Study on establishment and clinical application of new peripheral blood flow index in ulcer lesion of severe ischemic limb

• Project/Area Number: 16K10647
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular surgery
• Research Institution: Asahikawa Medical College
• Principal Investigator: Akasaka Kazumi 旭川医科大学, 医学部, 講師 (80344555)
• Co-Investigator(Kenkyū-buntansha): 藤井 聡 旭川医科大学, 医学部, 教授 (90291228)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2018: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000); Fiscal Year 2017: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2016: ¥3,900,000 (Direct Cost: ¥3,000,000、Indirect Cost: ¥900,000)
• Keywords: 重症虚血肢 / 微小循環評価 / 末梢血流 / 皮膚潰瘍 / マイクロRNA / 超音波検査

Outline of Final Research Achievements

We experienced clinically improved cases of postoperative revascularization for critical limb ischemia, in which microcirculation evaluation by Superb Micro-vascular Imaging (SMI) and skin perfusion pressure (SPP) both confirmed improvement postoperatively. However, the blood flow display by SMI did not always agree with SPP. In the future, it will be necessary to display weaker blood flow with SMI, examine the measurement site suitable for SMI different from SPP, and cope with the disparity between subjects based on anatomical differences.
It was also shown that microRNAs present in the exudates of ischemic ulcer lesions could be useful biomarkers to elucidate the pathophysiology of severe ischemic limb ulcers and to evaluate the validity of ulcer treatments. However, the relationship between microRNAs and SMI could not be clarified and future work is necessary. Elderly friendly testing of SMI and non-invasive sampling for ulcer microRNA are useful modalities in the aging society.

Academic Significance and Societal Importance of the Research Achievements

末梢動脈疾患患者数は増加の一途であるが，糖尿病や維持透析患者においては，重症化してから専門医へ紹介されるために潰瘍治癒の長期化が課題となっている．近年はより低侵襲の治療が可能となったこともあり，SMIの活用による簡便な微小循環の非侵襲的評価と早期診断により下肢切断を避けることは，患者の日常生活動作維持のためにも，国民医療費抑制のためにも重要である．また，潰瘍病変の浸出液のマイクロRNA解析はバイオマーカーとして有用となり，虚血性潰瘍の病態の解明に役立つ可能性がある．患者の負担なく検体の採取が可能であり，高齢者などの虚血性潰瘍の治療戦略をたてる上で有用である．

Research Products

• [Journal Article] Measurements of brachial artery cross-sectional vascular area and volume elastic modulus using automated oscillometric measurements: reproducibility between examinersand intra-rater reliability. (2020)
  • Author(s): Ito K, Ito E , Saito K, Tomoda Y, Akasaka K, Fujii S.
  • Journal Title: Rinsho Byori Volume: in press
  • Peer Reviewed
• [Presentation] 心房中隔欠損症に皮膚筋炎関連間質性肺炎による肺高血圧症を合併した１例． (2020)
  • Author(s): 長多真美、赤坂和美、中森理江、河端奈穂子、齊藤江里香、佐渡正敏、簑島暁帆、竹内利治、長谷部直幸、藤井 聡．
  • Organizer: 日本心エコー図学会第31回学術集会．
• [Presentation] 心不全症状にて発見された下大静脈へ穿破した右総腸骨動脈瘤の1例 (2020)
  • Author(s): 齊藤江里香、赤坂和美、長多真美、中森理江、河端奈穂子、佐渡正敏、藤井聡
  • Organizer: 日本超音波医学会
• [Presentation] Low Levels of Circulating Extracellular Vesicle-Encapsulated HULC Are Associated with Left Ventricular Hypertrophy in Japanese (2020)
  • Author(s): Satoshi Fujii, Kazumi Akasaka, Kenji Takahashi
  • Organizer: XXVIII Congress of the International Society on Thrombosis and Haemostasis (ISTH)
  • Int'l Joint Research
• [Presentation] 重症虚血肢における超音波による低流速血流評価の可能性 (2019)
  • Author(s): 赤坂和美、河端奈穂子、東 信良、藤井 聡
  • Organizer: 第66回日本臨床検査医学会学術集会
• [Presentation] 急速に進行したパンヌスによる僧帽弁位生体弁機能不全の1例 (2019)
  • Author(s): 池田弥代、赤坂和美、長多真美、中森理江、伊藤栄祐、斉藤久美子、河端奈穂子、齋藤江里香、佐渡正敏、谷野美智枝、中西仙太郎、紙谷寛之、藤井 聡
  • Organizer: 日本心エコー図学会 第30回学術集会
• [Presentation] 頸動脈超音波検査を用いたステント留置術後のステント内突出物の経時的評価 (2019)
  • Author(s): 長多真美、赤坂和美、池田弥代、中森理江、河端奈穂子、斎藤江里香、佐渡正敏、藤井 聡、和田 始、東 信良
  • Organizer: 第60回日本脈管学会総会