{"created":"2023-06-19T10:28:27.879475+00:00","id":605,"links":{},"metadata":{"_buckets":{"deposit":"2dcc0cd7-6bc6-46a8-aa31-80d906d6d183"},"_deposit":{"created_by":25,"id":"605","owners":[25],"pid":{"revision_id":0,"type":"depid","value":"605"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00000605","sets":["1709617079800:35:186:430"]},"author_link":["120030","120031"],"item_1694495855422":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_type":"VoR"}]},"item_3_biblio_info_12":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"1987","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"173","bibliographicPageStart":"160","bibliographicVolumeNumber":"13","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_8":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"原著","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_3_identifier_14":{"attribute_name":"URL","attribute_value_mlt":[{"subitem_identifier_type":"URI","subitem_identifier_uri":"http://igakkai.kms-igakkai.com/wp/wp-content/uploads/1987/KMJ13(2)160-173.1987.pdf"}]},"item_3_relation_20":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://doi.org/10.11482/KMJ-J13(2)160 ","subitem_relation_type_select":"DOI"}}]},"item_3_source_id_1":{"attribute_name":"雑誌書誌ID","attribute_value_mlt":[{"subitem_source_identifier":"AN00045593","subitem_source_identifier_type":"NCID"},{"subitem_source_identifier":"AN12940574","subitem_source_identifier_type":"NCID"}]},"item_3_source_id_19":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0386-5924","subitem_source_identifier_type":"PISSN"},{"subitem_source_identifier":"2758-089X","subitem_source_identifier_type":"EISSN"}]},"item_3_text_6":{"attribute_name":"著者所属(日)","attribute_value_mlt":[{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学検査診断学教室"}]},"item_3_text_7":{"attribute_name":"著者所属(英)","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Department of Clinical Pathology, Kawasaki Medical School"}]},"item_3_textarea_10":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"臨床化学検査を中心とする診断作法のひとつとしてCALD(computer-assisted laboratory diagnosis)が開発され,患者の全身状態および重要臓器の障害の指摘,そしてしばしば病名の推定さえ行われるようになった.ことに,CALDは肝・胆道疾患の診断にはすぐれた成績をあげている.本研究では,Oxleyらの診断基準に合致しかつ急性期に諸検査が経時的に行われた急性心筋梗塞(AMI)71例(軽快51,死亡20)を研究対象とした.対象例に本学附属病院中央検査部のCALDを適用したところ,52.1%(71例中37例)の診断率を得た.この数値を見るかぎりでは,残念ながら,現在稼働中のCALDは,AMIの診断に満足できる成績をあげていない.ところが,対象症例には,血清酵素アイソザイム検査が行われており,CK・MBの出現および(あるいは)LDH1>LDH2の異常所見の陽性率は94.4%であった.この事実に着目し,CALDの項目にアイソザイム検査を組み合わせることにより,臨床化学によるAMIの診断率は向上すると考えられた.ついで,臨床化学を中核にしてAMIの予後の推定を試みた.すなわち,CALDに採用されている血液化学成分19種に血液細胞成分3種(WBC,Plt,Lym)の検査項目を加えて,判断分析の手法で,軽快と死亡の転帰を予測するための判別式を誘導し,判別値を算出した.判別値Dが0を超える場合を死亡,0以下の例を軽快とみなし,予後予測を行ったところ,最終判定では,軽快群83.7%,死亡群100%の判別適中率をあげる良好な成績を得た.以上の結果より,現在実用化されているCALDの血液化学的成分(19種)に,心筋酵素アイソザイム検査(2種)を加えてAMIの診断を確実にし,またCALDの血液化学成分(19種)と血液細胞成分(3種)とを組み合わせて判別式を誘導し,それをAMIと診断された症例に適用すれば,AMIの予後予測に対し,有用な指標が得られることが期待される.AMIの診断については,これまで心電図および画像診断法が圧倒的に有用性を発揮していたが,血液化学中心の診察作法も,本研究のごとく工夫すれば日常診療に活用できると考えられた."}]},"item_3_textarea_11":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"Computer-assisted laboratory diagnosis (CALD) is a category of clinical diagnosis based on comprehensive interpretation of various sets of laboratory test by use of a computer. This has been being developed for these two decades in the United States and in Japan. Our CALD of Kawasaki Medical School Hospital enables us to diagnose a patient not only about his general condition and the extent of functional disturbances of the principal organs his body but also by mentioning the names of possible diseases without resorting to information on his morbid history and physical examination. The CALD has proved to be efficient especially for the diagnosis of patients with hepatobiliary disorders. However, in the author's experience the CALD failed to achieve satisfactory result in the diagnosis of myocardial infarction. Namely, medical records of 71 patients of acute myocardial infarction (AMI) who were abmitted to Kawasaki Medical School Hospital during a period of the past 4 years (1981～1985) were collected and subjected to our CALD. (Their diagnosis was confirmed by checking according to Oxley's criteria.) The result was disappointing : only 52.1% of the cases were really detectable as AMI. Fortunately, in these AMI cases serum isozyme study had happened to be carried out as one of the routine tests along with the blood chemical tests properly pertaining to our CALD, and the record of the isozyme study disclosed that creatine phosphokinase isozyme CK-ME and/or predominance of LDH1 over LDH2 (LDH1>LDH2) were encountered in 94.4%. Therefore, it was naturally expected that the detection rate of AMI by our CALD would be raised up to 90% level by simultaneous performance of serum isozyme (CK and LDH) study. And this expectation has been realized. Then, attempt was made to reinforce our CALD so that it may be utilized for predicting the prognosis of AMI patient by resorting solely to the examination of pathological changes of the chemical and cellular ingredients of blood. Measured values of three cellular elements of blood, i.e. counts of white blood cells, lymphocytes and platelets were put together with the estimations of 19 sorts of chemical ingredients properly pertaining to our CALD. A discriminant equation was derived by use of a somputer with these 22 (=3+19) elements by the technique of discriminant analysis. Discrimination value D which enables distinction of \"Dead (D>0)\" from \"Alive (D<0)\" as to the AMI prognosis was calculated in a computer by substitution of individual terms of the equation with the really measured values of the relevant blood chemical ingredients and cellular elements. The hit rate of prognosis predieted in this way was satisfactory: ultimately, it was 83.7% for the \"Alive\" group who took beneficial course and 100% for the \"Dead\" group who succumbed to AMI attack. The utility of laboratory diagnosis based solely on chemical and cellular analysis of blood has thus been extended to AMI, a disease which has been, from the view point of diagnostic measures, a malady of electrocardiography and radiological imageology."}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"木村, 丹","creatorNameLang":"ja"},{"creatorName":"キムラ, マコト","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Kimura, Makoto","creatorNameLang":"en"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2017-01-23"}],"displaytype":"detail","filename":"KJ00009816559.pdf","filesize":[{"value":"1.6 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"KJ00009816559.pdf","objectType":"fulltext","url":"https://kwmed.repo.nii.ac.jp/record/605/files/KJ00009816559.pdf"},"version_id":"c4c9d5c1-f40a-4011-9b25-d39c06e6447a"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"Computer-assisted laboratory diagnosis (CALD)","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Acute myocardial infarction (AMI)","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Laboratory data based prognosis of AMI","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"病態検査情報解析による急性心筋梗塞の血液プロフィールおよび予後予測に関する研究","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"病態検査情報解析による急性心筋梗塞の血液プロフィールおよび予後予測に関する研究","subitem_title_language":"ja"},{"subitem_title":"Studies on Blood Chemical Profiling and Prognostic Prediction in Patients with Acute Myocardial Infarction through the Laboratory Data Analysis","subitem_title_language":"en"}]},"item_type_id":"3","owner":"25","path":["430"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2017-01-23"},"publish_date":"2017-01-23","publish_status":"0","recid":"605","relation_version_is_last":true,"title":["病態検査情報解析による急性心筋梗塞の血液プロフィールおよび予後予測に関する研究"],"weko_creator_id":"25","weko_shared_id":-1},"updated":"2023-10-06T02:49:51.041688+00:00"}