.7%) were judged to be abnormal because either or both ABR threshold was higher than 60 dBnHL. Significant predictors of ABR abnormality in high risk infants were (1) long-term respiratory care (longer than 10 days), (2) brain damage (due to hypoxia）(3) head and neck anomalies, (4) syndromes due to chromosome aberration or dysbolism, (5）persistent pulmonary hypertension of the newborn (PPHN), and (6) non - bacterial infection during the fetal stage. Four iofants developed bilateral profound hearing loss, although they had shown normal ABR at discharge from the NICU. Three of them had long-term respiratory care using high frequency oxygenation (HFO) and one of them also had PPHN. Another one had short- term respiratory care and PPHN. All of them seemed to have had severe hypoxia. We propose a new time-saving protocol for the delayed hearing disturbance, which consists of two tests as follows ; 1) ABR-test for the infants who have the above (1) to (6) neonatal predictors, with careful follow-ups, 2) （COR-test at the age of 12 months for all infants discharged from the NICU. 1998-06-29T15:00:00Z http://hdl.handle.net/10564/450 タイトル: SIDS(suddeninfantdeathsyndrome)を思わせた小児急性肺炎の一剖検例 著者: 丸山, 博司; 玉田, 育子; 薗田, 典明; 天沼, 利宏; 小西, 陽一 抄録: An autopsy case of acute infant pneumonia mimicking sudden infant death syndrome (SIDS) is reported. The patient was a boy, one year and three months of age, who had been healthy since his normal full-term birth, but did not receive any preventive injections at all. The laboratory data on admission demonstrated leucocytosis, positive CRP, and hypo-γ-globulinemia. He suddenly died from respiratory arrest in a hospital only one and half days after his first symptom. At autopsy a bronchopneumonia was path- ologically confirmed. The death etiology is discussed in comparison with SIDS. 1998-06-29T15:00:00Z http://hdl.handle.net/10564/449 タイトル: A CASE OF SEVERE ANNULOAORTIC ECTASIA DETECTED COINCIDENTALLY FROM AN ANNUAL MEDICAL CHECK 著者: Mizuno, Reiko; Fujimoto, Shinichi; Yamano, Shigeru; Nakano, Hiroshi; Dohi, Kazuhiro 抄録: This report describes a case of severe annuloarotic ectasia (AAE) who presented without any symptoms. A 33-year-old man was noted to have a cardiac murmur at an annual medical checkup. Evaluation of the cardiac murmur revealed severe AAE with moderate aortic regurgitation (AR). He underwent immediate surgical treatment success- fully and remains in good clinical condition. Therefore, even in asymptomatic patients, the possibility of severe AAE should not be overlooked in patients with a murmur. Further, echocardiographic evaluation should be performed in such patients. 1998-06-29T15:00:00Z