{"id":3619,"date":"2013-08-13T16:41:51","date_gmt":"2013-08-13T07:41:51","guid":{"rendered":"http:\/\/fujiitoshiki.com\/improvesociety\/?p=3619"},"modified":"2013-08-26T21:53:54","modified_gmt":"2013-08-26T12:53:54","slug":"systematic-review-and-meta-analysis-anti-tumor-necrosis-factor-therapy-and-cardiovascular-events-in-rheumatoid-arthritis","status":"publish","type":"post","link":"https:\/\/www.fujiitoshiki.com\/improvesociety\/?p=3619","title":{"rendered":"Systematic Review and Meta-Analysis: Anti-Tumor Necrosis Factor &alpha; Therapy and Cardiovascular Events in Rheumatoid Arthritis"},"content":{"rendered":"<div class=\"theContentWrap-ccc\"><p>\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306b\u5bfe\u3059\u308b\u751f\u7269\u5b66\u7684\u88fd\u5264\u306e\u4f7f\u7528\u306f\u708e\u75c7\u3092\u52b9\u7387\u3088\u304f\u6539\u5584\u3055\u305b\u308b\u3060\u3051\u3067\u306a\u304f\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3067\u3059\uff0e\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u9078\u629e\u3057\u305f\u306e\u3067\u3059\u304c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u306f\u7d71\u8a08\u7684\u6709\u610f\u3067\u306f\u306a\u304b\u3063\u305f\u3068\u306e\u3053\u3068\u3067\u3059\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3067\u306f\u7d71\u8a08\u7684\u6709\u610f\u306a\u7d50\u679c\u304c\u51fa\u307e\u3057\u305f\u304c\u51fa\u7248\u30d0\u30a4\u30a2\u30b9\u306e\u53ef\u80fd\u6027\u304c\u3042\u308a\uff0c\u7d50\u8ad6\u3092\u51fa\u3059\u306b\u306f\u6642\u671f\u5c1a\u65e9\u3068\u601d\u308f\u308c\u307e\u3059\uff0e<\/p>\n<p><a href=\"\/\/fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot.png\"><img loading=\"lazy\" decoding=\"async\" src=\"\/\/fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot-300x300.png\" alt=\"Funnelplot\" width=\"300\" height=\"300\" class=\"alignnone size-medium wp-image-3762\" srcset=\"https:\/\/www.fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot-300x300.png 300w, https:\/\/www.fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot-150x150.png 150w, https:\/\/www.fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot-100x100.png 100w, https:\/\/www.fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot-110x110.png 110w, https:\/\/www.fujiitoshiki.com\/improvesociety\/wp-content\/uploads\/Funnelplot.png 455w\" sizes=\"auto, (max-width: 300px) 85vw, 300px\" \/><\/a><\/p>\n<h1>Systematic Review and Meta-Analysis: Anti-Tumor Necrosis Factor &alpha; Therapy and Cardiovascular Events in Rheumatoid Arthritis<\/h1>\n<p>CHERYL BARNABE, BILLIE-JEAN MARTIN, AND WILLIAM A. GHALI<\/p>\n<p><a href=\"\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acr.20371\/full\" title=\"Systematic review and meta-analysis: Anti\u2013tumor necrosis factor \u03b1 therapy and cardiovascular events in rheumatoid arthritis\" target=\"_blank\">Arthritis Care &#038; Research vol. 63, No. 4, April 2011, pp 522-529<\/a><\/p>\n<h3>\u5bfe\u8c61<\/h3>\n<p>\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u5236\u5fa1\u306f\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u30ea\u30b9\u30af\u3092\u6e1b\u5f31\u3055\u305b\u3066\u3044\u308b\u304b\u3082\u3057\u308c\u306a\u3044\uff0e\u6211\u3005\u306f\u6297TNF-&alpha; \u6cbb\u7642\u3068\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u75c7\u7387\u3068\u306e\u9593\u306e\u76f8\u95a2\u3092\u7cfb\u7d71\u7684\u306b\u8a55\u4fa1\u3057\u3088\u3046\u3068\u3057\u305f\uff0e<\/p>\n<h3>\u65b9\u6cd5<\/h3>\n<p>\u3000\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u3046\u3061\uff0c\u6297 TNF-&alpha; \u6cbb\u7642\u3068\u4f1d\u7d71\u7684\u306a DMARDs \u6cbb\u7642\u6cd5\u3068\u3092\u6bd4\u8f03\u3057\u305f\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u3067\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff08\u5168\u30a4\u30d9\u30f3\u30c8\uff0c\u5fc3\u7b4b\u6897\u585e\uff0c\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\uff0c\u8133\u8840\u7ba1\u75be\u60a3\uff09\u306b\u3064\u3044\u3066\u8a18\u8f09\u306e\u3042\u308b\u3082\u306e\u3092 PubMed \u304a\u3088\u3073 EMBase \u304a\u3088\u3073\u30ab\u30f3\u30d5\u30a1\u30ec\u30f3\u30b9\u306e\u8981\u7d04\u304b\u3089\u540c\u5b9a\u3057\u305f\uff0e\u76f8\u5bfe\u5371\u967a\u5ea6\u307e\u305f\u306f\u30cf\u30b6\u30fc\u30c9\u6bd4\u3068\u305d\u306e 95% \u4fe1\u983c\u533a\u9593\u3092\u62bd\u51fa\u3057\u305f\uff0e\u30a4\u30f3\u30b7\u30c7\u30f3\u30c8\u304c\u5831\u544a\u3055\u308c\u305f\u5834\u5408\u306f\u7f79\u60a3\u5bc6\u5ea6\u3068\u305d\u306e\u5206\u6563\u3092\u8a08\u7b97\u3059\u308b\u305f\u3081\u306b\u4ed8\u52a0\u60c5\u5831\u3082\u62bd\u51fa\u3057\u305f\uff0e<\/p>\n<h3>\u7d50\u679c<\/h3>\n<p>\u3000\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30e1\u30bf\u89e3\u6790\u306f\u305d\u308c\u305e\u308c 16 \u7de8\u3068 11 \u7de8\u304c\u542b\u307e\u308c\u305f\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u304a\u3044\u3066\u306f\u6297 TNF-&alpha; \u6cbb\u7642\u306f\u5168\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u3068\u76f8\u95a2\u3057\u3066\u304a\u308a\uff0c\u8abf\u6574\u5f8c\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u3068 95% \u4fe1\u983c\u533a\u9593\u306f\u305d\u308c\u305e\u308c 0.46 (0.28-0.77) \u3067\u3042\u3063\u305f\uff0e\u5fc3\u7b4b\u6897\u585e\u306b\u3064\u3044\u3066\u306f 0.81 (0.68- 0.96) \u3067\u3042\u3063\u305f\uff0e\u307e\u305f\u8133\u8840\u7ba1\u75be\u60a3\u306b\u3064\u3044\u3066\u306f 0.69 (0.53 -0.89) \u3067\u3042\u3063\u305f\uff0e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u30e1\u30bf\u89e3\u6790\u3067\u306f\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u30ea\u30b9\u30af\u306e\u4f4e\u4e0b\u3092\u793a\u5506\u3059\u308b\u70b9\u63a8\u5b9a\u5024\u304c\u5f97\u3089\u308c\u305f\u304c\uff0c\u7d71\u8a08\u7684\u6709\u610f\u3067\u306f\u306a\u304b\u3063\u305f\uff08\u76f8\u5bfe\u5371\u967a\u5ea6 0.85,95% \u4fe1\u983c\u533a\u9593 0.28-2.5\uff09\uff0e<\/p>\n<h3>\u7d50\u8ad6<\/h3>\n<p>\u3000\u89b3\u5bdf\u7814\u7a76\u306b\u304a\u3051\u308b\u6297 TNF-&alpha; \u6cbb\u7642\u306f\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff0c\u5fc3\u7b4b\u6897\u585e\uff0c\u8133\u8840\u7ba1\u969c\u5bb3\u306e\u30ea\u30b9\u30af\u4f4e\u4e0b\u3068\u76f8\u95a2\u3057\u3066\u3044\u308b\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u51fa\u7248\u30d0\u30a4\u30a2\u30b9\u3068\u306e\u9593\u306b\u306f\u7570\u8cea\u6027\u304c\u3042\u308b\uff0e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u306e\u70b9\u63a8\u5b9a\u5024\u306f 95% \u4fe1\u983c\u533a\u9593\u3067\u529b\u4e0d\u8db3\u3067\u3042\u308a\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306f secondary outcome \u3067\u3042\u3063\u305f\u304c\uff0c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306f\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u50be\u5411\u306b\u3042\u308b\u3053\u3068\u3092\u8a3c\u660e\u3057\u305f\uff0e<\/p>\n<h2>\u5c0e\u5165<\/h2>\n<p>\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306f\u6162\u6027\u708e\u75c7\u6027\u75be\u60a3\u3067\u3042\u308a\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u75c7\u30ea\u30b9\u30af\u306e\u5897\u52a0\u3068\u95a2\u9023\u3057\u3066\u3044\u308b (1-3)\uff0e\u3053\u306e\u3053\u3068\u306f\u4f1d\u7d71\u7684\u306a\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u56e0\u5b50\u3068\u4e0d\u9069\u5207\u306b\u6cbb\u7642\u3055\u308c\u305f\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u708e\u75c7\u6027\u74b0\u5883 (4\u3068\u306e\u4e21\u8005\u306b\u5bc4\u4e0e\u3057\u3066\u3044\u308b\uff0e\u904e\u53bb 15 \u5e74\u9593\u3067\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u6226\u7565\u306f\u5287\u7684\u306b\u5909\u5316\u3057\u3066\u304a\u308a\uff0cDMARDs \u3068\u751f\u7269\u5b66\u7684\u88fd\u5264\u306b\u3088\u3063\u3066\u65e9\u671f\u306b\u5bdb\u89e3\u9054\u6210\u3059\u308b\u3053\u3068\u304c\u6cbb\u7642\u76ee\u6a19\u3068\u306a\u3063\u305f\uff0e\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u56e0\u5b50\u304c\u6ce8\u76ee\u3055\u308c\u308b\u3088\u3046\u306b\u306a\u3063\u305f\u306e\u306f\uff0c\u3053\u306e\u96c6\u56e3\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u3068\u7f79\u60a3\u7387\u306e\u4e0a\u6607\u304c\u5e83\u304f\u8a8d\u8b58\u3055\u308c\u308b\u3088\u3046\u306b\u306a\u3063\u305f\u3053\u3068\u306b\u3088\u308b\uff0e<\/p>\n<p>\u3000\u30ea\u30a6\u30de\u30c1\u306e\u75be\u60a3\u6d3b\u52d5\u6027\u3092\u9069\u5207\u306b\u7dad\u6301\u3059\u308b\u3053\u3068\u3067\u708e\u75c7\u3092\u6709\u52b9\u306b\u6cbb\u7642\u3059\u308b\u3053\u3068\u306f\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u304b\u3082\u3057\u308c\u306a\u3044\uff0e\u6700\u8fd1\u306e\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u306b\u3088\u308b\u3068\uff0c\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u304c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u306b\u5bfe\u3057\u3066\u6709\u52b9\u3067\u3042\u308b\u3068\u660e\u3089\u304b\u306b\u306a\u3063\u305f (5)\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u306f\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u3084\u4ed6\u306e\u6a19\u6e96\u7684 DMARDs \u304c\u5931\u6557\u3057\u305f\u60a3\u8005\u306b\u3068\u3063\u3066\u5207\u308a\u672d\u3068\u306a\u308b\u6cbb\u7642\u6cd5\u3067\u3042\u308b\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u304c\u4ed8\u52a0\u7684\u306b\u30ea\u30b9\u30af\u3092\u6291\u6b62\u3059\u308b\u3053\u3068\u306f\u660e\u3089\u304b\u3067\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u4ee3\u7406\u30de\u30fc\u30ab\u30fc\u306b\u826f\u3044\u610f\u5473\u3067\u306e\u30a4\u30f3\u30d1\u30af\u30c8\u3092\u6709\u3059\u308b\u3053\u3068\u304c\u8a3c\u660e\u3055\u308c\u305f\u3088\u3046\u306b\uff0e\u4ee5\u4e0b\u306e\u70b9\u304c\u660e\u3089\u304b\u306b\u306a\u3063\u305f\uff0c\u4f8b\u3048\u3070\u5faa\u74b0\u8840\u4e2d\u306e CRP \u3084 IL-6 \u306a\u3069\uff0e\u4ed6\u306e\u5185\u76ae\u6a5f\u80fd\u6e2c\u5b9a\u5024\u306e\u3046\u3061\uff0c\u9838\u52d5\u8108\u5185\u819c\u80a5\u539a\u3068 flow mediated dilatation \u3092\u6539\u5584\u3055\u305b\u308b (6-7)\uff0e<\/p>\n<p>\u3000\u6cbb\u7642\u3055\u308c\u305f\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306e\u5927\u898f\u6a21\u30b3\u30db\u30fc\u30c8\u306e\u7d44\u7acb\u306f\u7279\u7570\u7684\u306a\u6cbb\u7642\u6cd5\u306e\u8ee2\u6a5f\u3092\u8a55\u4fa1\u3059\u308b\u6a5f\u4f1a\u3092\u56fd\u969b\u7684\u306b\u4e0e\u3048\u3066\u304a\u308a\uff0c\u540c\u6642\u306b\u526f\u4f5c\u7528\u306e\u60c5\u5831\u3092\u3082\u63d0\u4f9b\u3057\u3066\u3044\u308b\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u306e\u8ee2\u5e30\u3068\u526f\u4f5c\u7528\u306b\u95a2\u3059\u308b\u6709\u610f\u306a\u91cf\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306f\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306b\u3088\u308a\u84c4\u7a4d\u3055\u308c\u308b\uff0e\u6211\u3005\u306f\u3069\u3093\u306a\u53ef\u80fd\u6027\u3067\u3082\u6297 TNF &alpha; \u6cbb\u7642\u306e\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u306b\u95a2\u3059\u308b\u81e8\u5e8a\u52b9\u679c\u3092\u5b9a\u7fa9\u3059\u308b\u305f\u3081\uff0c\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u3053\u308c\u3089\u306e2\u3064\u306e\u30bd\u30fc\u30b9\uff0c\u3064\u307e\u308a\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u3092\u7cfb\u7d71\u7684\u306b\u30ec\u30d3\u30e5\u30fc\u3057\u305f\u304b\u3063\u305f\uff0e\u7279\u306b\uff0c\u6211\u3005\u306e\u7591\u554f\u306f\u6b21\u306e\u3088\u3046\u306a\u3082\u306e\u3067\u3042\u3063\u305f\uff0c\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306b\u304a\u3051\u308b\u6297 TNF &alpha; \u6cbb\u7642\u3068 DMARDs \u6cbb\u7642\u3068\u3092\u6bd4\u8f03\u3057\u3066\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u306f\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u3067\u540c\u5b9a\u3055\u308c\u308b\u304b\u5426\u304b\u3092\u8a66\u9a57\u3057\u3066\u3044\u308b\u304b\u3067\u3042\u308b\uff0e<\/p>\n<h2>\u5bfe\u8c61\u3068\u65b9\u6cd5<\/h2>\n<p>\u3000\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30e1\u30bf\u89e3\u6790\u306f Preferred Reporting Themes for Systemic Revs ad Meta Analysis Group \u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u6982\u8aac\u3055\u308c\u305f\u30d5\u30ec\u30fc\u30e0\u30ef\u30fc\u30af\u306b\u5f93\u3063\u3066\u5b9f\u65bd\u3055\u308c\uff0c\u5831\u544a\u306b\u304a\u3051\u308b\u6a19\u6e96\u5316\u3068\u54c1\u8cea\u3092\u5411\u4e0a\u3055\u305b\u305f (8)\uff0e\u30ec\u30d3\u30e5\u30fc\u306e\u30d7\u30ed\u30c8\u30b3\u30fc\u30eb\u306f\u6587\u732e\u691c\u7d22\u306e\u524d\u306b\u958b\u767a\u3055\u308c\u305f\uff08\u8457\u8005\u306e\u9023\u7d61\u5148\u304b\u3089\u53ef\u80fd\u306a\u691c\u7d22\uff09\uff0e<\/p>\n<h3>\u30c7\u30fc\u30bf\u30bd\u30fc\u30b9\u3068\u30ea\u30b5\u30fc\u30c1<\/h3>\n<p>\u3000\u6211\u3005\u306f PubMed (1950 \u2013 2009\/11\/1) \u304a\u3088\u3073 EMBase (1980 \u2013 2009\/11\/1) \u306e\u7cfb\u7d71\u7684\u6587\u732e\u691c\u7d22\u3092\u5b9f\u65bd\u3057\u305f\uff0e\u95a2\u9023\u3059\u308b\u8a18\u8ff0\u306e\u30ec\u30d3\u30e5\u30fc\u539f\u8457\u304a\u3088\u3073\u53c2\u8003\u6587\u732e\u30ea\u30b9\u30c8\u306e\u9375\u3068\u306a\u308b\u539f\u8457\u306f\u3055\u3089\u306b\u95a2\u9023\u51fa\u7248\u7269\u304b\u3089\u691c\u7d22\u3057\u305f\uff0e\u6700\u8fd1\u51fa\u7248\u3055\u308c\u305f\u5c02\u9580\u5bb6\u306b\u3064\u3044\u3066\u306f\u3069\u3093\u306a\u51fa\u7248\u3055\u308c\u3066\u3044\u306a\u3044\u30c7\u30fc\u30bf\u306b\u3064\u3044\u3066\u3082\u63a5\u89e6\u3057\u3066\u540c\u5b9a\u3057\u305f\uff0e2007 \u5e74\u304b\u3089 2009 \u5e74\u306e\u30ea\u30a6\u30de\u30c1\u53ca\u3073\u5fc3\u81d3\u75c5\u5b66\u4f1a (European League Against Rheumatism, Ameican College of Rheumatology, Canadian Rheumatology Association,American College of Cardiology, American Heart Canadian Cardiovascular Society) \u306e\u5e74\u6b21\u7dcf\u4f1a\u306e\u4f1a\u8b70\u6284\u9332\u3082\u30ec\u30d3\u30e5\u30fc\u3057\u305f\uff0e\u8a73\u7d30\u306a\u660e\u7d30\u3084\u7d71\u8a08\u89e3\u6790\u306b\u304a\u3044\u3066\u4ed8\u52a0\u7684\u306a\u60c5\u5831\u304c\u8981\u6c42\u3055\u308c\u308b\u30a4\u30f3\u30b9\u30bf\u30f3\u30b9\u5185\u3067\u5bfe\u5fdc\u3059\u308b\u7b46\u8005\u306b\u76f4\u63a5\u63a5\u89e6\u3057\u305f\uff0e\u30bf\u30a4\u30c8\u30eb\u3084\u6284\u9332\u3067\u4f7f\u308f\u308c\u308b\u30ad\u30fc\u30ef\u30fc\u30c9\u3084\u540c\u7fa9\u8a9e\u3092\u4f7f\u7528\u3059\u308b\u306b\u3042\u305f\u308a\uff0c\u307e\u305f\u533b\u7642\u5bfe\u8c61\u8005\u306e\u898b\u51fa\u3057\u306b\u4f7f\u7528\u3059\u308b\u306b\u3042\u305f\u308a\uff0c\uff13\u3064\u306e\u30c6\u30fc\u30de\u304c\u5275\u9020\u3055\u308c\u305f\uff0e\u305d\u308c\u3089\u306e\u30c6\u30fc\u30de\u306f\u300e\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u300f\u300e\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u300f\u300e\u6297 TNF &alpha; \u6cbb\u7642\u300f\u3067\u3042\u3063\u305f\uff0e\u3053\u308c\u3089\u306e\uff13\u3064\u306e\u30c6\u30fc\u30de\u306f\u6297 TNF &alpha; \u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306b\u767a\u751f\u3059\u308b\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u5831\u544a\u3057\u305f\u7814\u7a76\u3092\u540c\u5b9a\u3059\u308b\u305f\u3081\uff0c\u30d6\u30fc\u30eb\u6f14\u7b97\u5b50\u306e AND \u306b\u3088\u308a\u7d50\u5408\u3057\u3066\u7528\u3044\u3089\u308c\u305f\uff0e\u52a0\u3048\u3066\uff0c\u300e\u6297 TNF \u6cbb\u7642\u300f\u300e\u95a2\u7bc0 \u30ea\u30a6\u30de\u30c1\u300f\u306e\u30c6\u30fc\u30de\u306f\u7d50\u5408\u3055\u308c\uff0c\u6211\u3005\u306fCochrane\u5171\u540c\u8a08\u753b\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u30d5\u30a3\u30eb\u30bf\u30fc\u3092\u9069\u7528\u3057\uff0c\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u3067\u6297 TNF &alpha; \u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u540c\u5b9a\u3057\u305f (9)\uff0e<\/p>\n<h3>\u8a66\u9a13\u306e\u9078\u629e<\/h3>\n<p>\u30002 \u540d\u306e\u8457\u8005 (CB and B-JM) \u306f\u72ec\u7acb\u3057\u3066\u539f\u8457\u3092\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3057\u3066\u5168\u6587\u30ec\u30d3\u30e5\u30fc\u3057\u305f\uff0e\u5168\u30bf\u30a4\u30c8\u30eb\u3068\u8981\u7d04\u3092\u5148\u8ff0\u306e\u691c\u7d22\u65b9\u6cd5\u3067\u53d6\u5f97\u3057\u3066\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3057\u305f\uff0e\u8a00\u8a9e\u306b\u5236\u7d04\u306f\u8a2d\u3051\u306a\u304b\u3063\u305f\uff0e\u539f\u8457\u306b\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u304c\u6297 TNF &alpha; \u6cbb\u7642\u3092\u53d7\u3051\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u3092\u3082\u5831\u544a\u3057\u3066\u3044\u308b\u5831\u544a\u304c\u3042\u308c\u3070\u542b\u3081\u305f\uff0e\u6211\u3005\u306e\u7126\u70b9\u304c\u81e8\u5e8a\u7684\u30a4\u30d9\u30f3\u30c8\u306b\u7f6e\u304b\u308c\u3066\u3044\u305f\u305f\u3081\uff0c\u52d5\u8108\u786c\u5316\u306e\u4ee3\u7406\u30de\u30fc\u30ab\u30fc\u306e\u307f\u3092\u5831\u544a\u3057\u3066\u3044\u308b\u3082\u306e\u306f\u9664\u5916\u3057\u305f\uff0e\u6700\u521d\u306e\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u306b\u304a\u3051\u308b\u8cdb\u540c\u306f 99.7 % \u3067\u3042\u3063\u305f\uff0e\u3069\u3093\u306a\u539f\u8457\u3067\u3042\u308c\u6700\u521d\u306e\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3067\uff12\u540d\u306e\u3044\u305a\u308c\u304b\u306e\u7b46\u8005\u306b\u3088\u308a\u7814\u7a76\u8cea\u554f\u306b\u3068\u3063\u3066\u967d\u6027\u306e\u95a2\u9023\u3092\u6709\u3057\u3066\u3044\u308b\u3068\u3057\u3066\u540c\u5b9a\u3055\u308c\u305f\u3082\u306e\u306f\u5168\u6587\u30ec\u30d3\u30e5\u30fc\u3057\u305f\uff0e<\/p>\n<p>\u3000\u6b21\u306e\u30b9\u30c6\u30c3\u30d7\u3068\u3057\u3066\u5168\u6587\u30ec\u30d3\u30e5\u30fc\u306b\u7740\u624b\u3057\u305f\uff0e\u3053\u306e\u6bb5\u968e\u3067\u306f\uff12\u3064\u306e\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3092\u8003\u616e\u3057\u305f\uff0e\u3064\u307e\u308a\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u3042\u308b\uff0e\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u304c\u6297 TNF &alpha; \u6cbb\u7642\u3068 DMARDs \u3068\u6bd4\u8f03\u3057\u305f\u6cbb\u7642\u3092\u53d7\u3051\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff08\u5fc3\u7b4b\u6897\u585e\uff0c\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\uff0c\u8133\u8840\u7ba1\u969c\u5bb3\uff09\u306b\u3064\u3044\u3066\u8a00\u53ca\u3057\u305f\u30aa\u30ea\u30b8\u30ca\u30eb\u306e\u30c7\u30fc\u30bf\u3092\u5831\u544a\u3057\u3066\u3044\u308c\u3070\uff0c\u539f\u8457\u306b\u306f\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3082\u542b\u307e\u308c\u305f\uff0e\u6211\u3005\u306f\u89b3\u5bdf\u671f\u9593\u304c 26 \u9031\u672a\u6e80\u306e\u5831\u544a\u306f\u9664\u5916\u3057\u305f\uff0e\u3044\u304b\u306a\u308b\u540c\u5b9a\u3055\u308c\u305f\u6709\u52b9\u6027\u3082\u78ba\u5b9f\u3089\u3057\u3044\u3068\u3044\u3046\u3053\u3068\u3068\uff0c\u77ed\u3044\u6cbb\u7642\u671f\u9593\u306b\u304a\u3051\u308b\u5909\u5316\u3067\u306a\u3044\u3068\u4fdd\u8a3c\u3059\u308b\u305f\u3081\u3067\u3042\u308b\uff0e\u7b2c\uff12\u6bb5\u968e\u3067\u89b3\u5bdf\u3055\u308c\u305f\u5408\u610f\u306f 95.9 % \u3067\u3042\u3063\u305f\uff0e\uff12\u540d\u306e\u7b46\u8005\u9593\u3067\u306e\u98df\u3044\u9055\u3044\u306f\uff13\u4eba\u76ee\u306e\u7b46\u8005 (WG) \u3092\u4ea4\u3048\u305f\u5354\u8b70\u306b\u3088\u3063\u3066\u89e3\u6c7a\u3057\u305f\uff0e\u5b9a\u91cf\u7684\u30e1\u30bf\u89e3\u6790\u306b\u542b\u307e\u308c\u305f\u7814\u7a76\u306f\uff0c\u540c\u7b49\u306e\uff12\u7fa4\u9593\u3067\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u306e\u5b9a\u7fa9\u3092\u53ef\u80fd\u306b\u3059\u308b\u305f\u3081\u306e\u5341\u5206\u306a\u30c7\u30fc\u30bf\u3092\u6709\u3057\u3066\u3044\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3068\u3055\u308c\u305f\uff0e<\/p>\n<h3>\u30c7\u30fc\u30bf\u62bd\u51fa\u3068\u54c1\u8cea\u8a55\u4fa1<\/h3>\n<p>\u3000\u30c7\u30fc\u30bf\u306f\u4e21\u8457\u8005\u306b\u3088\u3063\u3066\u72ec\u7acb\u306b\u62bd\u51fa\u3057\u305f\uff0e\u6211\u3005\u306f\u60a3\u8005\u306e\u4eba\u53e3\u52d5\u614b\uff0c\u5834\u6240\u306e\u8abf\u67fb\uff0c\u89b3\u5bdf\u671f\u9593\u3092\u8a18\u9332\u3057\u305f\uff0e\u6bd4\u8f03\u6cbb\u7642\uff08\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u3084 DMARDs\uff09\uff0c\u30ea\u30a6\u30de\u30c1\u306e\u75be\u60a3\u6d3b\u52d5\u6027\u56e0\u5b50\uff0c\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u56e0\u5b50\u307e\u305f\u306f\u65e2\u5b58\u306e\u6761\u4ef6\u3082\u8a18\u9332\u3057\u305f\uff0e\u76f8\u5bfe\u5371\u967a\u5ea6\u307e\u305f\u306f\u30cf\u30b6\u30fc\u30c9\u6bd4\u304a\u3088\u3073\u95a2\u9023\u3059\u308b 95% \u4fe1\u983c\u533a\u9593\u306f\u76f4\u63a5\u62bd\u51fa\u3057\u305f\uff0e\u30a4\u30f3\u30b7\u30c7\u30f3\u30c8\u304c\u5831\u544a\u3055\u308c\u305f\u969b\u306b\u306f\uff0c\u7f79\u60a3\u5bc6\u5ea6\u3068\u305d\u306e\u5206\u6563\u3092\u8a08\u7b97\u3059\u308b\u305f\u3081\u306b\u4e21\u7fa4\u3067\u306e\u30a4\u30d9\u30f3\u30c8\u6570\u3068\u60a3\u8005-\u5e74\u306e\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u3082\u307e\u305f\u62bd\u51fa\u3057\u305f\uff0e\u56de\u5e30\u30e2\u30c7\u30eb\u306b\u304a\u3044\u3066\u8abf\u6574\u5171\u5909\u91cf\u304c\u4f5c\u6210\u3055\u308c\u305f\u5834\u5408\u306b\u306f\u30c7\u30fc\u30bf\u62bd\u51fa\u306e\u969b\u306b\u6700\u3082\u8abf\u6574\u3055\u308c\u305f\u76f8\u5bfe\u5371\u967a\u5ea6\u3068\u540c\u7b49\u306e\u3082\u306e\u3092\u9078\u629e\u3057\u305f\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u7fa4\u3068\u4e00\u822c\u7684\u30ea\u30a6\u30de\u30c1\u6cbb\u7642\u7fa4\u3068\u306e\u6bd4\u8f03\u306b\u304a\u3044\u3066\u306f\u4e00\u822c\u6cbb\u7642\u7fa4\u304c\u7279\u5b9a\u3055\u308c\u306a\u3044\u72b6\u6cc1\u3067\u306f DMARDs \u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u3068\u4eee\u5b9a\u3057\u305f\uff0e\u7814\u7a76\u54c1\u8cea\u3092\u8a55\u4fa1\u3059\u308b\u306e\u306b\u5fc5\u8981\u306a\u60c5\u5831\u306f Egger \u3089\u306b\u3088\u308b\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u305f\u3081\u306e\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u306b\u5f93\u3044\u62bd\u51fa\u3057\u305f (10)\uff0e<\/p>\n<h3>\u30c7\u30fc\u30bf\u5408\u6210\u3068\u7d71\u8a08\u89e3\u6790<\/h3>\n<p>\u3000\u95a2\u9023\u6027\u306e\u5c3a\u5ea6\u3092\u8a08\u7b97\u3059\u308b\u305f\u3081\u306e\u5341\u5206\u306a\u30c7\u30fc\u30bf\u3092\u516c\u8868\u3057\u3066\u3044\u306a\u3044\u7814\u7a76\u306f\u30aa\u30ea\u30b8\u30ca\u30eb\u306e\u51fa\u7248\u3068\u3057\u3066\u516c\u8868\u3055\u308c\u305f\uff0e\u5f7c\u3089\u304c\u540c\u3058\u8ee2\u5e30\u3092\u5831\u544a\u3057\u305f\u3068\u3057\u3066\u3082\uff0c\u6211\u3005\u306f\uff12\u3064\u306e\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3092\uff11\u3064\u306b\u307e\u3068\u3081\u306a\u304b\u3063\u305f\uff0e\u3068\u3044\u3046\u306e\u306f\uff0c\u30e1\u30bf\u89e3\u6790\u306b\u5341\u5206\u306a\u60c5\u5831\u3092\u6301\u3064\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306e\u305f\u3081\u306b\u6211\u3005\u306f\uff0c\u5404\u3005\u306e\u8ee2\u5e30\u306e\u305f\u3081\u306e\u72ec\u7acb\u3057\u305f\u89e3\u6790\u306b\u304a\u3051\u308b\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff0c\u5fc3\u7b4b\u6897\u585e\uff0c\u8133\u8840\u7ba1\u969c\u5bb3\uff0c\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\u306e\u8abf\u6574\u6e08\u307f\u76f8\u5bfe\u5371\u967a\u5ea6\u3092\u5b9a\u7fa9\u3057\u305f\u304b\u3089\u3067\u3042\u308b\uff0e\u30cf\u30b6\u30fc\u30c9\u6bd4\u3068\u7f79\u60a3\u5bc6\u5ea6\u6bd4\u306f\u76f4\u63a5\u76f8\u5bfe\u5371\u967a\u5ea6\u3068\u3057\u3066\u8003\u616e\u3055\u308c\u308b\uff0e\u30aa\u30c3\u30ba\u6bd4\u3068\u3057\u3066\u8868\u73fe\u3055\u308c\u308b\u7d50\u679c\u306f Zhang \u3068 Yu \u306b\u3088\u308a\u8a18\u8ff0\u3055\u308c\u305f\u65b9\u6cd5 (11) \u3067\u76f8\u5bfe\u5371\u967a\u5ea6\u306b\u5909\u63db\u3055\u308c\u305f\uff0e\u30e1\u30bf\u89e3\u6790\u306b\u5341\u5206\u306a\u60c5\u5831\u3092\u6301\u3064\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u305f\u3081\uff0c\u6297 TNF &alpha; \u6cbb\u7642\u7fa4\u3068\u5bfe\u7167\u7fa4\u3068\u306e\u9593\u306e\u30a4\u30d9\u30f3\u30c8\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u3092\u8a08\u7b97\u3057\u305f\uff0e\u6211\u3005\u306f\u30e1\u30bf\u89e3\u6790\u306b\u306f Stata (Stata-Corp) \u30d0\u30fc\u30b8\u30e7\u30f3 10.0 \u3092\u7528\u3044\uff0c\u89b3\u5bdf\u7814\u7a76\u3092\u6a2a\u65ad\u3057\u305f\u5bfe\u6570\u5909\u63db\u3057\u305f\u76f8\u5bfe\u5371\u967a\u5ea6\u3092\u8a08\u7b97\u3057\uff0c\u300e\u3081\u3061\u3083\u304f\u3061\u3083\u306a\u300f\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u305f\u3081\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u3092\u6307\u793a\u3057\u305f\uff0e\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u306e\u305f\u3081\uff0c\u6211\u3005\u306f DerSimonian and Laird random-effect \u30e2\u30c7\u30eb\u3092\u63a1\u7528\u3057\u3066\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u8ee2\u5e30\u3092\u8a55\u4fa1\u3057\uff0cfixed-effect \u30e2\u30c7\u30eb\u3092\u63a1\u7528\u3057\u3066\u5fc3\u7b4b\u6897\u585e\u3068\u8133\u8840\u7ba1\u75be\u60a3\u306e\u8ee2\u5e30\u3092\u8a55\u4fa1\u3057\u305f\uff0e\u6211\u3005\u306f fixed-effects \u30e2\u30c7\u30eb\u3092\u63a1\u7528\u3057\u3066\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u8a55\u4fa1\u3057\u305f\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u304a\u3088\u3073\u5bfe\u6570\u76f8\u5bfe\u5371\u967a\u5ea6\u4e26\u3073\u306b\u305d\u308c\u3089\u306e 95% \u4fe1\u983c\u533a\u9593\u3092\u8981\u7d04\u3059\u308b\u305f\u3081\u306b forest plot \u6cd5\u304c\u958b\u767a\u3055\u308c\u305f\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u304a\u3051\u308b\u7d4c\u6642\u7684\u306a\u30a8\u30d3\u30c7\u30f3\u30b9\u84c4\u7a4d\u52b9\u679c\u3092\u540c\u5b9a\u3059\u308b\u305f\u3081\u306b\uff0c metacum \u306a\u30b3\u30de\u30f3\u30c9\u304c\u4f7f\u308f\u308c\u305f\uff0e<\/p>\n<p>\u3000\u7814\u7a76\u306e\u9593\u306e\u7570\u8cea\u6027\u306f Cochrane Q \u7d71\u8a08\u5024\u304a\u3088\u3073 I<sup>2<\/sup> \u7d71\u8a08\u5024\u3092\u7528\u3044\u3066\u8a55\u4fa1\u3057\u305f\uff0e\uff11\u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u306f Yates \u5909\u63db\u304c\u9069\u7528\u3055\u308c\uff0c\u89e3\u6790\u3092\u5b9f\u884c\u3057\u305f\uff0e\u3068\u3044\u3046\u306e\u306f\u305d\u306e\u7814\u7a76 (Geborek et al, 12) \u306b\u306f\u30a4\u30d9\u30f3\u30c8\u304c\u767a\u751f\u3057\u306a\u304b\u3063\u305f\u305f\u3081\u3067\u3042\u308b\uff0eBegg test \u304a\u3088\u3073 funnel plot \u306b\u3088\u308b\u53ef\u8996\u5316\u89e3\u6790\u306f\u51fa\u7248\u30d0\u30a4\u30a2\u30b9\u3092\u8a55\u4fa1\u3059\u308b\u305f\u3081\u306b\u7528\u3044\u305f\uff0e<\/p>\n<h2>\u7d50\u679c<\/h2>\n<p>\u3000\u5168\u90e8\u3067 5,022 \u306e\u8981\u7d04\u304c\u30c7\u30fc\u30bf\u30d9\u30fc\u30b9\u691c\u7d22\u65b9\u6cd5\u304b\u3089\u540c\u5b9a\u3055\u308c\u305f\uff0e\u4ed8\u52a0\u7684\u306a 7 \u3064\u306e\u51fa\u7248\u7269\u306f\u624b\u52d5\u3067\u306e\u691c\u7d22\u304a\u3088\u3073\u5354\u8b70\u306e\u624b\u7d9a\u304d\u306b\u3088\u308a\u540c\u5b9a\u3055\u308c\u305f\uff0e5,029 \u306e\u8981\u7d04\u306e\u3046\u3061 97 \u7de8\u304c\u5168\u6587\u30ec\u30d3\u30e5\u30fc\u306b\u9078\u629e\u3055\u308c\u305f (Figure 1)\uff0e\u4e88\u3081\u6307\u5b9a\u3057\u3066\u304a\u3044\u305f\u9069\u5408\u57fa\u6e96\u306b\u57fa\u3065\u3044\u3066 16 \u7814\u7a76\u304c\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u306b\u9078\u629e\u3055\u308c\u305f\uff0e\u305d\u308c\u3089\u306e\u7814\u7a76\u306e\u7279\u5fb4\u3092 Table 1 \u306b\u793a\u3057\u305f\uff0e\u8981\u7d04\u3059\u308b\u3068\uff0c\u6211\u3005\u306f 13 \u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\uff08106,202 \u540d\u306e\u60a3\u8005\uff09\u3068 3 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\uff082,126 \u540d\u306e\u60a3\u8005\uff09\u3092\u540c\u5b9a\u3057\u305f\uff0e\u30a4\u30d9\u30f3\u30c8\u306f\u7814\u7a76\u306b\u3088\u3063\u3066\u3070\u3089\u3064\u304d\u304c\u3042\u308a\uff0c\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff085 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304a\u3088\u3073 1 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\uff09\uff0c\u5fc3\u7b4b\u6897\u585e\uff086 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304a\u3088\u3073 2 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\uff09\uff0c\u8133\u8840\u7ba1\u75be\u60a3\uff084 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\uff09\uff0c\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\uff086 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\uff09\u3092\u542b\u3093\u3067\u3044\u305f\uff0e4 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304c\u5168\u3066\u306e\u6297 TNF &alpha; \u6cbb\u7642\u6cd5\u3092\u4f7f\u7528\u3057\u305f\u3068\u5831\u544a\u3057\uff0c5 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304c infliximab \u304a\u3088\u3073 etanercept \u306b\u7279\u5316\u3057\u3066\u5831\u544a\u3057\uff0c4 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306f infliximab, etanercept \u304a\u3088\u3073 adalimumab \u306e\u4f7f\u7528\u3092\u5831\u544a\u3057\u305f\uff0e1 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u304c infliximab, etanercept, adalimumab \u306e\u4f7f\u7528\u3092\u5831\u544a\u3057\u305f\uff0e\u6211\u3005\u306e\u691c\u7d22\u306b\u306f golimumab \u3082\u542b\u307e\u308c\u3066\u3044\u305f\u306b\u3082\u304b\u304b\u308f\u3089\u305a\uff0c\u540c\u5b9a\u3055\u308c\u305f\u7814\u7a76\u306b\u3053\u306e\u85ac\u5264\u3092\u4f7f\u7528\u3057\u305f\u3082\u306e\u306f\u306a\u304b\u3063\u305f\uff0eTable 2 \u306b\u5831\u544a\u3055\u308c\u305f\u30ea\u30b9\u30af\u6e2c\u5b9a\u304a\u3088\u3073\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u306b\u304a\u3051\u308b\u89e3\u6790\u306b\u7528\u3044\u305f\u8abf\u6574\u65b9\u6cd5\u304a\u3088\u3073\u5171\u5909\u91cf\u3092\u793a\u3057\u305f\uff0e\u30c7\u30fc\u30bf\u62bd\u51fa\u3092\u5b9f\u65bd\u3057\u305f\u5f8c\u306b\u30e1\u30bf\u89e3\u6790\u306b\u8010\u3048\u3046\u308b\u3068\u540c\u5b9a\u3055\u308c\u305f\u306e\u306f\uff0c\u305f\u3063\u305f 8 \u7de8\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068 3 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3060\u3051\u3067\u3042\u3063\u305f\uff0e<\/p>\n<h3>\u7814\u7a76\u54c1\u8cea<\/h3>\n<p>\u3000\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306f Egger (10) \u3089\u306b\u3088\u3063\u3066\u63d0\u6848\u3055\u308c\u305f\u8981\u7d20\u306b\u5f93\u3063\u3066\u8a55\u4fa1\u3055\u308c\u305f\uff0eTable 1 \u304a\u3088\u3073 Table 2 \u306b\u7814\u7a76\u54c1\u8cea\u3092\u8a55\u4fa1\u3059\u308b\u306e\u306b\u8981\u6c42\u3055\u308c\u308b\u60c5\u5831\u3092\u307e\u3068\u3081\u3066\u793a\u3059\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306e\u5927\u90e8\u5206\u306b\u304a\u3044\u3066\u306f\u60a3\u8005\u30b5\u30f3\u30d7\u30ea\u30f3\u30b0\u3068\u8ee2\u5e30\u306e\u8a55\u4fa1\u306f\uff0c\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u30c7\u30b6\u30a4\u30f3\u306b\u304a\u3051\u308b\u56fa\u6709\u306e\u9650\u754c\u3092\uff0c\u51fa\u6765\u308b\u3060\u3051\u5ba2\u89b3\u7684\u306b\u4e0e\u3048\u3089\u308c\u308b\uff0e2 \u7de8\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13 (Listing et al, 2008 [13], Dixon et al, 2007 [14]) \u306f\u9ad8\u54c1\u8cea\u3068\u8003\u3048\u3089\u308c\uff0c11 \u7de8\u306f\u4e2d\u7b49\u5ea6\u306e\u54c1\u8cea\u3068\u3055\u308c\u305f\uff0e\u4e2d\u7b49\u5ea6\u306e\u54c1\u8cea\u306e\u9650\u754c\u306e\u5927\u90e8\u5206\u306f\uff0c\u4ee3\u8868\u3068\u30b3\u30db\u30fc\u30c8\u306e\u75be\u60a3\u30b3\u30fc\u30b9\u306b\u304a\u3051\u308b\u6642\u9593\u30dd\u30a4\u30f3\u30c8\u3092\u5b9a\u7fa9\u3059\u308b\u60c5\u5831\u304c\u63d0\u4f9b\u3055\u308c\u306a\u3044\u6b20\u5982\u3067\u3042\u308b\uff0e1 \u3064\u3092\u9664\u3044\u305f\u5168\u3066\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u3068\u3063\u3066\uff0c\u30b3\u30db\u30fc\u30c8\u306b\u7d44\u307f\u5165\u308c\u3089\u308c\u305f\u5f8c\u306e\u6cbb\u7642\u6cd5\u306f\u6a19\u6e96\u5316\u3082\u3055\u308c\u305a\u7121\u4f5c\u70ba\u5316\u3082\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\uff0e\u73fe\u5b9f\u306e\u89b3\u5bdf\u7814\u7a76\u306b\u671f\u5f85\u3055\u308c\u3066\u3044\u308b\u3088\u3046\u306b\uff0e5 \u3064\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306f\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u3067\u306e\u30ea\u30a6\u30de\u30c1\u3084\u5fc3\u8840\u7ba1\u5371\u967a\u56e0\u5b50\u306b\u3064\u3044\u3066\u8abf\u6574\u3057\u3066\u304a\u3089\u305a\uff0c\u3053\u308c\u3089\u306e\u3046\u3061\uff0c\u4e8b\u524d\u306b\u6307\u5b9a\u3057\u305f\u30e1\u30bf\u89e3\u6790\u306e\u305f\u3081\u306e\u9069\u5408\u57fa\u6e96\u306b\u5408\u81f4\u3057\u3066\u3044\u305f\u306e\u306f\u305f\u3063\u305f 3 \u7de8\u3067\u3042\u3063\u305f\uff0e\u5168\u3066\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306f\u9ad8\u54c1\u8cea\u3067\u3042\u308a\uff0c3 \u7de8\u306e\u7814\u7a76\u306f\u76f2\u691c\u5316\uff0c\u7121\u4f5c\u70ba\u5272\u4ed8\uff0c\u8a66\u9a13\u4e2d\u306e\u60a3\u8005\u306e\u6d41\u308c\u3092\u900f\u660e\u5316\u3059\u308b\u5831\u544a\u3068\u3044\u3063\u305f\u30ad\u30fc\u8981\u7d20\u3092\u6709\u3057\u3066\u3044\u305f\uff0e<\/p>\n<h3>\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u7d50\u679c<\/h3>\n<p>\u3000\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff0c\u5fc3\u7b4b\u6897\u585e\uff0c\u8133\u8840\u7ba1\u969c\u5bb3\u3092\u767a\u75c7\u3057\u305f\u4f8b\u306b\u3064\u3044\u3066\u306e\u6297 TNF &alpha; \u6cbb\u7642\u52b9\u679c\u3092 forest plot \u3092 Figure 2 \u306b\u793a\u3059\uff0e\u8981\u7d04\u3059\u308b\u3068\uff0c\u6297 TNF &alpha; \u6cbb\u7642\u306f\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u75c7\u306e\u30ea\u30b9\u30af\u6e1b\u5c11\u3068\u76f8\u95a2\u3057\uff08\u8abf\u6574\u76f8\u5bfe\u5371\u967a\u5ea6\u306f 0.46, 95% \u4fe1\u983c\u533a\u9593\u306f 0.28-0.77\uff09\uff0c\u5fc3\u7b4b\u6897\u585e\u306b\u3064\u3044\u3066\u306f (0.81, 95%CI 0.68-0.96)\uff0c\u8133\u8840\u7ba1\u969c\u5bb3\u306f (0.69, 95%CI 0.53-0.89)\u3067\u3042\u3063\u305f\uff0e\u3053\u308c\u3089\u306e\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306e\u89e3\u6790\u306b\u3088\u3063\u3066\u7814\u7a76\u9593\u306e\u7570\u8cea\u6027\u304c\u660e\u3089\u304b\u306b\u306a\u3063\u305f\uff0e\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306b\u5bfe\u3059\u308b I<sup>2<\/sup> = 89.3%, (\u7570\u8cea\u78ba\u7387 P < 0.001), \u5fc3\u7b4b\u6897\u585e\u306b\u3064\u3044\u3066\u306f I<sup>2<\/sup> = 39.9% (P = 0.139), \u8133\u8840\u7ba1\u75be\u60a3\u306b\u3064\u3044\u3066\u306f I<sup>2<\/sup> = 39.3% (P = 0.176) \u3067\u3042\u3063\u305f\uff0e\u5404\u3005\u306e\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306b\u5bfe\u3057\u3066\u51fa\u7248\u30d0\u30a4\u30a2\u30b9\u3092\u89e3\u6790\u3057\u305f\uff0e\u5916\u89b3\u691c\u67fb\u306f Begg&#8217;s test \u304c\u6709\u610f\u306a\u5024 (P = 0.05) \u3092\u3082\u3063\u3066\u5168\u3066\u306e\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u51fa\u7248\u30d0\u30a4\u30a2\u30b9\u3092\u793a\u5506\u3057\u3066\u3044\u305f\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u306b\u3088\u3063\u3066\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u304c\u5897\u3048\u305f\u3068\u3059\u308b\u5831\u544a\u306f\u5c11\u306a\u304b\u3063\u305f\uff0efunnel plot \u306b\u3088\u308b\u5fc3\u7b4b\u6897\u585e\u3068\u8133\u8840\u7ba1\u75be\u60a3\u306f\u5bfe\u7167\u7684\u3067\u3042\u308a\uff0cBegg&#8217;s test \u306e\u5024\u306f\u305d\u308c\u305e\u308c P = 0.851, P = 0.174 \u3067\u3042\u3063\u305f\uff0e\u5404\u3005\u306e\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306b\u3064\u3044\u3066\u5831\u544a\u3057\u305f\u5c11\u6570\u306e\u7814\u7a76\u3067\u306f\u8996\u899a\u7684\u304b\u3064\u7d71\u8a08\u7684\u306a funnel plot \u306e\u89e3\u91c8\u306b\u9650\u754c\u304c\u3042\u308b\u3068\u5831\u544a\u3057\u3066\u3044\u305f\uff0e<\/p>\n<p>\u3000\u5168\u3066\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u5bfe\u3059\u308b\u7d2f\u7a4d\u30e1\u30bf\u89e3\u6790\u304c\u5b9f\u65bd\u3055\u308c\uff0c\u8ee2\u5e30\u3068\u3057\u3066\u306e\u5fc3\u7b4b\u6897\u585e\u3092\u5831\u544a\u3057\u305f\u7814\u7a76\u306b\u3064\u3044\u3066\u7d4c\u6642\u7684\u306a\u5909\u5316\u304c\u8d77\u304d\u308b\u304b\u8a55\u4fa1\u3057\uff0c\u3053\u306e\u89e3\u6790\u306b\u3088\u3063\u3066\u5e74\u4f59\u306b\u6e21\u308a\u6297 TNF &alpha; \u6cbb\u7642\u3068\u306e\u9593\u306b\u6709\u610f\u306a\u5909\u5316\u306f\u306a\u3044\u3053\u3068\u304c\u660e\u3089\u304b\u306b\u306a\u3063\u305f\uff0e<\/p>\n<p>\u3000\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\u3092\u8ee2\u5e30\u3068\u3057\u3066\u5831\u544a\u3057\u305f\u7814\u7a76\u306b\u304a\u3044\u3066\u306f\u5229\u7528\u306b\u8db3\u308b\u6570\u304c\u5341\u5206\u3067\u306a\u304b\u3063\u305f\u3053\u3068\u3084\uff0c\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306b\u95a2\u3057\u3066\u4e00\u8cab\u6027\u3092\u6b20\u3044\u305f\u5b9a\u7fa9\uff0c\u5354\u4f1a\u306e\u65b9\u5411\u6027\u304c\u4e0d\u78ba\u5b9f\u306b\u53bb\u308b\u306a\u3069\u3057\u305f\u305f\u3081\uff0c\u7740\u624b\u3067\u304d\u306a\u304b\u3063\u305f\uff0e\u6211\u3005\u306f\u305d\u308c\u306b\u3082\u304b\u304b\u308f\u3089\u305a\uff0c\u3053\u306e\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306b\u3064\u3044\u3066\u5831\u544a\u3057\u305f 6 \u3064\u306e\u7814\u7a76\u306b\u95a2\u3059\u308b\u6240\u898b\u3092\u63d0\u4f9b\u3057\u305f\uff0eWolfe and Michaud \u306f\u6297 TNF &alpha; \u6cbb\u7642\u3092\u53d7\u3051\u305f\u7fa4\u3067\u306f DMARDs \u6cbb\u7642\u3092\u53d7\u3051\u305f\u7fa4\u3068\u6bd4\u8f03\u3057\u3066\u5168\u5fc3\u4e0d\u5168\u30a4\u30d9\u30f3\u30c8\u7f79\u60a3\u7387\u304c 1.2 % (95%CI -1.9 &#8211; -0.5) \u6e1b\u5c11\u3059\u308b\u3053\u3068\u3092\u5831\u544a\u3057\u305f\u304c\uff0c\u767a\u751f\u4f8b\u306b\u304a\u3044\u3066\u306f\u6709\u610f\u3067\u306f\u306a\u304b\u3063\u305f (15)\uff0eCarmona \u3089\u306f\u6297 TNF &alpha; \u66dd\u9732\u7fa4\u3068\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u66dd\u9732\u7fa4\u3068\u306e\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\u75c7\u4f8b\u306e\u7387\u6bd4\u304c 0.14 (95%CI 0.06-0.32) \u3067\u3042\u308b\u3068\u540c\u5b9a\u3057\u305f (16)\uff0eListing \u3089\u306e\u30b0\u30eb\u30fc\u30d7\u306f\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\u767a\u75c7\u3057\u305f\u306e\u306f\u6297 TNF &alpha; \u7fa4\u3067\u306f 25 \u540d\u306e\u3046\u3061 16 \u540d\u3067\u3042\u308a\uff0c\u5bfe\u3057\u3066DMARDs \u3067\u30de\u30c3\u30c1\u3055\u305b\u305f\u5bfe\u7167\u7fa4\u3067\u306f 25 \u540d\u4e2d 20 \u540d\u3067\u3042\u3063\u305f\u3068\u540c\u5b9a\u3057\uff0c\u76f8\u5bfe\u5371\u967a\u5ea6\u306f 0.8 (95%CI 0.56-1.14) \u3067\u3042\u3063\u305f (13)\uff0e\u4e00\u65b9\uff0cGole \u3089\u306e\u7814\u7a76\u3067\u306f\u6297 TNF &alpha; \u6cbb\u7642\u7fa4\u3068 DMARDs \u7fa4\u3068\u306e\u9593\u306b\u5fc3\u4e0d\u5168\u767a\u75c7\u7387\u306b\u672c\u8cea\u7684\u306a\u5dee\u7570\u306f\u306a\u3044\u3068\u660e\u3089\u304b\u306b\u306a\u3063\u305f\uff08103 \u540d\u306e\u3046\u3061 7 \u540d\u306b\u5bfe\u3057\u3066 100 \u540d\u306b\u5bfe\u3057\u3066 8 \u540d, \u76f8\u5bfe\u5371\u967a\u5ea6 0.85, 95%CI 0.32-2.26\uff09(17)\uff0e\u4ed6\u306e\uff12\u3064\u306e\u7814\u7a76\u3067\u306f\u6297 TNF &alpha; \u7fa4\u3067\u5fc3\u4e0d\u5168\u306e\u30ea\u30b9\u30af\u304c\u4e0a\u6607\u3057\u305f\uff0eCurtis \u3089\u306f 4.4 \u500d\u306e\u30ea\u30b9\u30af\u4e0a\u6607\u3092\u540c\u5b9a\u3057\uff0cSetoguchi \u3089\u306f\u8abf\u6574\u30cf\u30b6\u30fc\u30c9\u6bd4\u304c 2.1 (95%CI 1.0-4.3) \u3068\u540c\u5b9a\u3057\u305f (18, 19)\uff0e<\/p>\n<h3>\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u7d50\u679c<\/h3>\n<p>\u30003 \u3064\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u30e1\u30bf\u89e3\u6790\u306b\u3088\u308a\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u75c7\u7387\u306e\u76f8\u5bfe\u5371\u967a\u5ea6\u304c\u6297 TNF &alpha; \u7fa4\u306b\u304a\u3044\u3066 DMARDs \u7fa4\u3068\u6bd4\u8f03\u3057\u3066 0.85 (95%CI 0.28-2.59) \u3067\u3042\u308b\u3068\u660e\u3089\u304b\u306b\u306a\u3063\u305f (Figure 3)\uff0e\u3053\u306e 95% \u4fe1\u983c\u533a\u9593\u306f\u3068\u3066\u3082\u5e83\u304f\uff0c\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306e\u30e1\u30bf\u89e3\u6790\u3067\u898b\u3064\u304b\u3063\u305f\u70b9\u63a8\u5b9a\u5024\u3068 1.0 \u306e\u4e21\u8005\u3092\u5305\u542b\u3059\u308b\uff0e\u305d\u306e\u7814\u7a76\u3067\u306f\u540c\u8cea\u3067\u3042\u308b\u3053\u3068\u304c\u660e\u3089\u304b\u306b\u306a\u3063\u305f (I<sup>2<\/sup> = 0%, P = 0.90)\uff0e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306e\u6240\u898b\u304b\u3089\u306f\u7d71\u8a08\u7684\u6709\u610f\u3067\u306f\u306a\u3044\u3082\u306e\u306e\uff0c\u70b9\u63a8\u5b9a\u5024\u306f\u52b9\u679c\u306b\u304a\u3044\u3066\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u540c\u3058\u65b9\u5411\u3092\u793a\u3057\u3066\u304a\u308a\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306b\u304a\u3044\u3066\u306f\u3053\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u5dee\u7570\u3092\u8a55\u4fa1\u3059\u308b\u306b\u306f\u529b\u4e0d\u8db3\u3067\u3042\u308a\uff0c\u6570\u304c\u5c11\u306a\u3059\u304e\u308b\u3053\u3068\u3092\u8a8d\u3081\u3056\u308b\u3092\u3048\u306a\u3044\uff0e<\/p>\n<h2>\u8003\u5bdf<\/h2>\n<p>\u3000\u672c\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30e1\u30bf\u89e3\u6790\u306f\u4f8b\u306e\u4eee\u8aac\u3092\u652f\u6301\u3059\u308b\uff0c\u3064\u307e\u308a\u6297 TNF &alpha; \u88fd\u5264\u306b\u3088\u308b\u6cbb\u7642\u306f\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306e\u5168\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff0c\u5fc3\u7b4b\u6897\u585e\uff0c\u8133\u8840\u7ba1\u75be\u60a3\u306e\u30ea\u30b9\u30af\u6e1b\u5c11\u3068\u76f8\u95a2\u3057\u3066\u3044\u308b\u3068\uff0e\u30ea\u30a6\u30de\u30c1\u60a3\u8005\u306e\u6b7b\u56e0\u306b\u304a\u3044\u3066\u5fc3\u8840\u7ba1\u75be\u60a3\u304c 35-50% \u3092\u5360\u3081\u3066\u3044\u308b\u3053\u3068\u304b\u3089\uff0c\u3053\u306e\u6240\u898b\u306f\u5927\u304d\u306a\u6f5c\u5728\u7684\u91cd\u8981\u6027\u3092\u6709\u3057\u3066\u3044\u308b (20)\uff0e\u5168\u3066\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304c\u793a\u3057\u305f\u3088\u3046\u306b\uff0c\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u8ee2\u5e30\u306b\u3082\u304b\u304b\u308f\u3089\u305a\uff0c\u611f\u5ea6\u5206\u6790\u5f8c\u3082\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u30ea\u30b9\u30af\u6e1b\u5c11\u304c\u8a3c\u660e\u3055\u308c\u305f\uff0e\u66f4\u306b\uff0c\u7d2f\u7a4d\u89e3\u6790\u304c\u8a3c\u660e\u3057\u305f\u3088\u3046\u306b\uff0c\u305d\u306e\u52b9\u679c\u306f\u5e74\u4f59\u306b\u6e21\u308a\u5b89\u5b9a\u3057\u3066\u3044\u305f\uff0e\u5c11\u6570\u306e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3057\u304b\u3053\u306e\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30e1\u30bf\u89e3\u6790\u306e\u9069\u5408\u57fa\u6e96\u306b\u5408\u81f4\u3057\u306a\u304b\u3063\u305f\u306b\u3082\u304b\u304b\u308f\u3089\u305a\uff0c\u70b9\u63a8\u5b9a\u5024\u306e\u65b9\u5411\u306f\u7d71\u8a08\u7684\u6709\u610f\u3067\u306f\u306a\u304b\u3063\u305f\u3082\u306e\u306e\uff0c\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u65b9\u5411\u306b\u4e00\u81f4\u3057\u3066\u3044\u305f\uff0e<\/p>\n<p>\u3000\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u306e\u6240\u898b\u306f\u4e00\u8cab\u6027\u306e\u3042\u308b\u3082\u306e\u304b\uff0c\u4e56\u96e2\u3057\u3066\u3044\u308b\u304b\u7d50\u8ad6\u4ed8\u3051\u308b\u3079\u304d\u3060\u308d\u3046\u304b\uff1f\u7d71\u8a08\u7684\u306b\u306f\u305d\u308c\u3089\u306f\u4e00\u8cab\u3057\u3066\u304a\u3089\u305a\uff0c\u305d\u308c\u3086\u3048\u305d\u308c\u3089\u306f\u540c\u3058\u52b9\u679c\u3092\u8a3c\u660e\u3057\u305f\u3082\u306e\u3068\u4e3b\u5f35\u3055\u308c\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\uff0e\u3057\u304b\u3057\u306a\u304c\u3089\uff0c\u305d\u306e\u30b3\u30db\u30fc\u30c8\u306e\u6709\u52b9\u6027\u306e\u63a8\u5b9a\u5024\u306f\u6709\u610f\u3067\u3042\u308b\u4e00\u65b9\uff0c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u306f\u6709\u610f\u3067\u306a\u3044\uff0e\u5f8c\u8005\u306e\u63a8\u5b9a\u5024\u306f 1.0 \u306b\u8fd1\u3044\uff0eConcato \u3089\u306f\u65e2\u306b\uff0c\u3088\u304f\u30c7\u30b6\u30a4\u30f3\u3055\u308c\u305f\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u306e\u9593\u306e\u4e00\u822c\u7684\u306a\u5408\u540c\u6240\u898b\u306e\u5024\u3068\u95a2\u9023\u6027\u306b\u3064\u3044\u3066\u8b70\u8ad6\u3057\u3066\u3044\u308b (21)\uff0e\u5f7c\u3089\u306f\u6b21\u306e\u3088\u3046\u306b\u63d0\u6848\u3057\u3066\u3044\u308b\uff0e\u305d\u306e\u3088\u3046\u306a\u30b7\u30ca\u30ea\u30aa\u306f\u3088\u304f\u3042\u308b\u3053\u3068\u3067\u3042\u308a\uff0c\u7279\u7570\u7684\u306a\u66dd\u9732\u52b9\u679c\u304c\u95a2\u5fc3\u306e\u3042\u308b\u8ee2\u6a5f\u306b\u3064\u3044\u3066\u7d50\u8ad6\u3059\u308b\u305f\u3081\u306e\u4ed8\u52a0\u7684\u306a\u5805\u7262\u6027\u3092\u63d0\u4f9b\u3057\u3066\u3044\u308b\u3068\uff0e\u3057\u304b\u3057\u306a\u304c\u3089\uff0c\u6211\u3005\u306f &#8220;healthy user effect&#8221; \u306e\u6211\u3005\u306e\u7d50\u679c\u3078\u306e\u5bc4\u4e0e\u306e\u53ef\u80fd\u6027\u306b\u3064\u3044\u3066\u8003\u616e\u3059\u3079\u304d\u3060\u308d\u3046 (22)\uff0e\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u6587\u8108\u306b\u304a\u3044\u3066\u306f &#8220;healthy user&#8221; \u306f\u4e00\u822c\u306b\u82e5\u304f\u5065\u5eb7\u3067\u3042\u308a\uff0c\u3088\u308a\u7a4d\u6975\u7684\u306a\uff08\u6297 TNF &alpha; \u88fd\u5264\u3092\u542b\u3080\uff09\u30ea\u30a6\u30de\u30c1\u7ba1\u7406\u306e\u3088\u3046\u306a\u30d8\u30eb\u30b9\u30b5\u30fc\u30d3\u30b9\u3092\u53d7\u3051\u308b\u50be\u5411\u304c\u3042\u308a\uff0c\u6f5c\u5728\u7684\u306b\u4ed6\u306e\u5fc3\u8840\u7ba1\u56e0\u5b50\u3092\u4fee\u98fe\u3059\u308b\u6cbb\u7642\u3092\u53d7\u3051\u308b\u50be\u5411\u306b\u3042\u308b\uff0e\u3053\u308c\u306f\u6b21\u306e\u3053\u3068\u3092\u6697\u793a\u3057\u3066\u3044\u308b\uff0e\u3064\u307e\u308a\uff0c\u60a3\u8005\u9593\u306e\u7d20\u6750\u306e\u9055\u3044\u304c\u3042\u308a\uff0c\u305d\u308c\u306f\u6297 TNF &alpha; \u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u304b\u305d\u3046\u3067\u306a\u3044\u304b\u306e\u9055\u3044\u3067\u3042\u308a\uff0c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306b\u5bfe\u3057\u3066\u76f8\u5bfe\u7684\u306b\uff08\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u304a\u3044\u3066\u306f\u6e2c\u5b9a\u4e0d\u80fd\u306a\u4ea4\u7d61\u56e0\u5b50\u306f\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u51fa\u6765\u306a\u3044\u305f\u3081\uff09\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u6e1b\u5c11\u306e\u9055\u3044\u3068\u306a\u308b\u3068\uff0e\u89b3\u5bdf\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u306e\u9593\u306e\u52b9\u679c\u306e\u5dee\u7570\u306f\uff0c\u30db\u30eb\u30e2\u30f3\u88dc\u5145\u7642\u6cd5\u306e\u5dee\u3067\u306f\u306a\u3044\u304b\u3068\u306e\u8b70\u8ad6\u3082\u8d77\u304d\u305f (23)\uff0e\u3057\u304b\u3057\u30db\u30eb\u30e2\u30f3\u88dc\u5145\u7642\u6cd5\u306e\u8a18\u9332\u3055\u308c\u305f\u3082\u306e\u3068\u306f\u7570\u306a\u308a\uff0c\u6211\u3005\u306e\u6240\u898b\u306f\u7814\u7a76\u30c7\u30b6\u30a4\u30f3\u3068\u69d8\u3005\u306a\u30e6\u30fc\u30b6\u30fc\u5c64\u3068\u3092\u8d85\u3048\u3066\u4e00\u8cab\u3057\u3066\u3044\u305f\uff0e\u6297 TNF &alpha; \u88fd\u5264\u3068\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u6e1b\u5c11\u3068\u306e\u95a2\u9023\u6027\u306f\u30d8\u30eb\u30b9\u30b1\u30a2\u5206\u914d\u69cb\u9020\u306e\u7570\u306a\u308b\u56fd\u5bb6\u3092\u8d85\u3048\u3066\u4e00\u8cab\u3057\u3066\u3044\u305f (15, 24)\uff0e\u305d\u306e\u52b9\u679c\u306f\u307e\u305f\u793e\u4f1a\u7d4c\u6e08\u7684\u968e\u5c64\u3092\u8d85\u3048\u3066\u4e00\u8cab\u3057\u3066\u304a\u308a\uff0c\u30e1\u30c7\u30a3\u30b1\u30a4\u30c9\u3092\u53d7\u3051\u308b\u3088\u3046\u306a\u60a3\u8005\u3067\u3082\u6297 TNF &alpha; \u6cbb\u7642\u3067\u540c\u3058\u5229\u76ca\u3092\u5f97\u3066\u3044\u308b\u3088\u3046\u306b\u898b\u3048\u305f (19)\uff0e\u305d\u306e\u52b9\u679c\u306f\u5e74\u9f62\u3092\u8d85\u3048\u3066\u4e00\u8cab\u3057\u3066\u304a\u308a\uff0c\u82e5\u5e74\u60a3\u8005\u3084\u9ad8\u9f62\u60a3\u8005\u3044\u305a\u308c\u306b\u304a\u3044\u3066\u3082\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u3092\u6e1b\u5c11\u3055\u305b\u3066\u3044\u305f (14, 16)\uff0e\u6700\u5f8c\u306b\u306a\u308b\u304c\uff0c\u6211\u3005\u306e\u7d2f\u7a4d\u89e3\u6790\u306b\u304a\u3044\u3066\u8a3c\u660e\u3055\u308c\u305f\u3088\u3046\u306b\uff0c\u6211\u3005\u306e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u304c\u51fa\u7248\u3055\u308c\u305f\u6642\u671f\u3092\u8d85\u3048\u3066\u4e00\u8cab\u3057\u3066\u3044\u305f\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u304c\u3082\u3063\u3068\u5e83\u7bc4\u56f2\u306b\u51e6\u65b9\u3055\u308c\uff0c\u3082\u3063\u3068\u60a3\u8005\u96c6\u56e3\u306b\u62e1\u5927\u3059\u308b\u3053\u3068\u3067\uff0c\u6211\u3005\u306f\u305d\u306e\u88fd\u5264\u306e\u4f7f\u7528\u3068\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u6e1b\u5c11\u3068\u306e\u95a2\u9023\u3092\u89b3\u5bdf\u3057\u7d9a\u3051\u305f\uff0e<\/p>\n<p>\u3000\u6211\u3005\u306e\u30ec\u30d3\u30e5\u30fc\u306f\u6f5c\u5728\u7684\u306b\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u539f\u56e0\u3068\u306a\u308b\u6a5f\u5e8f\u3092\u540c\u5b9a\u3057\u3066\u3044\u306a\u3044\uff0e\u75be\u75c5\u7ba1\u7406\u81ea\u4f53\u3092\u6539\u5584\u3055\u305b\u305f\u308a\u708e\u75c7\u30d1\u30e9\u30e1\u30fc\u30bf\u30fc\u3092\u6539\u5584\u3055\u305b\u305f\u308a\u3057\u3066\u3067\u3082\uff0c\u7d50\u679c\u3068\u3057\u3066\u6f5c\u5728\u7684\u306b\u5fc3\u6bd2\u6027\u306e\u3042\u308b\u85ac\u7269\uff0c\u4f8b\u3048\u3070\u6297\u708e\u75c7\u6027\u85ac\u7269\u3084\u526f\u814e\u76ae\u8cea\u30db\u30eb\u30e2\u30f3\u306a\u3069\uff0c\u306e\u4f7f\u7528\u3092\u6e1b\u5c11\u3055\u305b\u3066\u3044\u308b\uff0e\u3042\u308b\u3044\u306f\u6297 TNF &alpha; \u88fd\u5264\u306e\u76f4\u63a5\u306e\u52b9\u679c\u3067\u3042\u3063\u3066\uff0c\u6297 TNF &alpha; \u88fd\u5264\u306b\u3088\u308b\u52d5\u8108\u786c\u5316\u3084\u708e\u75c7\u306e\u4ee3\u7406\u30de\u30fc\u30ab\u30fc\u306e\u6539\u5584\u3092\u898b\u3066\u3044\u308b\u306e\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u57fa\u790e\u79d1\u5b66\u7814\u7a76\u306e\u6587\u8108\u306e\u4e2d\u3067\u8003\u616e\u3055\u308c\u308b\u3079\u304d\u3067\u3042\u308b\uff0e\u6297 TNF &alpha; \u6cbb\u7642\u306f CRP \u306e\u6e1b\u5c11\u3068\u76f8\u95a2\u3057\u3066\u304a\u308a\uff0cCRP \u306f\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u72ec\u7acb\u5371\u967a\u56e0\u5b50\u3068\u3057\u3066\u77e5\u3089\u308c\u3066\u3044\u308b (25, 26)\uff0e\u5f37\u76f4\u6027\u810a\u690e\u708e\u3084\u4ed6\u306e\u708e\u75c7\u6027\u75be\u60a3\u306e\u6cbb\u7642\u306f\uff0c3\u30f6\u6708\u9593\u306e\u6cbb\u7642\u5f8c\u306e\u8102\u8cea\u7d44\u6210\u306b\u304a\u3044\u3066\u30a8\u30bf\u30cd\u30eb\u30bb\u30d7\u30c8\u304c\u8003\u616e\u3059\u3079\u304d\u6539\u5584\u3092\u8a3c\u660e\u3057\u305f (27)\uff0e\u8840\u7ba1\u751f\u7269\u5b66\u7684\u7814\u7a76\u3092\u901a\u3058\u3066 Gonzalez-Juanatey \u3068\u305d\u306e\u7814\u7a76\u8005\u305f\u3061\u306f\u5185\u76ae\u6a5f\u80fd\u306e\u6539\u5584\u3092\u8a3c\u660e\u3057\u305f\uff0e\u305d\u308c\u306b\u306f\u6297 TNF &alpha; \u3092\u542b\u3080\u751f\u7269\u5b66\u7684\u88fd\u5264\u3092\u6295\u4e0e\u3055\u308c\u305f\u60a3\u8005\u306e flow-mediated dilatation \u307e\u305f\u306f carotid intima-media thickness \u3092\u6e2c\u5b9a\u3057\u305f (28, 29)\uff0eEuropean League Against Rheumatism \u306e\u6700\u8fd1\u306e\u63a8\u5968\u3067\u306f\u708e\u75c7\u6027\u95a2\u7bc0\u708e\u306b\u5bfe\u3059\u308b\u65e9\u671f\u306e\u7a4d\u6975\u7684\u6cbb\u7642\u3092\u5f37\u8abf\u3057\u3066\u304a\u308a\uff0c\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u30922\u3064\u306e\u7d4c\u8def\u3067\u4f4e\u4e0b\u3055\u305b\u308b\u76ee\u7684\u3067\u6297 TNF &alpha; \u88fd\u5264\u3068\u30e1\u30bd\u30c8\u30ec\u30ad\u30bb\u30fc\u30c8\u3092\u4f7f\u7528\u3059\u308b\u3053\u3068\u3092\u63a8\u5968\u3057\u3066\u3044\u308b (30)\uff0e1\u756a\u76ee\u306e\u7d4c\u8def\u3068\u306f\u6297 TNF &alpha; \u88fd\u5264\u3067\u708e\u75c7\u3092\u6e1b\u5c11\u3055\u305b\u308b\u3053\u3068\u306b\u3088\u308b\u76f4\u63a5\u52b9\u679c\u3067\u3042\u308a\uff0c2\u756a\u76ee\u306f\u95a2\u7bc0\u708e\u3068\u95a2\u7bc0\u6a5f\u80fd\u3092\u6539\u5584\u3059\u308b\u3053\u3068\u3067\u8eab\u4f53\u6d3b\u52d5\u6027\u304c\u5411\u4e0a\u3057\uff0c\u305d\u306e\u5f8c\u4ed6\u306e\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u56e0\u5b50\uff0c\u4f8b\u3048\u3070\u7cd6\u5c3f\u75c5\u3084\u9ad8\u8840\u5727\u306a\u3069\uff0c\u3092\u6e1b\u5c11\u3055\u305b\u308b\u3053\u3068\u306b\u306a\u308b\uff0e<\/p>\n<p>\u3000\u6211\u3005\u306e\u7814\u7a76\u306b\u306f\uff0c\u30b3\u30db\u30fc\u30c8\u306f\u305d\u308c\u305e\u308c\u306e\u6cbb\u7642\u7fa4\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\uff0c\u6240\u5b9a\u306e\u6cbb\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3044\u308b\u3068\u4eee\u5b9a\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u9650\u754c\u304c\u3042\u308b\uff0eDMARDs \u3084\u4f55\u306e\u88fd\u5264\u306e\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u60a3\u8005\u306e\u5272\u5408\u3092\u8003\u616e\u3057\u305f\u60c5\u5831\u304c\u5229\u7528\u3067\u304d\u306a\u3044\uff0e\u6211\u3005\u306f\u6b21\u306e\u524d\u63d0\u3092\u7f6e\u304f\u3057\u304b\u306a\u304b\u3063\u305f\uff0c\u4e21\u6cbb\u7642\u7fa4\u5171\u306b\u540c\u3058\u304f\u5bdb\u89e3\u3092\u30b4\u30fc\u30eb\u3068\u3057\u3066\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u308b\u3068\uff0e\u6211\u3005\u306f\u6297 TNF &alpha; \u5358\u72ec\u6cbb\u7642\u7fa4\u3068\u305d\u308c\u306b DMARDs \u3092\u4f75\u7528\u3057\u305f\u7fa4\u3068\u3092\u6bd4\u8f03\u3057\u305f\u89e3\u6790\u304c\u3067\u304d\u306a\u304b\u3063\u305f\uff0e\u3068\u3044\u3046\u306e\u306f\u305d\u306e\u60c5\u5831\u304c\u6587\u732e\u304b\u3089\u306f\u63d0\u4f9b\u3055\u308c\u306a\u304b\u3063\u305f\u305f\u3081\u3067\u3042\u308b\uff0e\u30e1\u30bf\u56de\u5e30\u5206\u6790\u3082\u51fa\u6765\u306a\u304b\u3063\u305f\uff0c\u91cd\u8981\u306a\u4f75\u5b58\u75be\u60a3\u3068\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u56e0\u5b50\u306e\u60c5\u5831\u304c\u9650\u5b9a\u3055\u308c\u3066\u3044\u305f\u304b\u3089\u3067\u3042\u308b\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3082\u307e\u305f\u95a2\u5fc3\u306e\u3042\u308b\u8ee2\u5e30\u306e\u30e2\u30c7\u30ea\u30f3\u30b0\u306e\u305f\u3081\u7d71\u8a08\u7684\u306b\u8abf\u6574\u3092\u5909\u5316\u3055\u305b\u305f\uff0e\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u306e\u7d50\u679c\u306e\u30e1\u30bf\u89e3\u6790\u306f\u9650\u5b9a\u7684\u3067\u8457\u660e\u306b\u7570\u8cea\u3067\u3042\u308b\u3053\u3068\u3092\u3082\u6211\u3005\u306f\u8a8d\u3081\u305f\uff0e\u5c11\u306a\u304f\u3068\u3082\u4e00\u90e8\u3067\u306f\uff0c\u5de8\u5927\u306a\u30b5\u30f3\u30d7\u30eb\u30b5\u30a4\u30ba\u304c\u7570\u8cea\u691c\u5b9a\u306b\u306f\u904e\u5270\u3067\u3042\u308b\u3053\u3068\u3092\u8aac\u660e\u3057\u3046\u308b\uff0e\u305d\u308c\u305e\u308c\u306e\u7814\u7a76\u306e\u52b9\u679c\u91cf\u306e visual inspection \u306f\u4e00\u8cab\u3057\u3066\u6297 TNF &alpha; \u6cbb\u7642\u3067\u30a4\u30d9\u30f3\u30c8\u304c\u6e1b\u5c11\u3057\u305f\u3053\u3068\u3092\u8a3c\u660e\u3057\u3066\u304a\u308a\uff0c\u6545\u306b\u30e1\u30bf\u89e3\u6790\u306f\u52b9\u679c\u304c\u5747\u4e00\u306a\u65b9\u5411\u3068\u5224\u65ad\u3055\u308c\u305f\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u308b\uff0e<\/p>\n<p>\u3000\u6297 TNF &alpha; \u306b\u3088\u308b\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306b\u95a2\u3059\u308b\u9650\u754c\u306f\uff0c\u6297 TNF &alpha; \u6cbb\u7642\u306b\u3088\u308b\u77ed\u671f\u6cbb\u7642\u52b9\u679c\u3092\u7b2c 1 \u306b\u5b9f\u65bd\u3057\u3066\u304a\u308a\uff0c\u526f\u4f5c\u7528\u306f secondary end point \u3068\u306a\u3063\u3066\u3044\u308b\u3053\u3068\u306b\u3088\u308b\uff0e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u306f\u9ad8\u5ea6\u306b\u9078\u629e\u3055\u308c\u305f\u96c6\u56e3\u304b\u3089\u306a\u308a\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u304c\u4f4e\u3044\u3088\u3046\u306b\u898b\u3048\u308b\uff0e\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u6211\u3005\u306e\u7814\u7a76\u306b\u542b\u3081\u305f\u5229\u70b9\u306f\uff0c\u526f\u4f5c\u7528\u304c\u53b3\u3057\u3044\u57fa\u6e96\u3067\u5224\u5b9a\u3055\u308c\u308b\u70b9\u306b\u3042\u308a\uff0c\u8ee2\u5e30\u306e\u63d0\u4f9b\u304c\u78ba\u5b9f\u3067\u3042\u308b\u3053\u3068\u3067\u3042\u3063\u305f\uff0e\u305d\u308c\u3089\u306f\u307e\u305f\u6297 TNF &alpha; \u6cbb\u7642\u3068\u6a19\u6e96\u7684\u306a DMARDs \u6cbb\u7642\u3068\u306e\u52b9\u679c\u3092\u76f4\u63a5\u6bd4\u8f03\u3059\u308b\u3053\u3068\u3092\u53ef\u80fd\u306b\u3057\u305f\uff0e<\/p>\n<p>\u3000\u6211\u3005\u306e\u30ec\u30d3\u30e5\u30fc\u6240\u898b\u306b\u3064\u3044\u3066\u306e\u6700\u5f8c\u306e\u6ce8\u610f\u70b9\u3068\u3057\u3066\uff0ccertolizmab \u304c\u6211\u3005\u306e\u7814\u7a76\u3067\u306f\u8003\u616e\u3055\u308c\u3066\u3044\u306a\u3044\u3053\u3068\u3067\u3042\u308b\uff0eCertolizmab \u306f\u627f\u8a8d\u3055\u308c\u305f\u3070\u304b\u308a\u3067\u3042\u308a\uff0c\u6211\u3005\u306e\u30ec\u30d3\u30e5\u30fc\u958b\u59cb\u6642\u306b\u306f\u81e8\u5e8a\u73fe\u5834\u306b\u5e83\u304c\u308a\u59cb\u3081\u305f\u3070\u304b\u308a\u3067\u3042\u308a\uff0c\u6211\u3005\u306e\u691c\u7d22\u65b9\u6cd5\u306b\u306f\u5148\u9a13\u7684\u306b\u542b\u307e\u308c\u3066\u3044\u306a\u304b\u3063\u305f\uff0e\u6211\u3005\u306e\u9069\u5408\u57fa\u6e96\u306b\u5408\u81f4\u3059\u308b certolizmab \u306e\u7814\u7a76\u306f1\u3064\u3060\u3051\u3067\u3042\u308a (31)\uff0c\u3053\u306e\u5831\u544a\u306b\u306f\u6211\u3005\u306e\u30e1\u30bf\u89e3\u6790\u306b\u30a4\u30f3\u30d1\u30af\u30c8\u3092\u4e0e\u3048\u308b\u7d50\u679c\u306f\u306a\u304b\u3063\u305f\uff0e<\/p>\n<p>\u3000\u8981\u7d04\u3059\u308b\u3068\uff0c\u6211\u3005\u306f\u6b21\u306e\u3053\u3068\u3092\u540c\u5b9a\u3057\u305f\uff0c\u6297 TNF &alpha; \u88fd\u5264\u306b\u3088\u308b\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306e\u6cbb\u7642\u306f\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u6e1b\u5c11\u306b\u95a2\u9023\u3057\u3066\u3044\u308b\u3088\u3046\u3067\uff0c\u305d\u306e\u6240\u898b\u306f\u660e\u3089\u304b\u306a\u751f\u7269\u5b66\u7684\u306a\u3082\u3063\u3068\u3082\u3089\u3057\u3055\u3092\u652f\u6301\u3057\u3066\u3044\u308b\uff0e\u6211\u3005\u306f\uff0c\u30ea\u30a6\u30de\u30c1\u306b\u304a\u3051\u308b\u6297 TNF &alpha; \u88fd\u5264\u306e\u5229\u76ca\u306e\u66f4\u306a\u308b\u89b3\u5bdf\u306b\u52aa\u3081\u305f\uff0c\u7279\u306b\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3068\u30b3\u30db\u30fc\u30c8\u306e\u4e21\u8005\u306b\u304a\u3044\u3066\u3088\u308a\u9577\u671f\u9593\u89b3\u5bdf\u3057\u305f\u3082\u306e\u3092\uff0e\u3088\u308a\u9577\u671f\u9593\u89b3\u5bdf\u3059\u308c\u3070\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u6e1b\u5c11\u52b9\u679c\u3092\u3088\u308a\u9855\u8457\u306b\u89b3\u5bdf\u3067\u304d\uff0c\u6297 TNF &alpha; \u6cbb\u7642\u3092\u73fe\u5728\u53d7\u3051\u3066\u3044\u308b\u60a3\u8005\u306f\u76f8\u5bfe\u7684\u306b\u82e5\u304f\uff0c\u6570\u5e74\u5f8c\u306b\u5fc3\u8840\u7ba1\u75be\u60a3\u306b\u7f79\u60a3\u3059\u308b\u3053\u3068\u306f\u306a\u304f\u306a\u308b\u304b\u3082\u77e5\u308c\u306a\u3044\uff0e\u6f5c\u5728\u7684\u306a\u5171\u540c\u8a2d\u7acb\u8005\u304c\u3088\u308a\u8a73\u7d30\u306a\u60c5\u5831\u3092\u63d0\u4f9b\u3059\u308b\u7814\u7a76\u306b\u3088\u308a\uff0c\u3053\u306e\u6587\u732e\u672c\u4f53\u306b\u3088\u308a\u9ad8\u3044\u4fa1\u5024\u3092\u4ed8\u52a0\u3059\u308b\u3053\u3068\u306b\u306a\u308b\u3060\u308d\u3046\uff0e<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>\u3000\u95a2\u7bc0\u30ea\u30a6\u30de\u30c1\u306b\u5bfe\u3059\u308b\u751f\u7269\u5b66\u7684\u88fd\u5264\u306e\u4f7f\u7528\u306f\u708e\u75c7\u3092\u52b9\u7387\u3088\u304f\u6539\u5584\u3055\u305b\u308b\u3060\u3051\u3067\u306a\u304f\uff0c\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u30ea\u30b9\u30af\u3092\u6e1b\u5c11\u3055\u305b\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3068\u3044\u3046\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3067\u3059\uff0e\u89b3\u5bdf\u30b3\u30db\u30fc\u30c8\u8a66\u9a13\u3068\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u9078\u629e\u3057\u305f\u306e\u3067\u3059\u304c\u7121\u4f5c\u70ba\u5316\u6bd4\u8f03\u8a66\u9a13\u3067\u306f &hellip; <a href=\"https:\/\/www.fujiitoshiki.com\/improvesociety\/?p=3619\" class=\"more-link\"><span class=\"screen-reader-text\">&#8220;Systematic Review and Meta-Analysis: Anti-Tumor Necrosis Factor &alpha; Therapy and Cardiovascular Events in Rheumatoid Arthritis&#8221; \u306e<\/span>\u7d9a\u304d\u3092\u8aad\u3080<\/a><\/p>\n","protected":false},"author":1,"featured_media":3762,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[7],"tags":[],"class_list":["post-3619","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-statistics"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/posts\/3619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3619"}],"version-history":[{"count":29,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/posts\/3619\/revisions"}],"predecessor-version":[{"id":3766,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/posts\/3619\/revisions\/3766"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=\/wp\/v2\/media\/3762"}],"wp:attachment":[{"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fujiitoshiki.com\/improvesociety\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}