川崎病の 病因研究概論 - jskd.jp

1 1 2013 .. etiologic agents 2016 9 2

2 3 1 2 Part I 4 7 10 13 15 Part II 23 27 29 32 36 38 41 44 Part. 1. 4 Part 1. 5 (Hamashima1) 1973, 2) 1973, Tasaka3) 1978) Shishido 4)(1979) 5) 2008 Rickettsia Japonica 5 6,7) 1983 Propionibacterium acnes 8)

3 1986 Propionibacterium acnes 1980 Streptococcus sanguis 9 1984 10) 1991 Streptococcus sanguis Glucan Glucan Glucan IL-1 LPS A A T V T V Hokonohara 11) (1987) anti-streptolysin O (ASO) anti-strptokinase (ASK) 4 A Masuda 12) (1998) SPE-C SPE-C Morita 13) (1997) streptococcal pyrogenic exotoxin A C (SPE-A, SPE-C) Yoshioka 14)(2003) SPE-C Part.

4 1. 5 SPE-C T V 2 6S5 Nomura 15)(2003) 6 SPE-A Toxic shock syndrome Abe Leung Abe 16)(1992) T V 2 8 TCRV 2 8 Leung 17)(1993) TSST-1 (Curtis et ) 1994, Curtis et ) 1995) TCRV 2 8 T (Pietra et ) 1994, Sakaguchi et ) 1995) Yamashiro 22) (1996) TCRV 2 T Nomura 23) 1998 25 TCRV TSST-1 (Nishiyori et ) 1994, Terai et ) 1995) Nomura 26) 2002 TSST-1 TSST-1 6 TSST-1 TSST-1 27) 2001 462 13% 22% Tahara 28)

5 2006 372 42 11% Yersinia pseudotuberculosis-derived mitogen 29) Chlamydophilia pneumoniae Numazaki 30) 1996 IgM Schrag 31) 2000 Strigl 32) 2000 ( 33) 1997 34) 2001 35) 2001) 36) 2007 3 2 Lee 37) 2011 358 54 12 22% Part. 1.

6 6 1970 40 1. Hamashima Y, et al. Rickettsia-like bodies in infantile acute febrile mucocutaneous lymphnode syndrome. Lancet 1973:2;42 2. Mucocutaneous lymphnode syndrome, MCLS, 1973:31;3491-3505 3.

7 Tasaka K, et al. Studies on rickettsia-like body in Kawasaki disease attempts of the isolation and characterization. Acta Path Jpn. 1978:28;235-245 4. Shishido A. Failure to confirm the rickettsial etiology of MCLS (Kawasaki disease). Jpn J Med Sci Biol 1979:32;250-251 5. 1 2008:61;801-803 6. Propionibacterium acnes variant 1983;87:347-352 7. Propionibacterium acnes variant 1983;41:2029-2039 8. Propionibacterium acnes 1986;90:2176-2181 9. MCLS Streptococcus sanguis 1984;25:221-225 10. Prog Med 1991;11:75-78 11.

8 Hokonohara M, et al. Study of antibody response to 4 streptococcal antigens in rheumatic fever and Kawasaki disease with or without cardiovascular lesions. Jpn Circ J 1987;51:1353-1356 12. Masuda K, et al. Transient low T cell response to streptococcal pyrogenic exotoxin-C in patients with Kawasaki disease. Pediatr Res 1998;44:27-31 13. Morita A, et al. Serologic evidence that streptococcal superantigens are not involved in the pathogenesis of Kawasaki disease. Microbiol Immunol 1997;41:895-900 14. Yoshioka T, et al. Relation of streptococcal pyrogenic exotoxin C as a causative superantigen for Kawasaki disease. Pediatr Res 2003;53:403-410 15. Nomura Y, et al. Possible relationship between streptococcal pyrogenic exotoxin A and Kawasaki syndrome in patients older than six months of age.

9 Pediatr Infect Dis J 2003;22:794-798 16. Abe J, et al. Selective expansion of T cells expressing T-cell receptor variable regions V beta 2 and V beta 8 in Kawasaki disease. Proc Natl Acad Sci USA, 1992;89:4066-4070 17. Leung DY, et al. Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome. Lancet, 1993;342;1385-1388 18. Curtis N, et al. Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome. Lancet 1994;343:299 19. Curtis N, et al. Evidence for a superantigen Part. 1. 7 mediated process in Kawasaki disease. Arch Dis Child 1995;72;308-311, 20. Pietra BA, et al. TCR V beta family repertoire and T cell activation markers in Kawasaki disease.

10 J immunol 1994;153:1881-1888, 21. Sakaguchi M, et al. Characterization of CD4+ T helper cells in patients with Kawasaki disease (KD): preferential production of tumour necrosis factor-alpha (TNF-alpha) by V beta 2- or V beta 8- CD4+ T helper cells. Clin Exp Immunol 1995;99:276-282 22. Yamashiro Y, et al. Selective increase of V beta 2+ T cells in the small intestinal mucosa in Kawasaki disease. Rediatr Res 1996;39:264-266 23. Nomura Y, et al. Twenty-five types of T-cell receptor Vbeta family repertoire in patients with Kawasaki syndrome. Eur J Pediatr 1998;157:981-986 24. Nishiyori A, et al. Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome. Lancet 1994;343:299-300, 25.