研究者詳細 - 髙原　政宏

論文 - 髙原　政宏

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大腸内視鏡を用いた急性GVHDの診断における「回腸末端の絨毛の萎縮」の臨床的意義後方視的多施設共同研究

杉原雄策, 平岡佐規子, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 森藤由紀, 高橋索真, 桑木健志, 原田馨太, 藤井伸治, 田中健大, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.2 ) 2238 - 2238 2017年9月

術前精査でSM癌と診断した大腸腫瘍の行く末

原田馨太, 赤穂宗一郎, 榮浩行, 高嶋志保, 井口俊博, 竹井大介, 杉原雄策, 高原政宏, 平岡佐規子, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.2 ) 2174 - 2174 2017年9月

POEM(Per-Oral Endoscopic Myotomy)を施行した食道アカラシアの1例

杉原雄策, 原田馨太, 加藤諒, 山内健司, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 川野誠司, 平岡佐規子, 田辺俊介, 野間和宏, 白川靖博, 眞部紀明, 井上晴洋, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 115 - 121 2017年8月

記述言語：日本語出版者・発行元：岡山医学会

39歳男。食事摂取後の嚥下困難を主訴に近医受診し、上部消化管内視鏡検査で食道アカラシアと診断され、精査加療目的に当院紹介となった。食道X線造影検査(バリウム50ml内服)で食道内に5分間以上のバリウム停滞を認め、異常蠕動を認めた。高解像度食道内圧検査(嚥下試験)で下部食道の収縮圧は24mmHgであり、胃食道接合部の弛緩は認めなかった。これらの所見から、食道アカラシアのシカゴ分類type Iと診断し、POEMを施行した。翌日の食道X線造影検査でバリウムは速やかに胃内へ流入することが確認され、その後の経過も良好で、術後4日目に退院となり、1年後の現在まで症状の再燃は認めていない。

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Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice. 査読国際誌

Kato R, Harada K, Harada K, Takei D, Sugihara Y, Takashima S, Inokuchi T, Takahara M, Hiraoka S, Omura Y, Oda W, Okada H

Case reports in gastroenterology 11 ( 2 ) 271 - 276 2017年5月

Mucosectom2とSB knife Jr.の大腸の粘膜下層剥離術における前向き無作為比較試験

杉原雄策, 原田馨太, 河原祥朗, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 桑木健志, 平岡佐規子, 岡田裕之

Gastroenterological Endoscopy 59 ( Suppl.1 ) 944 - 944 2017年4月

P2-10 慢性腸炎マウスモデルにおけるベルベリンの改善効果と作用機序の検討

高原政宏, 高木章乃夫, 平岡佐規子, 池田愛璃, 足立卓哉, 松下浩志, 小池和子, 岡田裕之

日本臨床免疫学会会誌 40 ( 4 ) 311b - 311b 2017年

記述言語：日本語出版者・発行元：日本臨床免疫学会

<p>【背景】生薬であるベルベリン（BBR）は下痢止めとして臨床応用されているが，抗炎症など多彩な作用も有することが明らかになっている．BBRは細胞のエネルギーの調節因子であるAMPKを活性化させることが知られており，近年，このAMPKがT細胞を含む免疫細胞の応答に関わっていることが報告されている．【目的，方法】慢性腸炎マウスモデルを用いて，大腸炎粘膜のCD4⁺T細胞（LP CD4⁺T細胞）におけるBBRの抗炎症作用とその機序についての検証をin vitroおよびIn vivoで行う．1）CD4⁺CD45RB^highT細胞移入腸炎マウスのLPCD4⁺T細胞をPMA/Ionomysinで刺激し，IFN-γ産生細胞を誘導，BBRの効果について，AMPKの関与も含めて検討．2）上記腸炎マウスにBBRを含んだ餌を投与し，腸炎の抑制効果について検討．【結果】1）LP CD4⁺T細胞はBBRと共培養すると，IFN-γ産生細胞が優位に低下し，ウェスタンブロッティングでは，AMPKの活性化を認めた．次に，AMPKのagonistとantagonistを用いた培養系でIFN-γの産生を調べたところ，agonistで抑制，antagonistで増加を認めた．以上から，BBRにより活性化されたAMPKがIFN-γを制御していることが示唆された．2）上記腸炎マウスにBBRを経口投与した結果，腸炎は優位に抑制された．【結論】BBRは，慢性腸炎マウスモデルの腸炎を抑制し，その作用機序の一つとしてAMPKを介した機序が示唆された．</p>

DOI： 10.2177/jsci.40.311b

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家族性大腸腺腫症術後20年後に小腸癌を発症した1例

杉原雄策, 川野誠司, 原田馨太, 高嶋志保, 竹井大介, 井口俊博, 高原政宏, 平岡佐規子, 母里淑子, 岸本浩行, 永坂岳司, 岡田裕之

岡山医学会雑誌 129 ( 2 ) 111 - 114 2017年

記述言語：日本語出版者・発行元：岡山医学会

&emsp;A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.

DOI： 10.4044/joma.129.111

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POEM (Per-Oral Endoscopic Myotomy) を施行した食道アカラシアの1例

岡山医学会雑誌 129 ( 2 ) 115 - 121 2017年

記述言語：日本語出版者・発行元：岡山医学会

&emsp;Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.

DOI： 10.4044/joma.129.115

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その他リンク： http://search.jamas.or.jp/link/ui/2017339773

Consecutive Measurements by Faecal Immunochemical Test in Quiescent Ulcerative Colitis Patients Can Detect Clinical Relapse 査読国際誌

Sakiko Hiraoka, Jun Kato, Asuka Nakarai, Shiho Takashima, Toshihiro Inokuchi, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada

JOURNAL OF CROHNS & COLITIS 10 ( 6 ) 687 - 694 2016年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：OXFORD UNIV PRESS

We have reported that results of the quantitative faecal immunochemical test (FIT; haemoglobin concentrations in faeces measured using an antibody for human haemoglobin) effectively reflect the mucosal status of ulcerative colitis (UC). The aim of this study was to evaluate the predictability of flare-up in quiescent UC patients by consecutive FIT evaluation.
Patients with UC who fulfilled the following criteria by index colonoscopy were enrolled: clinical remission; mucosal healing (Mayo endoscopic subscore 0); and negative FIT (less than 100ng/mL). These patients were followed up prospectively every 1-3 months by monitoring patient symptoms and FIT results between index and subsequent colonoscopies.
The intervals between 2 colonoscopies (median 2.51 years) of 83 patients (49 males, median age at onset 34 years, median disease duration 9.74 years) were analysed. None of the 43 (52%) patients who maintained negative FIT throughout the observation period exhibited clinical relapse. On the other hand, 25/40 (63%) patients who showed positive conversion of FIT during the period experienced relapse. The cutoff FIT value of 450ng/mL could predict relapse with 73% positive predictive value and 96% negative predictive value. Moreover, positive conversion of FIT preceded occurrence of symptoms by 1 month or more in nearly one-third of patients with relapse.
Consecutive measurements of FIT in quiescent UC patients who achieved mucosal healing with negative FIT would help identify patients with clinical relapse whose symptoms had not yet presented. Further investigations are required for more precise prediction of relapse with this modality.

DOI： 10.1093/ecco-jcc/jjw025

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Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse 査読国際誌

Asuka Nakarai, Jun Kato, Sakiko Hiraoka, Shiho Takashima, Daisuke Takei, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada

WORLD JOURNAL OF GASTROENTEROLOGY 22 ( 21 ) 5079 - 5087 2016年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BAISHIDENG PUBLISHING GROUP INC

AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.
METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.
RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations <= 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).
CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.

DOI： 10.3748/wjg.v22.i21.5079

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Fecal Immunochemical Test Versus Fecal Calprotectin for Prediction of Mucosal Healing in Crohn's Disease 査読国際誌

Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Shiho Takashima, Asuka Nakarai, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Seiji Kawano, Keita Harada, Hiroyuki Okada

INFLAMMATORY BOWEL DISEASES 22 ( 5 ) 1078 - 1085 2016年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Background: Mucosal healing (MH) has been proposed as a treatment goal of inflammatory bowel disease patients. We reported recently that not only fecal calprotectin (Fcal) but also the fecal immunochemical test (FIT) can predict MH in ulcerative colitis. However, the predictive power of the fecal markers for MH in Crohn's disease (CD), particularly with small bowel lesions, has not been reported in detail. The aim of this study was to evaluate the predictability of FIT versus Fcal for MH in CD.
Methods: Consecutive CD patients underwent colonoscopy or balloon-assisted enteroscopy according to the disease location. FIT and Fcal were examined using stool samples collected the day before endoscopy.
Results: Seventy-one CD patients were analyzed, of whom 42 (59%) underwent balloon-assisted enteroscopy because of the presence of affected lesions in the small intestine. Both the Fcal and the FIT results were significantly correlated with endoscopic activity (r = 0.67 and 0.54, respectively). However, the FIT results did not correlate with the activity in patients with small bowel lesions alone, whereas Fcal did (r = 0.42 versus 0.78). Fcal predicted MH in CD with 87% sensitivity and 71% specificity, whereas the values for FIT were 96% and 48%, respectively. The specificity for MH among patients with small bowel lesions alone was low for FIT (40%) compared with Fcal (80%).
Conclusions: Both FIT and Fcal were correlated with the mucosal status of CD. However, the specificity of FIT was not satisfactory, particularly for small bowel lesions.

DOI： 10.1097/MIB.0000000000000728

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【IBD治療のcritical point-私ならこうする】潰瘍性大腸炎ステロイド依存性の見極めと治療方針チオプリン製剤による寛解維持療法

井口俊博, 平岡佐規子, 高嶋志保, 半井明日香, 高原政宏, 岡田裕之

臨床消化器内科 31 ( 6 ) 655 - 659 2016年5月

記述言語：日本語出版者・発行元：(株)日本メディカルセンター

チオプリン製剤は潰瘍性大腸炎においてステロイド依存例に対するステロイド減量効果,および寛解維持効果を有する貴重な薬剤である.活性体である6-TGN(6-thioguanine nucleotide)に変換され安定して薬効を発揮するまでに時間が必要であり,しばしば副作用を伴うことから使用に当たり習熟が不可欠である.しかし投与開始後から慎重にモニタリングを行うことで対応可能であり,その有効性,利便性,医療経済の観点から抗TNFα抗体製剤に優先してチオプリン製剤を活用すべきである.(著者抄録)

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EMR手技のスキルアップを目指してスネア先端を用いたprecutting EMRのススメ

原田馨太, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 平岡佐規子, 河原祥朗, 岡田裕之

日本大腸検査学会雑誌 32 ( 2 ) 127 - 127 2016年3月

同種造血幹細胞移植施行後GVHD症例の重症度・治療反応性は、回腸末端の内視鏡所見より予測できるか?

杉原雄策, 平岡佐規子, 高嶋志保, 竹井大介, 半井明日香, 高原政宏, 原田馨太, 岡田裕之, 山本和秀, 田中健大

Gastroenterological Endoscopy 57 ( Suppl.2 ) 2132 - 2132 2015年9月

Evaluation of Mucosal Healing in Ulcerative Colitis by Fecal Calprotectin Vs. Fecal Immunochemical Test 査読国際誌

Shiho Takashima, Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Daisuke Takei, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Hiroyuki Okada, Takehiro Tanaka, Kazuhide Yamamoto

AMERICAN JOURNAL OF GASTROENTEROLOGY 110 ( 6 ) 873 - 880 2015年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：NATURE PUBLISHING GROUP

OBJECTIVES: We previously showed that a quantitative fecal immunochemical test (FIT) can predict mucosal healing (MH) in ulcerative colitis (UC). Fecal calprotectin (Fcal) has also been reported as an important biomarker of UC activity. The aim of this study was to compare the predictive ability of these two fecal markers for MH in UC.
METHODS: FIT and Fcal were examined in stool samples from consecutive UC patients who underwent colonoscopy. Mucosal status was assessed via the Mayo endoscopic subscore (MES).
RESULTS: In total, 105 colonoscopies in 92 UC patients were evaluated in conjunction with the FIT and Fcal results. Both FIT and Fcal results were significantly correlated with MES (Spearman's rank correlation coefficient: 0.61 and 0.58, respectively). The sensitivity and specificity of the FIT values (<100 ng/ml) for predicting MH (MES 0 alone) were 0.95 and 0.62, respectively, whereas those of Fcal (<250 mu g/g) were 0.82 and 0.62, respectively. The sensitivities became similar when MH was defined as MES 0 or 1 (0.86 vs. 0.86). Although the predictability of MH evaluated by the area under the receiver operating characteristics curve was similar for the two fecal markers (FIT 0.83 vs. Fcal 0.82 for MES 0 alone), the FIT results were relatively robust regardless of the cutoff value selected.
CONCLUSIONS: Both FIT and Fcal can efficiently predict MH in UC, but FIT appears to be more sensitive than Fcal for predicting MES 0 alone.

DOI： 10.1038/ajg.2015.66

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TNFAIP3 promotes survival of CD4 T cells by restricting MTOR and promoting autophagy. 査読国際誌

Yu Matsuzawa, Shigeru Oshima, Masahiro Takahara, Chiaki Maeyashiki, Yasuhiro Nemoto, Masanori Kobayashi, Yoichi Nibe, Kengo Nozaki, Takashi Nagaishi, Ryuichi Okamoto, Kiichiro Tsuchiya, Tetsuya Nakamura, Averil Ma, Mamoru Watanabe

Autophagy 11 ( 7 ) 1052 - 1062 2015年6月

直腸肛門部腫瘍の術後吻合部狭窄に対する、内視鏡的新規治療RIC法応用の試み

原田馨太, 岡田裕之, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 川野誠司, 平岡佐規子, 河原祥朗, 近藤喜太, 山本和秀

Gastroenterological Endoscopy 57 ( Suppl.1 ) 927 - 927 2015年4月

内視鏡的粘膜下層剥離術(ESD)が施行された大腸T1(SM)癌の治療成績と予後の検討

榮浩行, 原田馨太, 浦岡俊夫, 高嶋志保, 井口俊博, 竹井大介, 杉原雄策, 半井明日香, 高原政宏, 小林沙代, 高橋索真, 齊藤俊介, 堀井城一朗, 東玲治, 平岡佐規子, 岡田裕之, 山本和秀

Gastroenterological Endoscopy 57 ( Suppl.1 ) 804 - 804 2015年4月

潰瘍性大腸炎患者における大腸腫瘍性病変の内視鏡治療当院の現況

原田馨太, 平岡佐規子, 高嶋志保, 竹井大介, 井口俊博, 半井明日香, 杉原雄策, 高原政宏, 衣笠秀明, 川野誠司, 河原祥朗, 岡田裕之, 山本和秀

日本消化器病学会雑誌 112 ( 臨増総会 ) A496 - A496 2015年3月

IL-7 promotes long-term in vitro survival of unique long-lived memory subset generated from mucosal effector memory CD4+ T cells in chronic colitis mice. 査読国際誌

Masahiro Takahara, Yasuhiro Nemoto, Shigeru Oshima, Yu Matsuzawa, Takanori Kanai, Ryuichi Okamoto, Kiichiro Tsuchiya, Tetsuya Nakamura, Kazuhide Yamamoto, Mamoru Watanabe

Immunol. Lett. 156 ( 1-2 ) 82 - 93 2013年11月

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