$B5J1l9T0Y$O$f$C$/$j$H$7$?!"DK$_$rH<$&;`$r>7$/(B
2009$BG/%U%#%s%i%s%I5J1l7Y9p(B


$B$[$H$s$I$NJ}$,%?%P%3$OGY4b!J$,$s!K$r5/$3$9860x$G$"$k$3$H$rCN$C$F$$$^$9!#;v $B45e$O5J1l 40$B:P0J>eCK@-$NE}7W$G$O!"KhF|(B25$BK\0J>e%?%P%3$r5[$&?M$N;`K4N($O!"5[$o$J$$?M$h$j9"F,4b!J$,$s!K$,!"(B
$B$J$s$H(B90$BG\0J>e!"$=$7$FGY4b!J$,$s!K$b#7G\$b9b$/$J$C$F$$$^$9!#!!:G6a$N8&5f$G$O!"5J1l$7$F$$$k?M$O!"(B
$B%?%P%3$r5[$o$J$$?M$h$j$b#7G/$bAa$/BgD24b$,8!=P$5$l!"BgD24b$H5J1l9T0Y$H$N4XO"@-$K$D$$$FL@$i$+$K(B
$B$5$l$F$$$^$9!#(B

$B<+J,$O!"$=$s$J$K5[$o$J$$$+$iBg>fIW!" $B=w@-$N$"$J$?!!!&!&!&!!@$3&0l0L$H$b$$$o$l$k5J1lN($r2?$H$b;W$o$J$$F|K\?MCK@-$N$"$J$?$K$b!"(B
$B$h$/M}2r$7$FM_$7$$;vJA$G$9!#(B

$B%?%P%3$N1l$OH/4b!J$,$s!KJ* $B0J>e$NM-32J* $Bc32$r@x:_2=$5$;$k$N$G$9!#%?%P%3$K$O%K%3%A%s$NB>$K!"%?!<%k!"0l;@2=C:AG$r4^$_!"(B
$B0l;@2=C:AGG;EY$O#1!A#5!s$H!"<+F0
$B%?%P%3$N1l$rD94|4V5[$$9~$`$H(B$BGY5$ $B$r0z$-5/$3$7$d$9$/$J$j$^$9!#GY5$?$N5$F;$,(B
$B=y!9$KGK2u$5$l$FGY$N495$5!G=$r<:$&IB5$$G!"#C#T8!::$G#4#0:PBe$N5J1lCK@-$N#5#1!s0J>e$KH/8+$5$l$F(B
$B$$$^$9!#8=:_!"GY5$COPD -$B$H8@$o$l!"A04b!J$,$s!K(B
$B>uBV$H9M$($i$l!"$=$N#4J,$N#1$,GY4b!J$,$s!K$K0\9T$9$k$H8@$o$l$F$$$^$9!#(B


$BB?$/$N?M$,(BCOPD$B$+$i;`$X$NF;$rJb$s$G9T$-$^$9!#(B


$BOBED%"%-;R$5$s$O(BTV$B2hLL$G(B2008$BG/$K(BCOPD$B$H?GCG$5$l$?8e!"%?%P%3$r5[$&$3$H$r;_$a!"(B
$B!V:#$G$b2N$$B3$1$F$$$^$9!W$H5J1l $B$+$C$F(B2003$BG/$KI. $B$I$&$7$F$b6X1l$XF'$_@Z$l$J$+$C$?$3$H$,!"%-%c%s%;%k$NM}M3$H?d;!$5$;$i$l$^$9!#(B
TV$B2hA|;#1F!!(B2011$BG/(B8$B7n(B


$BF|K\0e;U2q@):n%]%9%?!<(B


$B%?%P%3$O$N$I$dGY$KBP$76/$$FG@-$r;}$DB>!"?4B!7l4I7O$N=EMW4o41$K=EBg$J0-1F6A$r$b$?$i$7$^$9!#5J1l$O(B
$B?4B!$N@8L?@~$H$b$$$($k4'>uF0L.$NF0L.9E2=$N860x$H$J$j$^$9!#F|K\?MCK@-$G$O5J1l$K$h$C$F?46Z9<:I$,(B
4.0$BG\!"=w@-$G$O(B8.2$BG\H/IB%j%9%/$,9b$^$jHs>o$K4m81$J>uBV$K$J$j$^$9!#%?%P%3$r5[$C$F$$$k$H7l1U$,(B
$B8G$^$j$d$9$/$J$j!"%Q%$%W$,$D$^$C$?$h$&$K$J$C$F!"7lN.>c32$r0z$-5/$3$7!"?4B!$NF/$-$r0-$/$7$7$^$9!#(B
$B?4B!H/:n$K$h$k;`K4$N(B20$B!A(B25$B!s$O5J1l$N$?$a$H$$$o$l$F$$$^$9!# $B$3$&$7$?%1!<%9$b4^$^$l$F$$$k$H9M$($i$l$^$9!#(B



$B!!(B$B5J1l$K$h$k;`K4860x(B$B!JF|K\0e;U2q;qNA!K(B

$B!!(B$B5J1l$O4b!J$,$s!K!"?4B!IB!"GY5$$B!J1Q8l!K(B


$B5J1l$7$F$$$k?M$NG>B4Cf$NHfN($O!"Hs5J1lo$K9b$/$J$j$^$9!#G>$N7l4I$,GK$l$k$/$bKl2<=P7l$N(B
$B%j%9%/$O!"CK@-$G(B3.6$BG\!"=w@-$G(B2.7$BG\$G$9!#G>$N7l4I$,5M$^$C$FH/>I$9$kG>9<:I$J$I$r9g$o$;$?G>B4CfA4BN$N(B
$BH/>I%j%9%/$O!"CK@-$G(B1.3$BG\!"=w@-$G(B2.0$BG\$G$9!#$3$N?t;z$O!"%?%P%3$r5[$C$F$$$k$H!"$"$J$?$N;`K4N($r(B
$B9b$a$k$@$1$G$J$/!"H>?HIT?o$dCTJr$K$J$k3NN($,A}$($k$3$H$r0UL#$7$F$$$^$9!#(B

$B!z(B$B%3%s%F%s%D$N0lIt$O!V#2#0#0#4!!El5~ET?4%l%9%H%i%s(B $B%+%U%'6X1l@J%,%$%I!&%?%P%3I{N.1l-6!W$h$jE> $B2~Dj!!(B2013$BG/(B8$B7n!!>pJsDI2C!!(B2017$BG/(B6$B7n(B

$BL\ $B<+J,$ONc30!)2L$?$7$F$=$&$G$7$g$&$+!)(B $B=w@-$KBP$9$k0-1F6A(B $B5J1l3+;OG/Np$,Aa$$$[$IM-32(B $B5J1l=,47$OLtJ*0MB8(B
$BH/$,$sJ* $B?4B!H/:n$K$h$k;`K4(B $B $B5J1l$O;`$r>7$/(B
$B $B%?%P%3$O!V

$BF|K\%?%P%3%U%j!<3X2q8\Ld(B $B0e3XGn;N!!5\K\=gGl(B
COPYRIGHT(C)JUNHAKU MIYAMOTO,M.D. ALL RIGHTS RESERVED.