生活習慣病と酸化ストレス防御系(パネルディスカッション : 生活習慣病と心身医学,2007年,第48回日本心身医学会総会(福岡))  [in Japanese] Lifestyle-related Diseases and the Oxidative Stress Regulation System(Panel Discussion : Diseases Related to Lifestyles and Psychosomatic Medicine)  [in Japanese]

目的:生活習慣病の発症には,ホメオスタシスの歪みが問題となる.なかんずく,生体の酸化ストレス防御系は直接的に生活習慣病の発症と関連する.健常者と機能的身体的疾患,生活習慣病,癌関連疾患,精神疾患患者の酸化ストレス防御系について評価した.対象と方法:健常者50例(健常者群),患者群79例(患者群),さらに患者群をその病態により,機能的病態群(30例),器質的病態群(27例),癌関連疾患群(14例),精神疾患群(8例)の4群に分類した.ここで取り上げた症例は,それぞれの疾患において典型的な病態を示した症例とした.酸化ストレス防御系はFRAS 4 (Free Radical Analytical System 4)により測定し,d-ROM test値(酸化ストレス),BAP test値(抗酸化力),修正BAP/d-ROM比(修正比,潜在的抗酸化能)により評価した.結果:日本人の健常者のd-ROM test値は284.6±17.5CARR U, BAP test値は2137.1±228.3μMであり,その比(BAP/d-ROM)は,7.541±0.978であった.したがって,修正BAP/d-ROM比(修正比)=BAP test値/d-ROM test値/7.541で算出できる.修正比は,1.000±0.130であった.修正比が1以上の場合,潜在的抗酸化能が大,1以下の場合,潜在的抗酸化能が小といえる.健常者群に比し,患者群ではd-ROM test値は上昇し,各疾患群とも上昇していた.特に癌関連疾患群で高値を呈した.BAP test値は,患者群で上昇をみたが,各疾患群との比較では,癌関連疾患群のみが上昇していた.修正比は,患者群で低下し,疾患群との比較では機能的病態群以外,すべての疾患群で低下していた(特に癌関連疾患群).同じ疾患でも患者の病態ならびに生活習慣により,変動がみられた.考察:酸化ストレス防御系,特にd-ROM test値,修正比の評価は生活習慣病の早期発見に有用であることが明確になった.生活習慣病の内因的な要素(遺伝,疾患そのもの,睡眠障害)はd-ROMtest値によく反映し,食事内容(量,質)など外因的要素はBAP test値によく反映していた.QOLの高い治療の提供には,酸化ストレス防御系,ことに修正比の評価は欠かせないと考えられた.

Objective : In development of lifestyle-related diseases, imbalance in homeostasis plays some role. Above all, the oxidative stress regulation system of human body is directly involved in development of lifestyle-related diseases. In the present study, we evaluated the oxidative stress regulation system both in healthy subjects and in patients with various diseases such as functional diseases (functional somatic diseases), organic diseases (pathologically organized diseases), lifestyle-related diseases, cancer-related diseases, and psychiatric diseases. Subjects and methods : The subjects comprised 50 healthy volunteers (healthy subject-group) and 79 patients (patient-group, all these patients visited our hospital because of some kind of diseases). The patient-group was fur- ther divided into four groups according to the disease entity : functional disease group (30 cases), organic disease group (27 cases), cancer-related disease group (14 cases), and psychiatric disease group (8 cases). All the patients included in this study met our inclusion criteria of having typical condition of each disease group. As the variables to determine the oxidative stress regulation system, FRAS 4 (Free Radical Analytical System 4), d-ROM test (reactive oxygen metabolites, oxidative stress), BAP test (biological antioxidant potential, anti-oxidant potential) and modified BAP/d-ROM ratio (modified ratio, relative tolerance to oxidative stress) were used. Results : The Japanese healthy subjects showed 284.6±17.5CARR U in d-ROM test and 2137.1±228.3μ in BAP test. The ratio (BAP test value/d-ROM test value) was 7.541±0.978. So modified BAP/d-ROM ratio (modified ratio) is calculated by BAP value/d-ROM value/7.541. The ration is 1.000±0.130. When the modified ratio is bigger than 1.00, it is considered that the relative tolerance to oxidative stress is better, but when it is less than 1.00 the relative tolerance to oxidative stress is poor. As compared to the healthy subject-group, the d-ROM values were higher for all the patient groups. In particular, the value was remarkably higher for the cancer-related disease group. The value of BAP test was also elevated for the patient groups. When classified into each disease group, the elevation was seen only for the cancer-related disease group. The modified ratio was lower for the patient groups. When looking into the results as classified by each disease, the value was lower for all the disease groups except for the functional disease group (in particular, lower value was recorded for the cancer-related disease group). Even in patients with the same disease, variations in values were seen according to the disease entity and lifestyle of each patient. Discussion : It was shown from the present study that evaluation of the oxidative stress regulation system, in particular determination of d-ROM test value and modified ratio, is useful for early detection of lifestyle-related diseases. Endogenous factors of lifestyle-related diseases (heredity, disease itself, sleep disturbance) are well reflected in d-ROM test results, while exogenous factors such as contents of meals (quantity and quality) are in the results of BAP tests. It is considered that evaluation of the oxidative stress regulation system, in particular determination of modified ratio, is essential for providing treatment of high QOL.