Medical Management of Marfan Syndrome
48:55-52:09
I'm going to just talk about a couple of other issues now. There is and the, in particular I want to talk about the medications that we should not be giving and I'm sorry I'm running a bit later than I said I would. I just, just take me a bit longer to explain those things and then and then we'll go on to some, some questions so if I thinks there's time.
ここからは飲んではいけない薬についてお話しします。これまでの説明に時間をかけ過ぎてしまいましたので、時間があれば後ほど質問にお答えします。
So fluroquinolone antibiotics so, so there is some evidence to suggest that a a group of antibiotics called the fluroquinolones and the drug that's most widely used certainly in the UK is a drug called Cyprofloxacin often called Cypro. It is well established that this this medication can cause rupture of certain tendons in the body, the connective tissue especially the Achilles tendon and I, I've definitely seen patients myself where they have had a tear of the Achilles tendon in the heel of the foot. I've definitely seen that myself. That's well established. No doubt about that.
フルオロキノロン系の抗菌薬は、英国ではシプロフロキサシンという薬が広く使われていますが、結合組織である腱、特にアキレス腱を断裂させる可能性があることが明らかになっています。実際私もアキレス腱が断裂している患者さんを目にしていますので、間違いありません。
Now that has led people to think, "Well, that's interesting, maybe that could cause a wider problem in connective tissue." Where else do we find connective tissue? In the aorta and there is some data that suggests that some people have had increased risk of aortic dissection and current use of fluroquinolones is has been associated with a, a 2.9 times increased risk so, you know, nearly triple the risk of an increased risk of aortic tearing and people with Marfan syndrome have a much, much higher risk of tearing of the aorta the risk, you know, you, you know, people with Marfan Syndrome have a risk that is like a hundred times higher 150 times higher than the normal population and young people with Marfan syndrome have an age-adjusted risk of maybe 500 times increased risk compared to the normal age-adjusted population and so if you triple that it starts to get very, you know, much higher relative risks and so maybe that would be the type of medication that you should be looking to avoid.
このことから、結合組織の多い大動脈でも同様のことが当てはまると考えられます。実際、一部の方は大動脈解離のリスクが高まることを示すデータがあります。現在フルオロキノロン系の抗菌薬を使っている場合には、大動脈解離の発症リスクは2.9倍になるとのデータがあります。マルファン症候群の方では、一般集団の150倍というかなりの高リスクがあるとされており、若いマルファン患者さんでは、年齢に応じて調整されたリスクにおいて、一般集団の500倍のリスクがあるとされています。これらを約3倍すると、相当な相対リスクとなりますので、避けなければならない薬であるということがお分かりになると思います。
So I think that there is some conflicting evidence that's recently been published as well that says maybe that that risk doesn't exist and so I think the evidence is conflicting. I think, I think the way I approach this is to say if this medication can safely be avoided then I would avoid it. If there's an alternative medication I would choose the alternative. If there's no alternative and the infection is serious and, and this medication has to be used, well, I think you and your physician have to weigh up the risks and benefits and I could imagine that there are certain patients where its use could be justified but let's not use it willy nilly, is that a British phrase I think it probably is, okay?
最近発表された研究ではリスクは存在しないとするものもあり、矛盾したエビデンスが得られています。私のアプローチとしては、この種の抗菌薬を避けられるものならば避ける。代替薬があるのなら、そちらを選択する。代替薬がなく感染が重度で、使わざるを得ない場合には、主治医の先生と相談し、リスクと恩恵を天秤にかけて判断するということになると思います。この種の抗菌薬の利用が正当化されるような患者さんも一部おられると想像しますが、とにかく避けるということです。
And here's some mice data that shows, that it's, it's a, you know, here's some, some, some, some mice that have been given Cyprofloxacin in and certainly, you know, mice that are prone to getting aortic dissections when challenged with Cyprofloxacin and other agents to increase their risk of aortic dissection bad things can happen to their aortas, okay? So that's, that so, that's, that's a bit more data about it.
こちらにマウスを使ったデータがあります。大動脈解離の発症リスクを上昇させるための薬剤を投与された後に、シプロフロキサシンを投与されたマウスでは、大動脈解離等の問題を発症しやすくなっていました。こちらが詳細なデータです。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
