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腸肝在位Helicobacter cinaedi 感染症の臨床学的特徴、感染経路、検査法についての研究

荒岡, 秀樹 東京大学 DOI:10.15083/0002006990

2023.03.24

概要

[課程-2]
審査の結果の要旨
氏名 荒岡 秀樹
本研究は、腸肝在位 Helicobacter cinaedi 感染症の臨床学的特徴、感染経路、検査法に
ついて解析を試みたものであり、下記の結果を得ている。
1.

H. cinaedi 菌血症の感染経路についての研究:血液培養から検出した H. cinaedi と
便培養から検出した H. cinaedi の相同性を評価するためにパルスフィールドゲル電
気泳動法(PFGE)を実施した。研究期間内に得られた菌株のなかで、評価可能で
あった 9 患者、18 株の検討では、便由来の H. cinaedi と血液由来の H. cinaedi の
PFGE 型は一致した。菌血症の 1 つの主要な感染経路として、腸管から血液中への
bacterial translocation が起きていることが示唆された。

2.

H. cinaedi 菌血症の臨床的特徴についての研究:菌血症の再発に焦点をあてて研究
を実施した。研究期間内に 168 症例の H. cinaedi 菌血症患者が抽出された。H.

cinaedi 菌血症の再発は 34 例、菌血症再発の 100 日累積発症率は 18.7%であっ
た。菌血症再発の独立した危険因子として、3 か月以内の抗癌薬投与と 30 日以内の
全身ステロイド投与が特定された。47 例で菌血症再発を予防するための選択的消化
管除菌が実施されていた。選択的消化管除菌は菌血症再発の頻度を減少させる傾向
にあり、再発リスクを低下させる 1 つの治療戦略となりうることを示した。
3.

H. cinaedi の同定における迅速診断法についての研究:質量分析法(MALDI-TOF
MS)の有用性を検討した。血液培養から検出した H. cinaedi 54 株を MALDI-TOF
MS で同定した。全 54 株において同定結果の best match organism は H. cinaedi
であった。54 株中 2 株が 2.0 以上の score value を、50 株が 1.7~1.999 の score
value を、2 株は 1.7 未満の score value を示した。Score value 1.7 未満であった 2
株については、16s RNA 解析においても Helicobacter species の同定に留まった。

以上、本論文は腸肝在位 H. cinaedi 感染症の 1 つの主要な感染経路が、腸管から血液
中への bacterial translocation であること、H. cinaedi 感染症の臨床像として菌血症の
100 日累積再発率が 18.7%であったこと、抗癌薬投与と全身ステロイド投与が再発の危険
因子であること、選択的消化管除菌が再発のリスクを低下させる 1 つの治療戦略となりう
ること、H. cinaedi の同定において質量分析法が信頼できる検査法であること、を明らか
にした。本研究は、腸管在位 Helicobacter 属の研究に重要な貢献をなすと考えられる。
よって本論文は博士(医学 )の学位請求論文として合格と認められる。

この論文で使われている画像

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