原因不明不育症

ෘ↢ഭ௛⑼ቇ⎇ⓥ⾌⵬ഥ㊄㧔ሶߤ߽ኅᐸ✚ว⎇ⓥ੐ᬺ㧕
ಽᜂ⎇ⓥႎ๔ᦠ
ಽᜂ⺖㗴㧦ේ࿃ਇ᣿ਇ⢒∝ߦኻߔࠆ⮎‛≮ᴺߩ᦭ലᕈ⺞ᩏ
⎇ⓥಽᜂ⠪ ᧖ᶆ⌀ᑿ ฬฎደᏒ┙ᄢቇᄢቇ㒮කቇ⎇ⓥ⑼ᢎ᝼
⎇ⓥදജ⠪ የፒᐽᒾ ฬฎደᏒ┙ᄢቇᄢቇ㒮කቇ⎇ⓥ⑼⻠Ꮷ
⎇ⓥදജ⠪ ർ᛬⃨ᄩ ฬฎደᏒ┙ᄢቇᄢቇ㒮කቇ⎇ⓥ⑼ഥᢎ
⎇ⓥදജ⠪ ㋈ᧁ⽵ᄦ ฬฎደᏒ┙ᄢቇᄢቇ㒮කቇ⎇ⓥ⑼⻠Ꮷ
⎇ⓥⷐᣦ
ᆄߩᐕ㦂‫ޔ‬ᣢᓔᵹ↥߇ᰴ࿁ᵹ↥ߩ⁛┙ߒߚෂ㒾࿃ሶߢ޽ࠆߎߣ߇᣿ࠄ߆ߦߥߞߚ‫ߒޕ‬
߆ߒ‫⸻ޔ‬ᢿᓟೋ࿁ᅧᆼߦ߅޿ߡ 40 ઍߢ߽ 58㧑߇↢ఽ₪ᓧߢ߈ߚ‫ޕ‬
ᓟᣇⷞ⊛ᬌ⸛߆ࠄࠕࠬࡇ࡝ࡦන⁛‫≮ࡦ࡝ࡄࡋ࡮ࡦ࡝ࡇࠬࠕޔ‬ᴺ‫࠾࠼࡟ࡊ࡮ࡦ࡝ࡇࠬࠕޔ‬
࠱ࡠࡦ≮ᴺ‫≮∉఺ޔ‬ᴺ‫≮࡞࡯࠾ࡃࠪࡇޔ‬ᴺߩ᦭ലᕈߪߥ޿ߎߣ߇᣿ࠄ߆ߦߥߞߚ‫ޕ‬
㧭㧚⎇ⓥ⋡⊛
㧯㧚⎇ⓥ⚿ᨐ
ᣣᧄੱᅚᕈߩᅧᆼᐕ㦂ߪჇടߩ৻ㅜࠍߚߤߞߡ
ᆄߩᐕ㦂‫ޔ‬ᣢᓔᵹ↥߇ᰴ࿁ᵹ↥ߩ⁛┙ߒߚෂ㒾
߅ࠅ‫ޔ‬40 ઍߩਇᅧ‫ޔ‬ਇ⢒ᖚ⠪߇ỗჇߒߡ޿ࠆ‫ߎޕ‬
࿃ሶߢ޽ࠆߎߣ߇᣿ࠄ߆ߦߥߞߚ‫⸻ޔߒ߆ߒޕ‬ᢿ
ࠇࠄߩ 40 ઍਇ⢒∝ᖚ⠪ߩᰴ࿁ᅧᆼᚑഞ₸ࠍ⺑᣿
ᓟೋ࿁ᅧᆼߦ߅޿ߡ 40 ઍߢ߽ 58㧑߇↢ఽ₪ᓧߒ
ߔࠆߚ߼‫ޔ‬ฬฎደᏒ┙ᄢቇߦ߅޿ߡᅧᆼ▤ℂࠍߒ
ߡ޿ࠆߎߣ߇᣿ࠄ߆ߦߥߞߚ‫ޕ‬
ߚᖚ⠪ߩ࠺࡯࠲ࡌ࡯ࠬࠍ↪޿ߡ⸘▚ᑼࠍ▚಴ߒߚ‫ޕ‬
SAS ࠍ↪޿ߚࡠࠫࠬ࠹ࠖ࠶ࠢ⸃ᨆߦࠃߞߡࠕࠬ
߹ߚ‫ޔ‬ᄦ࡝ࡦࡄ⃿఺∉≮ᴺࠍઍ⴫ߣߔࠆߐ߹ߑ߹
ࡇ࡝ࡦන⁛‫≮ࡦ࡝ࡄࡋ࡮ࡦ࡝ࡇࠬࠕޔ‬ᴺ‫ࡇࠬࠕޔ‬
ߥᴦ≮ᴺ߇⹜ߺࠄࠇߡ޿ࠆ߇‫ޔ‬ේ࿃ਇ᣿ߦኻߔࠆ
࡝ࡦ࡮ࡊ࡟࠼࠾࠱ࡠࡦ≮ᴺ‫≮∉఺ޔ‬ᴺ‫࠾ࡃࠪࡇޔ‬
⏕┙ߐࠇߚᴦ≮ᴺߪሽ࿷ߒߥ޿‫ߢߎߘޕ‬ฦᴦ≮ᴺ
࡯࡞≮ᴺߩ᦭ലᕈߪߥ޿ߎߣ߇᣿ࠄ߆ߦߥߞߚ‫ޕ‬
ࠍ⮎‛ᛩਈߥߒ⟲ߣᲧセߒߡ᦭ലᕈ߇޽ࠆ߆ߤ߁
఺∉≮ᴺߪ᦭ᗧᏅߪߥ޿߇ᚑഞ₸߇ૐ޿௑ะߦ޽
߆ࠍᓟᣇⷞ⊛ߦᬌ⸛ߒߚ‫ޕ‬
ߞߚ‫ޕ‬
ᰴ࿁↢ఽ₪ᓧ₸ ps‫⚥ޔ‬Ⓧ↢ఽ₪ᓧ₸ pc ߪ
㧮㧚⎇ⓥᣇᴺ
1990 ᐕ߆ࠄ 2007 ᐕߦਇ⢒∝♖ᩏߩߚ߼ߦฬฎ
ደᏒ┙ᄢቇࠍฃ⸻ߒߚᖚ⠪ߩ߁ߜ᣿ࠄ߆ߥේ࿃ߢ
޽ࠆሶችᄸᒻ‫ޔ‬ᄦᇚᨴ⦡૕⇣Ᏹ‫ޔ‬᛫࡝ࡦ⢽⾰᛫૕
∝୥⟲ࠍ㒰ߊේ࿃ਇ᣿ 1250 ⚵ߩᄦᇚߦߟ޿ߡ⺞
ᩏߒߚ‫ޕ‬ᆄߩᐕ㦂‫ޔ‬ᣢᓔᵹ↥࿁ᢙ‫ࡦ࡝ࡇࠬࠕޔ‬න
⁛‫≮ࡦ࡝ࡄࡋ࡮ࡦ࡝ࡇࠬࠕޔ‬ᴺ‫ࡊ࡮ࡦ࡝ࡇࠬࠕޔ‬
࡟࠼࠾࠱ࡠࡦ≮ᴺ‫≮∉఺ޔ‬ᴺ‫≮࡞࡯࠾ࡃࠪࡇޔ‬ᴺ
ࠍ⮎‛ᛩਈߥߒߣᲧセߒ‫⸃ࠢ࠶ࠖ࠹ࠬࠫࡠޔ‬ᨆࠍ
logit(ps)=3.964-0.0652×(age)-0.408×(previous
number of miscarriages)
logit(pc)=6.806-0.1130×(age)-0.514×(previous
number of miscarriages)
਄⸥ߩ⸘▚ᑼߢ⸘▚ߔࠆߎߣ߇ߢ߈ߚ‫ޕ‬
ⴕߞߚ‫⎇ᧄޕ‬ⓥߪฬฎደᏒ┙ᄢቇ୶ℂᆔຬળߩᛚ
⹺ࠍᓧߚ‫ޕ‬
59
㧰㧚⠨ኤ
ㆊ෰ߩ⎇ⓥ߆ࠄ߽ᅚᕈߩᐕ㦂‫ޔ‬ᣢᓔᵹ↥࿁ᢙ߇
ෂ㒾࿃ሶߢ޽ࠆߎߣߪႎ๔߇޽ߞߚ߇‫ߢ߇⹺⏕ޔ‬
߈ߚ‫ޔߒ߆ߒޕ‬40 ઍߢ߽಴↥น⢻ߢ޽ࠅ‫ࠄ߈޽ޔ‬
߼ࠆᔅⷐߪߥ޿ߣ޿߁ᖱႎឭଏ߇น⢻ߣߥߞߚ‫ޕ‬
ᓥ᧪ߩႎ๔ߢ߽᣿ࠄ߆ߥࠃ߁ߦේ࿃ਇ᣿ਇ⢒∝ߦ
ኻߔࠆ⮎‛ᛩਈߪ᦭ലᕈߪߥ޿ߣ⠨߃ࠄࠇߚ‫఺ޕ‬
∉≮ᴺߦ⥋ߞߡߪᚑഞ₸߇ૐਅߔࠆ௑ะ߽޽ࠅ‫ޔ‬
FDA ߇൘๔ߔࠆࠃ߁ߦᧄ㇌ߢ߽⎇ⓥ⋡⊛એᄖߢ
ⴕࠊߥ޿ߎߣࠍផᅑߔࠆߴ߈ߢ޽ࠆ‫ޕ‬
ᅚᕈߩട㦂߇ਇᅧ∝‫ޔ‬ᵹ↥ߩෂ㒾࿃ሶߢ޽ࠆߎߣ
ߪ᣿⏕ߢ޽ࠅ‫ޔ‬ᅚᕈߦኻߔࠆ໪⊒ߪ㊀ⷐߢ޽ࠆ‫ޕ‬
E. ⚿⺰
ᆄߩᐕ㦂‫ޔ‬ᣢᓔᵹ↥߇ᰴ࿁ᵹ↥ߩ⁛┙ߒߚෂ㒾
࿃ሶߢ޽ࠆߎߣ߇᣿ࠄ߆ߦߥߞߚ‫⸻ޔߒ߆ߒޕ‬ᢿ
ᓟೋ࿁ᅧᆼߦ߅޿ߡ 40 ઍߢ߽ 58㧑߇↢ఽ₪ᓧߢ
߈ߚ‫ޕ‬
ᓟᣇⷞ⊛ᬌ⸛߆ࠄࠕࠬࡇ࡝ࡦන⁛‫࡮ࡦ࡝ࡇࠬࠕޔ‬
ࡋࡄ࡝ࡦ≮ᴺ‫≮ࡦࡠ࠱࠾࠼࡟ࡊ࡮ࡦ࡝ࡇࠬࠕޔ‬ᴺ‫ޔ‬
఺∉≮ᴺ‫≮࡞࡯࠾ࡃࠪࡇޔ‬ᴺߩ᦭ലᕈߪߥ޿ߎߣ
߇᣿ࠄ߆ߦߥߞߚ‫ޕ‬
㧲 ஜᐽෂ㒾ᖱႎ
․ߦߥߒ
㧳㧚⎇ⓥ⊒⴫
1.
⺰ᢥ⊒⴫
Sugiura-Ogasawara M, Ozaki Y, Kitaori T,
Suzumori N, Obayashi S, Suzuki S. Live birth
rate according to maternal age and previous
number of recurrent miscarriages.
Immunol 2009; 62: 314-319.
2.
ቇળ⊒⴫
ߥߒ
㧴㧚⍮⊛⽷↥ᮭߩ಴㗿࡮⊓㍳⁁ᴫ
㧔੍ቯࠍ฽߻‫ޕ‬㧕
1. ․⸵ขᓧ
60
Am J Reprod
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3.
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㔀⹹
⊒⴫⠪᳁ฬ
⺰ᢥ࠲ࠗ࠻࡞ฬ
⊒⴫⹹ฬ
Ꮞภ
ࡍ࡯ࠫ
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