研究者詳細 - 辻　喜久

論文 - 辻　喜久

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Relationship between pancreatic perfusion parameters and clinical complications of severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Naoki Takahashi, Tsukasa Yoshida, Masashi Tamaoki, Osamu Kikuchi, Yuji Watanabe, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

Pancreas 42 ( 1 ) 180 - 2 2013年01月 [査読有り] [国際誌]

DOI PubMed

原発性硬化性胆管炎として長期経過観察されたIgG4関連硬化性胆管炎の3例

南竜城, 栗田亮, 栗山勝利, 佐久間洋二朗, 大田悠司, 田邊渉, 丸野貴久, 塩川雅広, 澤井勇悟, 辻喜久, 宇座徳光, 児玉裕三

胆道 27 ( 3 ) 2013年

J-GLOBAL

Sensing of commensal organisms by the intracellular sensor NOD1 mediates experimental pancreatitis.

Yoshihisa Tsuji, Tomohiro Watanabe, Masatoshi Kudo, Hidenori Arai, Warren Strober, Tsutomu Chiba

Immunity 37 ( 2 ) 326 - 38 2012年08月 [査読有り] [国際誌]

The intracellular sensor NOD1 has important host-defense functions relating to a variety of pathogens. Here, we showed that this molecule also participates in the induction of a noninfectious pancreatitis via its response to commensal organisms. Pancreatitis induced by high-dose cerulein (a cholecystokinin receptor agonist) administration depends on NOD1 stimulation by gut microflora. To analyze this NOD1 activity, we induced pancreatitis by simultaneous administration of a low dose of cerulein (that does not itself induce pancreatitis) and FK156, an activator of NOD1 that mimics the effect of gut bacteria that have breached the mucosal barrier. The pancreatitis was dependent on acinar cell production of the chemokine MCP-1 and the intrapancreatic influx of CCR2(+) inflammatory cells. Moreover, MCP-1 production involved activation of the transcription factors NF-κB and STAT3, each requiring complementary NOD1 and cerulein signaling. These studies indicate that gut commensals enable noninfectious pancreatic inflammation via NOD1 signaling in pancreatic acinar cells.

DOI PubMed

Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: evaluation by perfusion computed tomography.

Sho Koyasu, Hiroyoshi Isoda, Yoshihisa Tsuji, Hiroshi Yamamoto, Kazuhiro Matsueda, Yuji Watanabe, Tsutomu Chiba, Kaori Togashi

European journal of radiology 81 ( 1 ) 43 - 6 2012年01月 [査読有り] [国際誌]

PURPOSE: Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. MATERIALS AND METHODS: Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54s beginning with a bolus injection of 40 ml of contrast agent (600-630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. RESULTS: Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100ml; p<0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100ml; p=0.92). CONCLUSION: Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.

DOI PubMed

膵血流解析による自己免疫性膵炎と膵癌の鑑別

廣田衛久, 滝川哲也, 林晋太郎, 三浦晋, 千葉勉, 正宗淳, 下瀬川徹, 津田雅視, 辻喜久, 菅野敦, 菊田和宏, 粂潔, 濱田晋, 海野純, 有賀宏之

膵臓 ( 日本膵臓学会 ) 27 ( 4 ) 601 - 607 2012年

自己免疫性膵炎（AIP）は膵癌（PC）との鑑別が臨床上の問題である．本研究では，Perfusion CTによる膵血流解析が両者の鑑別に有用であるかを検討した．AIP 12症例（全例type 1）とPC 22症例にPerfusion CTを施行し，single-compartment kinetic model法を用いて画像解析を行い，3つのパラメータを用いて両者を比較した．F_V値はAIPで平均81.3/分に対しPCでは平均19.3/分と有意に低値（p=0.0005），V_D値はAIPが28.8に対しPCでは93.6と有意に高値（p=0.0084），R²値はAIPが0.659に対しPCでは0.250と有意に低値（p<0.0001）であった．また，カラーマップ画像も鑑別に有用であった．本研究は，AIPとPCの鑑別におけるPerfusion CTの有用性を示す最初の報告である．

DOI CiNii J-GLOBAL

Perfusion computed tomography findings of autoimmune pancreatitis.

Morihisa Hirota, Masashi Tsuda, Yoshihisa Tsuji, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Tsutomu Chiba, Atsushi Masamune, Kennichi Satoh, Tooru Shimosegawa

Pancreas 40 ( 8 ) 1295 - 301 2011年11月 [査読有り] [国際誌]

OBJECTIVES: The aim of this study was to clarify the pancreatic blood perfusion in patients with autoimmune pancreatitis (AIP) and the changes after steroid treatment. METHODS: Perfusion computed tomography was performed in 11 patients with AIP and 12 control subjects. Pancreatic volumetric blood flow (F(V)), volume of distribution (V(D)), and blood transit time τ were determined from a single-compartment kinetic model. Nine patients with AIP were reexamined by perfusion computed tomography after corticosteroid administration. RESULTS: The pancreatic F(V) values of the 11 patients with AIP (82.7/min) were significantly lower than those of control subjects (163.5/min, P = 0.0006). On the other hand, the pancreatic V(D) and τ values were not significantly different between AIP and normal. After steroid treatment, the F(V) values of 9 reexamined patients with AIP (76.2/min) were significantly elevated (109.8/min, P = 0.0391). However, the changes of the values after the treatment differed in degree among individuals. The values of 4 patients were dramatically elevated to greater than 100/min, whereas those of 4 other patients did not improve well. The value of the remaining patient whose initial F(V) value was normal (168.09/min) did not change after the treatment. CONCLUSIONS: Pancreatic volumetric perfusion was attenuated in AIP patients. The perfusion was improved after the steroid treatment.

DOI PubMed

Relationship between serum angiopoietin-2 level and perfusion CT parameters in severe acute pancreatitis.

Tsubasa Watanabe, Yoshihisa Tsuji, Yuzo Kodama, Hiroyoshi Isoda, Hiroshi Yamamoto, Tsutomu Chiba

The American journal of gastroenterology 106 ( 10 ) 1859 - 61 2011年10月 [査読有り] [国際誌]

DOI PubMed

【膵疾患画像診断における最近の進歩】重症急性膵炎発症早期における"可逆性-非可逆性膵虚血"の診断

辻喜久, 渡邉翼, 塩川雅広, 栗田亮, 澤井勇悟, 上野憲司, 塩せいじ, 宇座徳光, 児玉裕三, 小泉幸司, 磯田裕義, 渡邊祐司, 山本博, 千葉勉

膵臓 ( 日本膵臓学会 ) 26 ( 1 ) 59 - 65 2011年02月 [査読有り]

[背景と目的]脳虚血性疾患では、虚血領域は2種類に分けられ、壊死に至る不可逆性の領域と、虚血であるものの治療によって壊死することなく治癒する可逆性虚血領域である。今回、重症急性膵炎にPerfusion CTを用いれば、可逆性虚血領域が診断できるか検討した。[方法]発症3日以内に、Perfusion CTを撮像した71人の重症急性膵炎患者を対象とした。全ての膵実質を、頭部、体部、尾部に分け、膵血流速度(FV)、膵血流量(VD)をPerfusion CT(Single compartment kinetic model)にて測定した。3週間後に造影CTを行い、頭部、体部、尾部がそれぞれ壊死したか診断した。[結果]発症早期に、FV、VDどちらも低下している場合、高率に壊死した。発症早期に、FV、VD片方だけ低下している場合、壊死する場合もあれば、回復する場合もあった。発症早期に、FV、VDどちらも低下していなければ壊死しなかった。[考察]発症早期にFV、VDどちらも低下した実質は高率に壊死し、このような実質は不可逆性膵虚血/早期壊死であると考えられた。単一のParameterのみ低下した実質は、必ずしも壊死しない場合があり、こうした実質は可逆性膵虚血である場合があると考えられた。以上から、複数のPerfusion Parameterを用いることで、可逆性-非可逆性膵虚血を診断しうる可能性があると考えられたが、こうしたPerfusion CTの所見と病理との比較や、用語の定義など、今後の課題であると考えられた。(著者抄録)

DOI CiNii J-GLOBAL

Measurement of canine pancreatic perfusion using dynamic computed tomography: influence of input-output vessels on deconvolution and maximum slope methods.

Miori Kishimoto, Yoshihisa Tsuji, Nana Katabami, Junichiro Shimizu, Ki-Ja Lee, Toshiroh Iwasaki, Yoh-Ichi Miyake, Shujiro Yazumi, Tsutomu Chiba, Kazutaka Yamada

European journal of radiology 77 ( 1 ) 175 - 81 2011年01月 [査読有り] [国際誌]

OBJECTIVE: We investigated whether the prerequisite of the maximum slope and deconvolution methods are satisfied in pancreatic perfusion CT and whether the measured parameters between these algorithms are correlated. METHODS: We examined nine beagles injected with iohexol (200 mgI kg(-1)) at 5.0 ml s(-1). The abdominal aorta and splenic and celiac arteries were selected as the input arteries and the splenic vein, the output veins. For the maximum slope method, we determined the arterial contrast volume of each artery by measuring the area under the curve (AUC) and compared the peak enhancement time in the pancreas with the contrast appearance time in the splenic vein. For the deconvolution method, the artery-to-vein collection rate of contrast medium was calculated. We calculated the pancreatic tissue blood flow (TBF), tissue blood volume (TBV), and mean transit time (MTT) using both algorithms and investigated their correlation based on vessel selection. RESULTS: The artery AUC significantly decreased as it neared the pancreas (P<0.01). In all cases, the peak time of the pancreas (11.5±1.6) was shorter than the appearance time (14.1±1.6) in the splenic vein. The splenic artery-vein combination exhibited the highest collection rate (91.1%) and was the only combination that was significantly correlated between TBF, TBV, and MTT in both algorithms. CONCLUSION: Selection of a vessel nearest to the pancreas is considered as a more appropriate prerequisite. Therefore, vessel selection is important in comparison of the semi-quantitative parameters obtained by different algorithms.

DOI PubMed

重症急性膵炎とnon-occlusive mesenteric ischemia

辻喜久, 辻喜久, 山本博, 能登原憲司, 児玉祐三, 千葉勉

日本腹部救急医学会雑誌 ( 日本腹部救急医学会 ) 31 ( 7 ) 1029 - 1037 2011年 [査読有り]

重症急性膵炎に非閉塞性腸間膜虚血症（non occlusive mesenteric ischemia：NOMI）を併発すると，予後不良である。また，重症急性膵炎におけるNOMI併発の機序など，いまだ不明な部分も多い。近年，重症急性膵炎患者における血管攣縮関連因子（angiopoietin-2, エンドセリン-1，VEGFなど）や凝固関連因子（ADAMTS13など）の異常が報告されており，NOMIとの関連が推測される。一方，NOMIの病理像については，不明な点が多い。われわれの経験では，虚血に由来した腸管のダメージが腸管の各所に不連続に偏在しており，NOMIの病理像の特徴の一つと考えられた。また，NOMIの診断方法は，血管撮影検査がgolden standardであるが，簡便な検査とはいいがたい。一方，われわれの肝perfusion CT検査を用いた研究では，肝血流障害がNOMIに併発することが明らかになり，肝血流を指標としてNOMIを診断できる可能性があると考えられた。最後に，こうした重症急性膵炎におけるNOMI発症の機序や病理像，診断方法の理解から，現在のわれわれの治療方針について報告する。

DOI CiNii J-GLOBAL

Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis.

Yoshihisa Tsuji, Kyoko Hamaguchi, Yuji Watanabe, Akira Okumura, Hiroyoshi Isoda, Naoki Yamamoto, Osamu Kikuchi, Hiroyuki Yamamoto, Kazuhiro Matsueda, Kenji Ueno, Shinsuke Tada, Kaori Togashi, Hiroshi Yamamoto, Tsutomu Chiba

Journal of gastroenterology 45 ( 11 ) 1155 - 62 2010年11月 [査読有り] [国内誌]

BACKGROUND: We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis. METHODS: We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed. RESULTS: Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography. CONCLUSION: While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose.

DOI PubMed CiNii

NOD1 contributes to mouse host defense against Helicobacter pylori via induction of type I IFN and activation of the ISGF3 signaling pathway.

Tomohiro Watanabe, Naoki Asano, Stefan Fichtner-Feigl, Peter L Gorelick, Yoshihisa Tsuji, Yuko Matsumoto, Tsutomu Chiba, Ivan J Fuss, Atsushi Kitani, Warren Strober

The Journal of clinical investigation 120 ( 5 ) 1645 - 62 2010年05月 [査読有り] [国際誌]

Nucleotide-binding oligomerization domain 1 (NOD1) is an intracellular epithelial cell protein known to play a role in host defense at mucosal surfaces. Here we show that a ligand specific for NOD1, a peptide derived from peptidoglycan, initiates an unexpected signaling pathway in human epithelial cell lines that results in the production of type I IFN. Detailed analysis revealed the components of the signaling pathway. NOD1 binding to its ligand triggered activation of the serine-threonine kinase RICK, which was then able to bind TNF receptor-associated factor 3 (TRAF3). This in turn led to activation of TANK-binding kinase 1 (TBK1) and IkappaB kinase epsilon (IKKepsilon) and the subsequent activation of IFN regulatory factor 7 (IRF7). IRF7 induced IFN-beta production, which led to activation of a heterotrimeric transcription factor complex known as IFN-stimulated gene factor 3 (ISGF3) and the subsequent production of CXCL10 and additional type I IFN. In vivo studies showed that mice lacking the receptor for IFN-beta or subjected to gene silencing of the ISGF3 component Stat1 exhibited decreased CXCL10 responses and increased susceptibility to Helicobacter pylori infection, phenotypes observed in NOD1-deficient mice. These studies thus establish that NOD1 can activate the ISGF3 signaling pathway that is usually associated with protection against viral infection to provide mice with robust type I IFN-mediated protection from H. pylori and possibly other mucosal infections.

DOI PubMed

The radiological exposure of pancreatic perfusion computed tomography.

Yoshihisa Tsuji, Koji Koizumi, Hiroyoshi Isoda, Kenji Ueno, Shinsuke Tada, Tsutomu Chiba, Ryuichirou Doi

Pancreas 39 ( 4 ) 541; author reply 541-3 2010年05月 [査読有り] [国際誌]

DOI PubMed

重症急性膵炎に合併したNOMIの病理所見と治療選択についての考察

辻喜久, 辻喜久, 能登原憲司, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

Perfusion CTによる自己免疫性膵炎と膵癌の鑑別

廣田衛久, 辻喜久, 下瀬川徹

日本消化器病学会雑誌 107 2010年

J-GLOBAL

重症急性膵炎発症早期における“Ischemia penumbra”について

辻喜久, 山本博, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

膵蔵Perfusion-CTにおける装置間の違い-自作ファントムにおける検討-

梶谷尊郁, 辻喜久, 山本浩之, 森山一郎, 矢田伸広, 氏平武樹, 奥井彰二, 小松明夫

日本放射線技術学会雑誌 66 ( 9 ) 2010年

J-GLOBAL

急性膵炎の重症化に関わる自然免疫担当分子の同定とその分子機序の解明

辻喜久, 渡邉智裕, 千葉勉

日本消化器病学会雑誌 107 2010年

J-GLOBAL

Spontaneous rupture of liver plasmacytoma mimicking hepatocellular carcinoma.

Kosuke Ueda, Hiroyuki Matsui, Tomohiro Watanabe, Junya Seki, Tatsuo Ichinohe, Yoshihisa Tsuji, Kayoko Matsumura, Yugo Sawai, Hiroshi Ida, Yoshihide Ueda, Tsutomu Chiba

Internal medicine (Tokyo, Japan) 49 ( 7 ) 653 - 7 2010年 [査読有り] [国内誌]

Extramedullary plasmacytoma of the liver is rare. Here, we report a case presenting with rupture of extramedullary plasmacytoma of the liver. She had a past history of multiple myeloma with IgA lambda type. Her serum was positive for hepatitis C virus infection and exhibited elevated levels of serum protein induced by vitamin K absence or antagonist-II. She was initially diagnosed as rupture of hepatocellular carcinoma (HCC) and then treated with transarterial chemoembolization (TACE) since bloody ascites and formation of hematoma were seen around hyper-vascular liver tumors on computed tomography. However, the clinical course of this case after TACE was atypical for HCC rupture, as shown by the development of a huge intra-abdominal abscess extending from the liver tumor. Immuno-histochemical analysis of the tumor biopsy specimen revealed massive infiltration of plasma cells expressing IgA and lambda chain. To our knowledge, this is the first case of rupture of extramedullary liver plasmacytoma.

PubMed

Colonic polyposis associated with autoimmune pancreatitis.

Hiroyuki Matsui, Tomohiro Watanabe, Kenji Ueno, Satoru Ueno, Yoshihisa Tsuji, Kayoko Matsumura, Masato Nakatsuji, Yoshihide Ueda, Tsutomu Chiba

Pancreas 38 ( 7 ) 840 - 2 2009年10月 [査読有り] [国際誌]

DOI PubMed

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