Details of a Researcher - Kasuga, Yoshifumi

Papers - Kasuga, Yoshifumi

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A case of abdominal compartment syndrome caused by amniotic fluid embolism treated with ABTHERA™ therapy: World's first report in the obstetric field

Hirata M., Hasegawa K., Kasuga Y., Haiden A., Ikenoue S., Yamamoto R., Tanaka M., Sasaki J., Ochiai D.

Taiwanese Journal of Obstetrics and Gynecology (Taiwanese Journal of Obstetrics and Gynecology) 60 ( 3 ) 579 - 580 2021

Accepted, ISSN 10284559

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Expectant management for early pregnancy miscarriage after radical trachelectomy: A single hospital-based study

Kasuga Y., Ikenoue S., Tanaka Y., Tamagawa M., Hasegawa K., Oishi M., Endo T., Sato Y., Tanaka M., Ochiai D.

Acta Obstetricia et Gynecologica Scandinavica (Acta Obstetricia et Gynecologica Scandinavica) 100 ( 7 ) 1322 - 1325 2021

Accepted, ISSN 00016349

Introduction: Women who have undergone radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer may be at higher risk for retained tissues after early-term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy. Material and methods: Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail. Results: The median maternal age at miscarriage was 39 years (range 31–42 years) and the median duration from abdominal radical trachelectomy to conception was 2.60 years (range 0.49–7.30 years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23 days (range 7–50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted. Conclusions: Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy.

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Clinical utility of 1-month postpartum random plasma glucose and glycated hemoglobin combined with pre-pregnancy body mass index for detecting postpartum glucose intolerance in Japanese women with gestational diabetes

Sugiyama K., Saisho Y., Kasuga Y., Ochiai D., Itoh H.

Journal of Diabetes Investigation (Journal of Diabetes Investigation) 12 ( 12 ) 2242 - 2246 2021

Accepted, ISSN 20401116

During the coronavirus disease 2019 pandemic, the Japanese Society of Diabetes and Pregnancy proposed the use of random plasma glucose and glycated hemoglobin measured 1 month after delivery combined with pre-pregnancy body mass index to detect postpartum glucose intolerance instead of carrying out the oral glucose tolerance test in women with gestational diabetes. We retrospectively evaluated the clinical utility of this strategy to detect postpartum glucose intolerance evaluated by the oral glucose tolerance test after delivery. A total of 275 Japanese women with gestational diabetes were included in the present study. The specificity of 1-month postpartum random plasma glucose and glycated hemoglobin combined with pre-pregnancy body mass index to predict postpartum glucose intolerance was 98.0%, with a negative predictive value of 72.6%. However, sensitivity was 6.4%, with a positive predictive value of 55.6%. In conclusion, this Japanese Society of Diabetes and Pregnancy strategy showed high specificity, but low sensitivity, for detecting glucose intolerance postpartum.

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Prophylactic therapy with human amniotic fluid stem cells improves long-term cognitive impairment in rat neonatal sepsis survivors

Abe Y., Ochiai D., Sato Y., Kanzaki S., Ikenoue S., Kasuga Y., Tanaka M.

International Journal of Molecular Sciences (International Journal of Molecular Sciences) 21 ( 24 ) 1 - 12 2020.12

Accepted, ISSN 16616596

A systemic inflammatory response induces multiple organ dysfunction and results in poor long-term neurological outcomes in neonatal sepsis. However, there is no effective therapy for treating or preventing neonatal sepsis besides antibiotics and supportive care. Therefore, a novel strategy to improve neonatal sepsis-related morbidity and mortality is desirable. Recently, we reported that prophylactic therapy with human amniotic stem cells (hAFSCs) improved survival in a rat model of lipopolysaccharide (LPS)-induced neonatal sepsis through immunomodulation. Besides improving the mortality, increasing survival without major morbidities is an important goal of neonatal intensive care for neonatal sepsis. This study investigated long-term neurological outcomes in neonatal sepsis survivors treated with hAFSCs using the LPS-induced neonatal sepsis model in rats. We found that prophylactic therapy with hAFSCs improved spatial awareness and memory-based behavior in neonatal sepsis survivors at adolescence in rats. The treatment suppressed acute reactive gliosis and subsequently reduced astrogliosis in the hippocampal region over a long period of assessment. To the best of our knowledge, this is the first report that proves the concept that hAFSC treatment improves cognitive impairment in neonatal sepsis survivors. We demonstrate the efficacy of hAFSC therapy in improving the mortality and morbidity associated with neonatal sepsis.

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特定妊婦への選定状況からみた当院における精神疾患合併妊娠の実態

桑名温子, 清河駿樹, 大橋千恵, 今村裕子, 石垣順子, 鈴木毅, 金善惠, 樋口隆幸, 林保良, 染谷健一, 中田さくら, 春日義史

関東連合産科婦人科学会誌 ((一社)関東連合産科婦人科学会) 57 ( 4 ) 431 - 436 2020.11

Accepted, ISSN 2186-0610

分娩後の養育について妊娠中からの公的支援が必要と考えられる妊婦を特定妊婦に選定し,多職種が連携して支援している.精神疾患合併妊娠は特定妊婦選定の理由の1つとなりうるが,家庭環境などを考慮し非選定例も多い.本研究の目的は,精神疾患合併妊娠を特定妊婦選定の有無で分類し検討することでその背景を明らかにすることとした.対象は2018年1月から2019年8月に当院で対応した精神疾患の既往または合併のある妊婦118例(特定妊婦28例,非特定妊婦90例)であり,当院倫理委員会承認のもと母体背景,精神疾患診断名と治療状況,周産期予後について検討した.特定妊婦群では若年妊娠(p<0.05),未婚,生活保護受給者,妊娠中の内服継続,通院継続,治療の自己中断歴(各々p<0.01)が有意に多かった.特定妊婦群ではうつ病以外にパーソナリティー障害や精神発達遅滞が多く,覚醒剤使用後遺症が3例あった.周産期予後について有意差はなかった.7例が児童相談所に保護となり,いずれも特定妊婦群であった.周産期予後に差はないものの,児童相談所保護が多いことから,妊娠中から地域との連携をスムーズにするという点で特定妊婦選定の意義が再認識された.医療機関においては一般診療以外の労力が大きいことから,選定対象と具体的な対応については今後も検討が必要であると考えられた.(著者抄録)

Preterm delivery and hypertensive disorder of pregnancy were reduced during the COVID-19 pandemic: A single hospital-based study.

Kasuga Y, Tanaka M, Ochiai D

The journal of obstetrics and gynaecology research 46 ( 12 ) 2703 - 4 2020.10

ISSN 1341-8076

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Sonographic findings of cervical laceration caused by vaginal delivery in pregnancy after radical trachelectomy.

Kasuga Y, Miyakoshi K, Endo T, Takeda T, Nakamura M, Ochiai D, Tanaka M

Journal of medical ultrasonics (2001) 47 ( 4 ) 655 - 657 2020.10

ISSN 1346-4523

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Prophylactic therapy with human amniotic fluid stem cells improved survival in a rat model of lipopolysaccharide-induced neonatal sepsis through immunomodulation via aggregates with peritoneal macrophages.

Sato Y, Ochiai D, Abe Y, Masuda H, Fukutake M, Ikenoue S, Kasuga Y, Shimoda M, Kanai Y, Tanaka M

Stem cell research & therapy (Stem Cell Research and Therapy) 11 ( 1 ) 300 2020.07

Accepted

Background: Despite recent advances in neonatal care, sepsis remains a leading cause of mortality in neonates. Mesenchymal stem cells derived from various tissues, such as bone marrow, umbilical cord, and adipose tissue, have beneficial effects on adult sepsis. Although human amniotic fluid stem cells (hAFSCs) have mesenchymal stem cell properties, the efficacy of hAFSCs on neonatal sepsis is yet to be elucidated. This study aimed to investigate the therapeutic potential of hAFSCs on neonatal sepsis using a rat model of lipopolysaccharide (LPS)-induced sepsis. Methods: hAFSCs were isolated as CD117-positive cells from human amniotic fluid. Three-day-old rat pups were intraperitoneally treated with LPS to mimic neonatal sepsis. hAFSCs were administered either 3 h before or at 0, 3, or 24 h after LPS exposure. Serum inflammatory cytokine levels, gene expression profiles from spleens, and multiple organ damage were analyzed. hAFSC localization was determined in vivo. In vitro LPS stimulation tests were performed using neonatal rat peritoneal macrophages co-cultured with hAFSCs in a cell-cell contact-dependent/independent manner. Immunoregulation in the spleen was determined using a DNA microarray analysis. Results: Prophylactic therapy with hAFSCs improved survival in the LPS-treated rats while the hAFSCs transplantation after LPS exposure did not elicit a therapeutic response. Therefore, hAFSC pretreatment was used for all subsequent studies. Inflammatory cytokine levels were elevated after LPS injection, which was attenuated by hAFSC pretreatment. Subsequently, inflammation-induced damages in the brain, lungs, and liver were ameliorated. hAFSCs aggregated with peritoneal macrophages and/or transiently accumulated in the liver, mesentery, and peritoneum. Paracrine factors released by hAFSCs induced M1-M2 macrophage polarization in a cell-cell contact-independent manner. Direct contact between hAFSCs and peritoneal macrophages further enhanced the polarization. Microarray analysis of the spleen showed that hAFSC pretreatment reduced the expression of genes involved in apoptosis and inflammation and subsequently suppressed toll-like receptor 4 signaling pathways. Conclusions: Prophylactic therapy with hAFSCs improved survival in a rat model of LPS-induced neonatal sepsis. These effects might be mediated by a phenotypic switch from M1 to M2 in peritoneal macrophages, triggered by hAFSCs in a cell-cell contact-dependent/independent manner and the subsequent immunomodulation of the spleen.

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Universal screening for SARS-CoV-2 in asymptomatic obstetric patients in Tokyo, Japan.

Ochiai D, Kasuga Y, Iida M, Ikenoue S, Tanaka M

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (International Journal of Gynecology and Obstetrics) 150 ( 2 ) 268 - 269 2020.06

Accepted, ISSN 0020-7292

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A new diagnostic strategy for gestational diabetes during the COVID-19 pandemic for the Japanese population.

Kasuga Y, Saisho Y, Ikenoue S, Ochiai D, Tanaka M

Diabetes/metabolism research and reviews 36 ( 8 ) e3351 2020.05

Accepted, ISSN 1520-7552

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The association between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who previously underwent one-step hysteroscopic myomectomy

Kasuga Y., Lin B.L., Kim S.H., Higuchi T., Iwata S., Nakada S.

Gynecology and Minimally Invasive Therapy (Gynecology and Minimally Invasive Therapy) 9 ( 2 ) 54 - 58 2020.04

Accepted, ISSN 22133070

© 2020 Gynecology and Minimally Invasive Therapy. Objectives: There are no data describing the correlation between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women after transcervical resection myomectomy (TCR-M). The aim of the study is to investigate the correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who had previously undergone TCR-M. Materials and Methods: This was a retrospective, single-center study. We reviewed the records of 34 pregnant women who had previously undergone TCR-M for submucosal myoma and perinatal care in our hospital between January 2012 and January 2019. We examined surgical and pregnancy outcomes and evaluated correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in women who delivered after 22 gestational weeks (n = 24). Results: Median maternal age at conception was 38 years (range, 28-44) and median duration between TCR-M and conception was 1.4 years (range, 0.3-5.8). There were 24 deliveries after 22 gestational weeks and 10 pregnancy losses. Among these 24 deliveries, the median gestational age at delivery was 39 weeks (range, 34-41); median birthweight, 3025 g (range, 2092-4012); and median blood loss at delivery, 573 g (range, 100-3000). There were no cases of placenta accreta and uterine rupture. Placenta implantation at a prior myomectomy location was detected in 14/24 women using transabdominal ultrasonography. Median blood loss was significantly higher in the implantation than in the nonimplantation group (P < 0.01). Conclusion: Our one-step TCR-M is useful for women with submucosal myoma. However, we suggest that clinicians should review and check the association between prior myomectomy locations and placenta implantation.

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頭痛および視野欠損を契機に診断に至った脳動脈解離による脳梗塞合併妊娠の1例

秋田啓介, 春日義史, 玉川真澄, 上條慎太郎, 大石真希, 遠藤豊英, 大谷利光, 池ノ上学, 落合大吾, 宮越敬, 田中守, 青木大輔

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 69 ( 2 ) 212 - 217 2020.04

Accepted, ISSN 2186-0599

緒言:脳動脈解離は若年発症脳梗塞の原因となり、リスク因子としては片頭痛や高血圧が挙げられるが、妊婦における初発例は稀である。今回我々は妊娠中に発症した脳動脈解離による脳梗塞の1例を経験したので報告する。症例:31歳、3妊1産。既往歴として片頭痛を認めた。妊娠26週0日に激しい頭痛が出現し、その1週間後に右側半盲を認めた。頭部MRI/MRA検査で左後大脳動脈の狭小化と左後頭葉の虚血性変化が認められ、脳動脈解離による脳梗塞の診断となった。神経学的症状の増悪や血圧の変動なく経過し、妊娠37週5日に経腟分娩に至った。児は2926gの女児でApgar score 8/10点(1/5分値)であった。分娩中や分娩後に血圧の変動や新規の神経学的異常所見の出現は認めなかった。結論:神経学的異常所見を伴う頭痛を認める際には脳動脈解離を含めた脳血管障害を念頭に頭蓋内病変精査を行う必要があると考えられた。(著者抄録)

妊娠中期に卵巣癌と診断し、手術療法と化学療法治療後に生児を得られた1例

田中邦生, 長谷川慶太, 吉村拓馬, 大石真希, 大谷利光, 池ノ上学, 春日義史, 落合大吾, 岩田卓, 宮越敬, 田中守, 青木大輔

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 69 ( 2 ) 387 - 391 2020.04

Accepted, ISSN 2186-0599

緒言:卵巣癌合併妊娠は1万から5万例に1例と頻度が低く、対応に一定の見解はない。今回我々は妊娠中期に卵巣癌を診断され、手術療法と化学療法を行い生児を得られた症例を経験した。症例:44歳、1妊0産。妊娠16週時に卵巣癌を疑われ、妊娠18週時に右付属器摘出術、左卵巣腫瘍摘出術、大網生検を施行した。右卵巣原発の高異型度漿液性癌IIIC期の診断にて術後パクリタキセルとカルボプラチン(TC)併用療法を4サイクル施行し、妊娠35週5日時に選択的帝王切開術とinterval debulking surgeryを同時に施行した。2118gの女児を娩出し、術後TC療法を2サイクル施行した。術後母体は再発を認めず、児の発育も良好である。結論:卵巣癌合併妊娠に対して、予め分娩時期を想定した管理・治療を行ったことで母児ともに合併症なく手術療法と化学療法を行うことができた。(著者抄録)

Transvaginal ultrasound features of the residual cervix in pregnancy after radical trachelectomy

Kasuga Y., Miyakoshi K., Tanaka M.

Journal of Medical Ultrasonics (Journal of Medical Ultrasonics) 47 ( 2 ) 335 - 337 2020

ISSN 13464523

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Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study

Akiba Y., Ikenoue S., Endo T., Kasuga Y., Ochiai D., Miyakoshi K., Ishii R., Yakubo K., Tanaka M.

BJOG: An International Journal of Obstetrics and Gynaecology (BJOG: An International Journal of Obstetrics and Gynaecology) 128 ( 2 ) 329 - 335 2020

Accepted, ISSN 14700328

© 2020 Royal College of Obstetricians and Gynaecologists Objective: Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation. Design: Exploratory observational study. Setting: Saitama Municipal Hospital. Sample: A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women. Methods: AVol and TVol were assessed between 20 and 37 weeks’ gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology. Main outcome measures: AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37 weeks’ gestation). Results: Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32 weeks’ gestation. AVol was significantly larger in the GDM group than in the NGT group after 32 weeks’ gestation (P < 0.05). TVol was not statistically different between the groups across gestation. Conclusions: Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM. Tweetable abstract: AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32 weeks’ gestation.

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Impaired early phase insulin secretion associated with gestational diabetes mellitus in underweight women

Kasuga Y., Miyakoshi K., Saisho Y., Ikenoue S., Ochiai D., Tanaka M.

Journal of Maternal-Fetal and Neonatal Medicine (Journal of Maternal-Fetal and Neonatal Medicine) 35 ( 12 ) 1 - 3 2020

Accepted, ISSN 14767058

© 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group. Background: No reports have focused on the clinical and metabolic characteristics of gestational diabetes (GDM) in underweight women. The aim of this study is to investigate the clinical and metabolic features of underweight GDM (pregravid BMI, <18.5 kg/m2: U-GDM). Materials and methods: Women diagnosed with GDM were categorized based on their pre-pregnancy BMI as either underweight (n = 49) or normal weight (pregravid BMI, 18.5–25.0 kg/m2: n = 271: N-GDM). During the study period, GDM was diagnosed using the International Association of Diabetes in Pregnancy Study Group criteria. Women with multi-fetal pregnancies, fetal congenital anomalies, overt diabetes in pregnancy, and pre-gestational diabetes mellitus were excluded. Results: There were no notable differences in maternal age at delivery and the rate of nulliparous between the U-GDM and N-GDM groups. Regarding antepartum oral glucose tolerance test profiles, women with U-GDM exhibited significantly lower fasting plasma glucose (FPG) levels than those with N-GDM (p <.01). The Insulinogenic Index of women with U-GDM was significantly lower than that of women with N-GDM (p <.05). Conclusion: Impaired early phase insulin secretion was associated with GDM onset in underweight women.

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Changes in bone metabolic profile associated with pregnancy or lactation

Miyamoto T., Miyakoshi K., Sato Y., Kasuga Y., Ikenoue S., Miyamoto K., Nishiwaki Y., Tanaka M., Nakamura M., Matsumoto M.

Scientific Reports (Scientific Reports) 9 ( 1 ) 6787 2019.12

Accepted

© 2019, The Author(s). Calcium and nutrients are transferred from mothers to fetuses or infants during pregnancy or lactation, respectively, promoting metabolic changes in the mother, many uncharacterized. To evaluate these changes, we undertook two parallel studies. In one we analyzed fourteen clinical cases of vertebral fragility fractures, at or before three months after partum, in mothers who breastfed their infants. In the other, we enrolled 79 additional pregnant subjects, some who chose to breastfeed and others who did not, and analyzed changes in bone metabolic status starting between 34 and 36 weeks of gestation and ending one month after partum. In the larger group, bone-resorbing and bone-forming parameters such as serum TRACP5b and osteocalcin, respectively, significantly increased after partum. Among parameters that changed after partum, serum PTH and the bone-resorbing markers serum TRACP5b and urine NTX were significantly higher in mothers who only breastfed infants compared to mothers who fed infants formula or a mix of both. However, bone-forming parameters were comparable between breastfeeding and non-breast-feeding groups after partum, suggesting that elevated bone-resorption occurs only in the breastfeeding group. Radiographic analysis after partum demonstrated that no subject among the 79 analyzed showed vertebral fractures, even those who breastfed exclusively. Among fracture cases analyzed, subjects exhibited significantly lower bone mineral density than did non-fracture cases in breastfeeding-only subjects. We conclude that bone metabolic status significantly changes over the period between pregnancy and post-partum lactation, and that low bone mineral density seen in a small subset of breastfeeding-only cases likely causes post-partum vertebral fragility fractures.

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再癒着に留意した子宮鏡下癒着剥離術施行後に良好な周産期経過をたどった重度アッシャーマン症候群の1例

王洪欣, 春日義史, 吉村拓馬, 大橋千恵, 石垣順子, 鈴木毅, 金善惠, 樋口隆幸, 染谷健一, 林保良, 中田さくら

神奈川産科婦人科学会誌 (神奈川産科婦人科学会) 56 ( 1 ) 29 - 32 2019.10

Accepted, ISSN 0910-2485

緒言:アッシャーマン症候群は子宮内膜損傷により子宮内腔が癒着した状態であり、子宮性不妊の原因となる。今回我々は再癒着に留意した子宮鏡下癒着剥離術(trans-cervical resection of Asherman syndrome:(TCR-A)施行後に良好な周産期経過をたどった重度アッシャーマン症候群の1例を経験した。症例:29歳、3妊0産(人工妊娠中絶1回、稽留流産2回)、いずれも子宮内容除去術を施行されている。過少月経ならびに既往よりアッシャーマン症候群を疑われ、精査加療目的に当院を紹介受診した。子宮鏡検査では子宮内腔の2/3以上が結合織性癒着し、重度アッシャーマン症候群と診断し、TCR-Aの方針とした。子宮内腔の白色で内膜が存在しない癒着部分をはさみ鉗子で鋭的に切断解放し、術後癒着予防のために子宮内避妊器具を挿入した。術後1ヵ月の子宮鏡検査では子宮内腔の再癒着を認めなかった。術後5ヵ月で自然妊娠成立し、癒着胎盤の発生に留意して管理したが、妊娠経過に異常は認めなかった。妊娠37週3日に経腟分娩に至り、児は2265gの女児、Apgar score8/9点(1/5分値)であった。分娩時出血量は200g、胎盤剥離はスムーズであり、癒着胎盤を認めなかった。結語:再癒着に留意したTCR-Aを行ったことで自然妊娠成立し、良好な妊娠分娩予後をたどった可能性が示唆された。(著者抄録)

腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例

松井友哉, 春日義史, 石垣順子, 鈴木毅, 金善惠, 樋口隆幸, 染谷健一, 中田さくら

神奈川産科婦人科学会誌 (神奈川産科婦人科学会) 56 ( 1 ) 46 - 49 2019.10

Accepted, ISSN 0910-2485

目的:本邦における結核発生数は減少傾向にあるものの、他の先進国と比較して多く、特に発展途上国出身者に多い。今回我々は腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例を経験したので報告する。症例:42歳、8妊5産、フィリピン国籍。妊娠20週に約2週間継続した咳を認めたが、鎮咳薬で軽快していた。妊娠23週2日、左腰背部痛と呼吸苦を主訴に外来を受診したところ、左季肋部圧痛と左肋骨脊柱角叩打痛を認めた。腎盂腎炎の診断で入院管理とし、抗菌薬投与を開始したところ、第6病日に吸気時に増悪する背部痛が顕在化した。画像検査や採血検査上、結核が疑われたが、喀痰培養検査などは陰性であったために経皮的胸膜生検を行った。臨床経過ならびに病理組織学的検査結果より結核性胸膜炎及び肺結核と診断したため、多剤併用療法を開始した。その後の経過は順調であり、既往帝王切開術後妊娠のために妊娠37週5日に選択的帝王切開術を施行した。児は男児で3380g、Apgar score8/9点(1/5分値)であった。児に先天性結核は認めず、母児ともに術後7日目に退院した。結論:今回我々は腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例を経験した。結核性胸膜炎発症時には腰背部痛を主訴に来院する可能性があり、特に発展途上国出身者では腰背部痛の鑑別疾患として結核性胸膜炎を念頭に入れることも必要であると考えられた。(著者抄録)

日本人妊娠糖尿病既往女性における産後糖代謝異常発症予測因子に関する後方視的検討

春日義史, 宮越敬, 税所芳史, 池ノ上学, 荒田尚子, 田中守

糖尿病と妊娠 ((一社)日本糖尿病・妊娠学会) 19 ( 2 ) S - 67 2019.08

Accepted, ISSN 1347-9172

日本人妊娠糖尿病(Gestational Diabetes Mellitus:GDM)既往女性における産後糖代謝異常(Postpartum Abnormal Glucose Tolerance:pAGT)発症予測因子を検討した。対象は日本人GDM合併単胎妊婦のうち、分娩後1年以内に75gOGTTを受けた女性である(pAGT[n=59]、正常耐糖能型[n=154])。GDM診断時OGTT血糖値ならびに遺伝因子とpAGTとの関連解析を行ったところ、OGTT2時間値のpAGT発症予測能が高かった(AUC=0.72)。遺伝因子では4遺伝子がpAGT群においてリスクアレルを多く持つ傾向にあり、検出された4遺伝子中、3遺伝子はインスリン分泌関連遺伝子であった。日本人GDM既往女性において、GDM診断時OGTT 2時間値がpAGT発症予測に有用であり、遺伝学的にインスリン分泌不全の関与が示唆された。(著者抄録)

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