石川 鎮清

自治医科大学健診センターの人間ドック受診者について, 通勤時間とBMI, 収縮期血圧, 拡張期血圧, 総コレステロール, 中性脂肪, HDLコレステロール, 飲酒, 喫煙, および運動習慣の関連について検討した.BMI, 収縮期血圧, 拡張期血圧, 中性脂肪は対象者全体のANOVAによる単変量解析では通勤時間が長い群ほどその平均は高く, またHDLコレステロールでは低くなっていた.他の生活習慣を重回帰分析で補正すると通勤時間60分以上という因子は独立してBMIと正の関連があったが, 他の測定項目との間に有意な関連はなかった.対象者全体の飲酒者, 喫煙者, 男女それぞれの飲酒者の割合は通勤時間が増加するほど高くなっていた.男の運動をする者の割合は通勤時間が増加するほど低くなっていた.動脈硬化性疾患予防のためには, 通勤時間の長い者ヘはライフスタイルも含めて生活指導をする必要がある.

全国の市区町村社会福祉協議会(社協)が福祉サービスの一環として提供している高齢者入浴サービスの方法とその現状を明らかにする為,全国の市区町社協名簿より25%の系統抽出した828箇所の市区町村社協の高齢者入浴サービス担当者を対象に1999年に郵送自記式調査を行った.調査票の回収率は83%(回答数683)であった.入浴サービス担当者である回答者は平均41.6歳で女が56%であった.職種は事務職30%,看護師23%,ヘルパー18%であった.65%の社協で何らかの入浴サービスを実施しており,その1998年度1年間の延べ件数の平均は訪問入浴が570.8件,施設内入浴が2299.3件であった.入浴方法は90%が浴槽を使用しており,入浴時間は中央値8.0分,湯温は同40.0℃であった.入浴前の血圧測定は94%,体温測定は95%の社協で実施しており,入浴可否判断の基準値を設けている社協は血圧については35%,体温については44%であったが,顔色や全身状態などその他の項目も参考にして入浴可否判断を行っていた.入浴可否判断をしている者は看護師が53%と最も多く,次いで,介護福祉士が12%,ヘルパーが12%であった

We have been conducting a cohort study titled the Jichi Medical School Cohort Study (The JMS Cohort Study) since 1992, which is aiming to clarify the risk factors of cardiovascular and cerebrovascu-lar diseases in the Japanese. The baseline data were gathered from April 1992 through July 1995 in 12 rural districts using a legal mass screening system. The total samples were 12,490 males and females, and the overall response rate for the total population was 63%. The mean ages were 55.2 years for males and 55.3 years for females, respectively. Smoking rates were 50.5% and 5.5%, and drinking rates were 75.1% and 25.0% for males and females, respectively. We also examined the Standardized mortality ratios (SMRs) of the cohort subjects for 7.6 year follow-up period. The SMRs were 0.68 [95% confidence interval (CI): 0.59-0.78] for males and 0.73 (95% CI: 0.62-0.85) for females for the cohort subjects, whereas the SMRs were 1.00 (95% CI 0.97-1.04) for males and 1.06 (95% CI: 1.02-1.10) for females for all residents. In this article, we outlined the cohort study and showed general characteristics of the baseline data, and the SMRs of the subjects. We have been following the eligible subjects, and are preparing to show some prospective data regarding cardiovascular and cerebrovascular risks in the near future.

We have been conducting a cohort study titled the Jichi Medical School Cohort Study (The JMS Cohort Study) since 1992, which is aiming to clarify the risk factors of cardiovascular and cerebrovascu-lar diseases in the Japanese. The baseline data were gathered from April 1992 through July 1995 in 12 rural districts using a legal mass screening system. The total samples were 12,490 males and females, and the overall response rate for the total population was 63%. The mean ages were 55.2 years for males and 55.3 years for females, respectively. Smoking rates were 50.5% and 5.5%, and drinking rates were 75.1% and 25.0% for males and females, respectively. We also examined the Standardized mortality ratios (SMRs) of the cohort subjects for 7.6 year follow-up period. The SMRs were 0.68 [95% confidence interval (CI): 0.59-0.78] for males and 0.73 (95% CI: 0.62-0.85) for females for the cohort subjects, whereas the SMRs were 1.00 (95% CI 0.97-1.04) for males and 1.06 (95% CI: 1.02-1.10) for females for all residents. In this article, we outlined the cohort study and showed general characteristics of the baseline data, and the SMRs of the subjects. We have been following the eligible subjects, and are preparing to show some prospective data regarding cardiovascular and cerebrovascular risks in the near future.

The distribution of serum C-reactive protein (CRP) levels and their association with age, sex, and atherosclerotic risk factors were studied in a large Japanese population between 1992 and 1995, The subjects consisted of 2,275 males and 3,832 females aged 30 years and over. CRP was measured by nephelometry. The distribution of CRP was highly skewed toward a lower level than that of previous studies and seemed to be a combination of two separate distribution curves. The increase in CRP with age was statistically significant, and males had higher CRP levels than did females. Males who were current smokers had higher CRP levels than did nonsmokers. Age, systolic blood pressure, diastolic blood pressure, triglycerides, fibrinogen, and body mass index were all positively associated with CRP in both sexes, while total cholesterol and blood glucose were positively related in females only. High density lipoprotein cholesterol was inversely related in both sexes. Multiple logistic regression analysis showed that sex, age, systolic pressure, high density lipoprotein cholesterol, triglycerides, fibrinogen, and body mass index were significant independent variables. In conclusion, the distribution of CRP among the Japanese was quite different from that among Westerners, although CRP levels correlated with other atherosclerotic risk factors, similar to those in Westerners.

健康・福祉関連サービス需要実態調査の回答者21723名において,入浴介助が必要な者は男478名(5.2%),女812名(6.4%)で,男女とも年代が上がるにしたがってその割合は高くなる傾向であった.入浴介助が必要な者の割合を背景因子ごとにみると,全く寝たきりでは男97.1%,女100%,殆ど寝たきりで男98.7%,女97.9%であった.在宅サービスの利用については,ホームヘルプサービス利用者では男77.6%,女73.3%,訪問看護サービス利用者では男87.1%,女87.6%,デイサービス利用者では男女とも81.1%,ショートステイ利用者では男92.5%,女88.5%であった.又,男を介護している介護者は57.4%が配偶者で70歳代,女は35.0%が子の配偶者で50歳代が多く,福祉による入浴サービスの提供が不可欠であることが示唆された

全国12地区12033人を対象としたコホート研究で検討した.Coxの比例ハザードモデルを用いて,年齢,BMI,収縮期血圧,拡張期血圧,総コレステロール,中性脂肪で補正してHDLコレステロールの値によって5分位で分けた各群の全死亡に対するハザード比を求めた.男では,HDLコレステロールが38mg/dl未満の群と比較して38-43mg/dlの群がハザード比0.51(95%信頼区間,0.31-0.84),44-49mg/dlの群がハザード比0.62(95%信頼区間,0.39-0.97)と有意に低かった.女ではHDLコレステロールが42mg/dl未満の群と比較してそれ以上の群ではハザード比は1より低かったが有意では無かった

C-reactive protein (CRP) is an acute-phase reactant that is related to future cardiovascular events. However, little is known about the long-term intra-individual stability of CRP in community residents. The 5-year intra-individual correlation of CRP levels was examined in the Jichi Medical School Cohort Study in Japan. CRP measurements were obtained in 1993 and in 1998 from 388 presumptively healthy individuals aged 30-69 years at baseline. The Pearson's correlation coefficient of CRP between baseline and follow-up measurements was 0.43 (95% confidence interval (CI): 0.34-0.51). Additional analyses by sex and smoking status at baseline revealed similar coefficients. The correlation coefficient of CRP was lower than that of other classical risk factors, such as body-mass index (BMI), blood pressure, and total and high-density lipoprotein (HDL) cholesterol. A subgroup of individuals with higher levels of CRP at both baseline and follow-up measurements had higher BMI, hemoglobin Ale, and plasma fibrinogen, and lower levels of HDL-cholesterol than others, even after adjusting for age, sex, and smoking status in a multiple logistic model. In conclusion, the stability of CRP levels was statistically significant in a long-term population-based study. A subgroup with higher levels of CRP who had an aggregation of cardiovascular risk factors was identified by the 2 measurements.

1998年の1年間に自治医科大学健診センターを受診した5735人の臨床検査成績について,平成9年国民栄養調査や他の調査報告と,その傾向について単純比較をした.今回の研究は,その検査項目について各項目の平均,標準偏差,及び年齢階級別の傾向の概要を把握することが目的であった.国民栄養調査の結果と比較し,男女とも血圧が低値,女の中性脂肪が低値を示す一方,男のBMIは高値を示していた.30歳代男で便中ヘモグロビンは他年代と比較し高値を示していた.他の項目の測定値の傾向には大きな特徴はなかった

Coexistence of diabetes mellitus and Graves' disease may be classified into either an immunologically-related or an incidental phenomenon. It has been reported that anti-GAD antibody (GAD-Ab) persists at high levels for longer duration in subjects with type 1 diabetes and Graves' disease, whereas the prevalence of positive GAD-Ab (1.5%) in 131 non-diabetic subjects with Graves' disease was comparable to that in normal subjects (0.3%, P=0.2012). Thus, GAD-Ab might be a marker of the immunologically-related coexistence of the two diseases. To test this hypothesis, we investigated characteristics of Japanese subjects having both diseases according to the presence or absence of GAD-Ab. Sixty-one patients having diabetes mellitus and Graves' disease (24 men, 37 women, aged 53+/-2 years old, mean+/-SE) were consecutively registered between 1993-1997. The patients were divided into two groups of 14 GAD-Ab positive and 47 negative subjects. In the GAD-Ab positive subjects, earlier (32+/-3 years old) and abrupt onset (86%) of diabetes and insulin dependency (64%) were documented, as would be expected from the features of type 1 diabetes. Graves' disease often preceded diabetes (57%), presenting typical manifestations (79%). In contrast, older (45+/-2 years old, P=0.0031) and gradual onset (87%, P<0.0001) of diabetes, non-insulin dependency (74%, P<0.0001), and masked manifestations of Graves' disease (57%, P=0.0214) were common in the negative subjects. Precedence of diabetes dominated in these subjects (43%, P=0.0109). Immunological studies showed less frequent HLA-DR 2 locus (0%, P<0.02) in the GAD-Ab positive subjects. There was also a trend of higher frequency of HLA-DQA1*03 allele and of lower frequency of DQAI*01 allele in these subjects. Allelic frequency of cytotoxic T lymphocyte antigen 4 (CTLA-4) differed between the positive and negative subjects (P=0.0432). There were distinct clinical and immunological differences between the GAD-AI, positive and negative subjects having both diabetes mellitus and Graves' disease. The present results indicate that GAD-Ab measurement could draw a distinction between the immunologically-related and incidental coexistence of the two diseases.

OBJECTIVE CTLA-4, expressed on activated T cells, is thought to be a negative regulator of T cell function. Its gene (2q33) may confer genetic susceptibility to type 1 diabetes mellitus (IDDM12), The present study was undertaken to clarify the role of CTLA-4 gene polymorphism in Japanese subjects with type 1 diabetes and its effect on their clinical features. SUBJECTS AND METHODS In 117 Japanese subjects with type 1 diabetes, the CTLA-4 exon 1 polymorphism (49 A/G) was defined by PCR-RFLP analysis. Anti-GAD antibodies (GAD-Ab) and fasting serum C-peptide were also determined. 141 healthy age-and sex-matched subjects served as controls. RESULTS The frequency of each polymorphism was not different between the type 1 diabetic subjects and the controls; AA 21, AG 42 and GG 54 for the diabetic subjects, and AA 22, AG 47 and GG 72 for the controls. The frequency of the GG genotype was higher in the diabetic subjects with positive GAD-Ab (greater than 8 U/ml) (67%) than in the GAD-Ab negative subjects (39%) (P < 0.05). The prevalence of positive GAD-Ab declined with the duration of diabetes. In the diabetic subjects with disease duration of less than 5 years (n = 40), the frequency of the GG genotype was also higher in the GAD-Ab positive subjects (71%) (P < 0.05). In the analysis of all the diabetic subjects, there was a strong association between positive GAD-Ab (P < 0.0001). CONCLUSIONS There was no evidence that the CTLA-4 exon 1 polymorphism (49 A/G) confers genetic susceptibility to type 1 diabetes mellitus in our case-control study in Japanese subjects. However, the frequency of positive GAD-Ab was higher in the GG subjects. CTLA-4 polymorphism might contribute to the clinical heterogeneity of type 1 diabetes mellitus in Japanese subjects.

Lipoprotein(a) Lp(a). has been considered to be a predictor of premature coronary heart disease and other cardiovascular diseases. Lp(a) levels are largely genetically determined, but the detailed mechanism of Lp(a) elevation is uncertain. We examined the association betw/een Lp(a) levels and apolipoprotein(a) apo(a). phenotypes as well as that of Lp(a) level and other various conditions. The subjects were 280 healthy Japanese (102 males and 178 females) aged 39 to 70 years who were living in a rural community in 1992. We obtained apo(a) phenotypes determined by SDS-PAGE as well as Lp(a) levels and other cardiovascular risk factors. We combined apo(a) phenotypes form 4 groups according to molecular weights (from high apo(a) molecular weight to low: I, II, III and IV). Lp(a) levels were associated with apo(a) phenotype-groups, that is, they were inversely associated with apo(a) molecular weight. Small apo(a) phenotypes were less frequent than large ones. The median Lp(a) level was higher in smoking (29.2 mg/dL) than in nonsmoking subjects (18.5 mg/dL) in phenotype-group III. Adjusted means of total cholesterol and fibrinogen levels in apo(a) phenotype-group IV were the highest of all phenotype-groups. Age, apo(a) phenotype, smoking status, total cholesterol and fibrinogen were positively correlated with Lp(a) levels by multiple regression analysis. Lp(a) levels were found to be mainly associated with apo(a) phenotype, but varied broadly within the same apo(a) phenotype at various conditions, such as smoking status and high total cholesterol. J Epidemiol, 1999 9: 32-39. © 1999, Japan Epidemiological Association. All rights reserved.

Epidemiological data reveal that hyperuricemia is a risk factor of atherosclerosis. The risk is possibly caused by a link between hyperuricemia and insulin resistance-related metabolic syndrome. Recently it has been proposed that a missense mutation (Trp64Arg) in the beta 3-adrenergic receptor (beta 3-AR) gene may contribute to the accumulation of multiple risk factors related to insulin resistance. The present study was undertaken to further clarify an association between the Trp64Arg mutation and the metabolic syndrome in 47 Japanese men with hyperuricemia, who are substantially at high risk of atherosclerosis. One patient (2%) had the homozygous mutation, 12 (26%) were heterozygous for the mutation, and 31 (72%) had no mutation found by the PCR-RFLP analysis. The Trp64Arg mutation was not related to past maximal body mass index (BMI), BMI and waist/hip ratio. The subjects with the heterozygous mutation showed a slightly higher incidence of impaired glucose tolerance and diabetes mellitus in the 75 g oral glucose challenge (67%), as compared with those without the mutation (39%). Serum insulin response at 60 min and the sum of serum insulin in the glucose challenge were greater in the former subjects than those in the latter subjects (P=0.041 and 0.076, respectively). An increase in serum lipoprotein(a) was also observed in the subjects with the heterozygous mutation, but the Trp64Arg mutation was not associated with other dyslipidemia, blood pressure or ischemic changes on the electrocardiogram. These results indicate that the heterozygous mutation of Trp64Arg in the beta 3-AR gene partly contributes to the accumulation of multiple risk factors in male subjects with hyperuricemia. A larger prospective study is necessary to elucidate a possible role of the Trp64Arg mutation in atherosclerotic diseases in future.

Factor VII coagulant activity (FVIIc) and fibrinogen (Fbg) levels have been investigated as cardiovascular risk factors. We studied these two factors with stratification for age, sex and blood pressure, and the relation with other atherosclerotic risk factors in a Japanese general population. The subjects were 3,139 Japanese (1,315 males and 1,824 females) aged 30 to 89 in 1992 and 1993. A linear increase with age was observed in the levels of Fbg in both men and women, but no differences were observed between men and women in each age group. A linear increase with age was also seen in the levels of FVIIc in women, but the levels of FVIIc in men were significantly higher for the age group 40-49 years than for any other age group. The levels of FVIIc in women were significantly higher than in men at age greater than or equal to 60 years. As concerning the effect of alcohol intake status, Fbg had a tendency to decrease with alcohol intake. Fbg and FVIIc levels were associated with an increase in smoking status in men, but no association was seen in women in either Fbg or FVIIc. FVIIc was positively correlated with age, body mass index, total cholesterol, triglycerides and fasting insulin level. Fbg was positively correlated with age, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL-cholesterol and triglycerides in women, but Fbg had few positive correlations with risk factors in men. A comparison with previous Western studies showed that the Fbg levels of our Japanese population were lower than those of the Caucasians studied, but the present FVIIc levels were nearly the same level or slightly higher than theirs. The association of Fbg and FVIIc and with other cardiovascular risk factors in Japanese was similar to those observed in Caucasians.

The present study was undertaken to determine whether improvement of hyperglycemia alters calcium and phosphorus handling, parathyroid hormone (PTH) secretion and bone turnover in patients with non-insulin-dependent diabetes mellitus (NIDDM). We measured serum and urinary mineral levels, serum intact PTH and osteocalcin on admission and at discharge (38 +/- 3 days later, Means +/- SEM) in 28 patients with poorly-controlled NIDDM (63 +/- 2 years old, 13 males and 15 females). During the hospitalization period, glycemic control was markedly improved. Serum calcium levels remained unchanged, but serum phosphorus increased. Urinary calcium and phosphorus excretion decreased. Serum intact PTH decreased from mid-normal (30.0 +/- 2.2 ng/l) to low normal values (24.0 +/- 1.3 ng/l) (P<0.01, normal values: 10 similar to 65 ng/l). Serum osteocalcin increased from 4.14 +/- 0.35 to 4.92 +/- 0.40 mu g/l (P<0.01, normal values: 2.5 similar to 13 mu g/l). On admission, urinary calcium and phosphorus excretion showed a positive correlation with urinary glucose excretion. Serum calcium levels showed a negative correlation with serum intact PTH (r=-0.46, P<0.05). Moreover, the change in serum calcium during the hospitalization was negatively correlated to the change in serum intact-PTH (r=-0.45, P<0.05). Serum phosphorus concentrations showed a positive correlation with the renal threshold for phosphorus excretion on admission (r=0.86, P<0.01). These results indicate that hyperglycemia causes excess urinary calcium and phosphorus excretion in patients with NIDDM. In response to urinary calcium loss, PTH secretion is mildly stimulated. Bone formation seems to be suppressed in the hyperglycemic state in spite of increased PTH secretion.