老年病の縦断的研究 Longitudinal Studies in Geriatric Medicine
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- 上田 一雄 UEDA Kazuo
- 九州大学医療技術短期大学部 School of Health Science, Kyushu University
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著者
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- 上田 一雄 UEDA Kazuo
- 九州大学医療技術短期大学部 School of Health Science, Kyushu University
抄録
老年病学における縦断研究の成果を, 老年者の生命予後と循環器病に関する知見に限定して, 最近の内外の文献を参照しながら述べた. 広義に解釈すると縦断研究にはコホート研究のみならず, 前向き症例-対照研究も含まれる. こうした手法を用いる場合には, 疫学研究のみならず, 臨床的研究でも多数の交絡因子を調整して, 得られた結果の独立性を確認することが常道になりつつある. 老年者の生命予後に関しては, 単に平均余命の延長を評価するのみでは不十分で, QOLが保持されねばならない. 健康度の自己評価度が高く, 栄養状態のパラメターとしてBMIや血清アルブミン値が低値を示さず, 適度な身体活動を保つ群の生命予後が良いことが示されている. 認知能力の低下は老年者のQOLを著しく阻害するが, 痴呆でない状態での平均余命が検討されている. 老年者循環器疾患の危険因子として左室肥大が再び注目を集めている. 頭蓋外アテローム硬化とも関係が深く, アテローム血栓性脳梗塞の危険因子となりうる. 血清脂質は加齢とともに減少するので, 老年者冠状動脈疾患の危険因子としての意義は低いが, 老年者でもインスリン抵抗性の介在する可能性は否定できない. 脳血管障害や冠状動脈疾患の死亡率は先進国では近年減少するが, 地域研究でも発症率の低下が認められている. しかし, 1980年代後半から減少幅が鈍化する傾向にある. 大規模症例-対照研究の結果からは, 血清脂質の改善により冠状動脈疾患を減少させ得ることが示されたが, 老年者での成績は乏しい. 老年者の収縮期性あるいは拡張期性高血圧でも, 管理により脳卒中を中心とする心血管病のリスクを減じうる. 老年者高血圧に対する降圧薬としてACE阻害薬の適性が論じられている.
The results of longitudinal studies in geriatric medicine were reviewed by referring to relatively recent publications. “Longidufinal studies” comprised not only cohort studies but also prospective case-control studies in the broad sense. Poor self-rated health, weight loss, hypoalbuminemia, inability to perform activities of daily living, low levels of physical activity, and cognitive dysfunction, all of which could be manifestations of chronic diseases, might shorten longevity. Cardiomegaly or left ventricular hypertrophy on ECG were again found to be important risk factors for cardiovascular disease in the aged, because of their relation to atherosclerosis. There is no evidence regarding the contribution of hyperlipidemia to the risk of cardiovascular disease in the aged, although insulin resistance can increase serum triglyceride levels and reduced level of high-density lipoprotein cholesterol even in the aged. Mortality due to stroke and heart disease have been decreasing in most developed countries, and several recent community-based studies have also shown decreases in the incidence of cerebral stroke. Large-scale case-control studies on the pharmacological treatment of hyperlipidemia have resulted in both primary and secondary prevention of coronary heart disease. However, information concerning the effects of treatment for hyperlipidemia on coronary heart disease in the aged is limited. Results of large-scale case-control studies indicate that pharmacological treatment of elderly hypertensive patients can reduce cardiovascular morbidity and mortality, and angiotensin-converting enzyme inhibitors have recently been shown ot be useful.
収録刊行物
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- 日本老年医学会雑誌
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日本老年医学会雑誌 35(5), 343-352, 1998-05-25
一般社団法人 日本老年医学会
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鈴木 隆雄
日保学誌 7(3), 133-138, 2004