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[ 代謝･内分泌 ]
Posted;2005年01月24日
ボツリヌス毒素の効能
ボツリヌス毒素を弱っている患者に注射すると言うと「何をするんだ！」と思う人は多いかもしれない。しかし、毒は薬にもなり、薬は毒にもなるものだ。ジョン・ホプキンス大学の研究者は1型糖尿病患者の悪心と嘔吐が幽門（胃の出口部分）へのボツリヌス毒素注射で改善することを報告した。
糖尿病患者では胃の動きが悪くなり、悪心や嘔吐で苦しむ者がいる。このような糖尿病胃不全麻痺が生じる原因のひとつとして幽門の痙攣があげられている。研究者らは、ボツリヌス毒素が平滑筋のアセチルコリン放出を抑制して一過性の麻痺を引き起こすことに着目し、実際に注射してみたようだ。幽門が一時的に麻痺すれば、痙攣して出口が狭まっていたために起こる胃内容物の排出遅延が軽減されると考えたのだ。
「Diabetes Care」10月号の報告によると、胃不全麻痺で苦しむ1型糖尿病患者8名（女性6名、平均年齢41歳、罹病期間25年）を対象に、プロスペクティブな検討を行ったそうだ。
検討の結果、ボツリヌス毒素注射によって幽門の痙攣が低下していることが確認され、ボツリヌス毒素は、標準治療（胃運動促進薬など）に今まで反応しなかった患者の症状を改善することがわかった。
ボツリヌス毒素を注射してから最初の1週間がもっとも症状の軽減効果が高かったが、症状を緩和する効果は7ヶ月間にわたって認められた。
▼【PubMed】Diabetes Care. 2004 Oct;27(10):2341-7.
The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus.
===========
ボツリヌス菌を投与すると言われて不安をつのらす患者の顔が思い浮かぶ。「毒をもって病を制す」という言葉を思い浮かべながら、”毒”を注射する臨床試験のインフォームドコンセント（患者の同意）をどうやって得たのだろうか？
糖尿病患者の胃腸障害は、臨床上大きな問題だが、（取り上げられているのかもしれないが・・・・）大きく取り上げられることは少ないように思う。
糖尿病というと血糖管理がまず第一の治療として思い浮かぶが、胃腸障害が血糖管理を難しくしている一面もあるだろう。もっと糖尿病胃腸障害と血糖管理の関係について積極的に論じられてもいいはずだ。そんなことを考えた。
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| ■ Unknown | |
| お疲れ様です。ボツリヌス毒素を過緊張の治療に用いるのは『神経毒』としての薬理作用から、以前から関心を引いているところですが、例えば脳性マヒなどがベースにあって痙性斜頸などの疼痛で困っている方に『ボツリヌス毒素』筋注したりはするのですが、局所に注射しても全身に作用することもあり、副作用として嚥下困難や力が入りにくいなどの症状が出ることがあります。また、幽門部に注射をするということは一回一回胃カメラとか場合によっては腹腔鏡とかで見ながら注射するんでしょうか？負担も大きい気がしますが… | |
| ひろふみ (2005-01-29 13:20:44) |
| ■ Unknown | |
| 薬物療法に比べると標準治療とは言いにくいですが、確立された治療法だと思います。商品名は『ボトックス』として一部疾患に保険適応もありますが、施用する医師に資格的制限があります。一般には斜頸などよりも『シワ』をとる美容形成で使われることで知られているかと思います。多分使用量は圧倒的にこちらが多いのではないかと。 | |
| ひろふみ (2005-02-01 23:05:33) |
| ■ Dana Jensen | |
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| ■ Dana Jensen | |
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| ■ Dana Jensen | |
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| ■ Brock Madden | |
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| ■ Brock Madden | |
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| ■ Stanton Guy | |
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| ■ Stanton Guy | |
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| ■ Diego Holman | |
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| ■ Diego Holman | |
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| ■ Bennie Gibson | |
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| ■ Bennie Gibson | |
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| ■ Alexis England | |
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| ■ Alexis England | |
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| ■ Jamie Lewis | |
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| ■ Jamie Lewis | |
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| ■ Alejandro Hendrix | |
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| ■ Alejandro Hendrix | |
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| ■ Rachael Carrillo | |
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| ■ Rachael Carrillo | |
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| ■ Buddy Bridges | |
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| ■ Buddy Bridges | |
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| ■ Chip Mcfadden | |
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| ■ Chip Mcfadden | |
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| ■ Jacky Boyd | |
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| ■ Jacky Boyd | |
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| Treva Maxwell (2007-10-01 04:21:45) |
| ■ Bertram Clements | |
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| Nicholas Baker (2007-10-03 03:27:04) |
| ■ Bertram Clements | |
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| Nicholas Baker (2007-10-03 03:27:08) |
| ■ Jerrold Townsend | |
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| Katy Barnes (2007-10-03 19:52:21) |
| ■ Jerrold Townsend | |
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| Katy Barnes (2007-10-03 19:52:25) |
| ■ Kerry Cruz | |
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| Alyson Drake (2007-10-06 03:08:06) |
| ■ Kerry Cruz | |
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| ■ Dwain Gay | |
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| ■ Dwain Gay | |
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| Gwen Brewer (2007-10-06 06:22:19) |
| ■ Dominic Lawson | |
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| Sondra Wiggins (2007-10-06 21:37:30) |
| ■ Dominic Lawson | |
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| Sondra Wiggins (2007-10-06 21:37:31) |
| ■ Renita Fuentes | |
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| Gabrielle Le (2007-10-08 01:03:07) |
| ■ Renita Fuentes | |
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| Gabrielle Le (2007-10-08 01:03:13) |
| ■ Eunice Reese | |
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| Jess Knapp (2007-10-08 20:56:34) |
| ■ Eunice Reese | |
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| Jess Knapp (2007-10-08 20:56:36) |
| ■ Leah Matthews | |
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| Rick Mitchell (2007-10-13 06:39:08) |
| ■ Leah Matthews | |
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| Rick Mitchell (2007-10-13 06:39:26) |
| ■ Earl Sharpe | |
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| Carson Buckner (2007-10-13 21:22:48) |
| ■ Earl Sharpe | |
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| Carson Buckner (2007-10-13 21:23:48) |
| ■ Janette Dale | |
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| Sean Glenn (2007-10-16 05:58:54) |
| ■ Janette Dale | |
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| Sean Glenn (2007-10-16 05:59:17) |
| ■ Robby Summers | |
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| Kennedy Bell (2007-11-14 20:34:45) |
| ■ Robby Summers | |
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| Kennedy Bell (2007-11-14 20:35:01) |
| ■ Laurel Copeland | |
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| Johnnie Wheeler (2007-11-26 02:03:29) |
| ■ Laurel Copeland | |
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| Johnnie Wheeler (2007-11-26 02:03:31) |
| ■ Angelique Hodges | |
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| Rona Robles (2007-11-26 05:34:12) |
| ■ Angelique Hodges | |
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| Rona Robles (2007-11-26 05:34:16) |
| ■ Brandon Hopper | |
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| Neal Pate (2007-11-27 00:24:59) |
| ■ Brandon Hopper | |
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| Neal Pate (2007-11-27 00:25:01) |
| ■ Alexis Serrano | |
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| Lance Cooper (2007-11-27 11:09:28) |
| ■ Alexis Serrano | |
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| Lance Cooper (2007-11-27 11:09:29) |
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| Francine Spencer (2007-11-27 20:55:01) |
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| Francine Spencer (2007-11-27 20:55:03) |
| ■ Travis Cross | |
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| Angelina Morris (2007-11-28 07:30:39) |
| ■ Travis Cross | |
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| Angelina Morris (2007-11-28 07:30:40) |
| ■ Lily Hurley | |
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| Marion Jordan (2007-11-28 21:21:53) |
| ■ Lily Hurley | |
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