Background/Aims: This multi-center study in Japan aimed to clarify whether any significant differences in clinical characteristics and symptoms exist between patients with functional dyspepsia (FD) and those with refractory FD, that is, FD with pancreatic enzyme abnormalities (FDP), and determine the severity of the pancreatic enzyme abnormalities affecting FD symptoms or exocrine pancreatic dysfunction by comparing relevant factors.

　Methods: In total, 111 consecutive patients who presented with FD (n＝46) or FD-P (n＝42) based on Rome III classification and 23 controls were recruited from four institutions in Japan. Their clinical characteristics and clinical symptoms were assessed using questionnaires. We measured the levels of five pancreatic enzymes (amylase, lipase, trypsin, phospholipase A2, and elastase-1) in the sera of the patients with FD and FD-P. Pancreatic exocrine function was analyzed using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA). Patients with FD-P (n＝19) consented and underwent endosonography (Olympus EUS-UCT 260 convex scanning endosonography).

　Results: No significant differences were noted in age, sex or body mass index (BMI) between patients with FD and FD-P. An abnormal trypsin level was the most prevalent change in the pancreatic enzymes of patients with FD-P. Severe pancreatic enzyme abnormalities in more than four of the tested pancreatic enzymes were observed in approximately 13％ of patients with FD-P. The triglyceride concentration was higher in patients with FD-P than in those with FD. Conversely, no significant association was detected among the presence of exocrine pancreatic dysfunction, pancreatic enzyme abnormalties, and clinical symptoms in patients with FD-P.

　Conclusions: Trypsin level is a useful marker for distinguishing FD from FD-P. Further studies are warranted to clarify whether the severity of pancreatic enzyme abnormalities and exocrine pancreatic dysfunction affect the pathophysiology of patients with FD-P.

　目的：冷え症者と非冷え症者における熱産生の差が，冷え症のメカニズムの一因であることを明らかにすること．

　方法：健常成人男女を対象に鼓膜温と母趾温の差が6 ℃以上の者を冷え症群（男性6 名，女性11 名），6 ℃未満の者を非冷え症群（男性6 名，女性10 名）とし，心拍数・血圧・鼓膜温・右母趾温・前額部と右母趾の皮膚血流量・副交感神経活動指標（HF）・交感神経活動指標（LF/HF）および熱産生に関する指標として筋肉総量・骨格筋量について男女別に群間比較した．

　結果：男性冷え症群はLF/HF が有意に高く，女性冷え症群はHF が有意に低かった．筋肉総量および骨格筋量は，統計学的有意差は認めないものの，男女ともに冷え症群の平均値は非冷え症群の平均値よりも低値を示した．

　結論：冷え症者は交感神経を介した末梢皮膚血流量の減少が認められるが，その背景には非冷え症者と比べて筋肉量が少なく，熱産生が低いことが示唆された．

　背景：2 型糖尿病患者では，非糖尿病患者に比べて認知症の発症率が高く，動脈硬化指標が認知症発症の予測因子になることが報告されている．

　目的：日本人において，頸動脈エコーの指標が2 型糖尿病患者の認知症発症の予測因子になるかについて検討した．

　方法：頸動脈エコー（max intima-media thickness, max IMT）とHasegawa Dementia Rating Scale-Revised 測定を，外来にて1 か月以内に行った2 型糖尿病患者85 例を対象に，平均4.7 年間フォローし，新規に認知症と診断された15 例について，認知症発症の寄与因子について，多変量ロジスティック解析により検討した．

　結果：2 型糖尿病患者において，年齢，性別（男性），脳血管疾患の既往とともに，max IMT（Odds Ratio：5.515，95％ CI：1.40810.000，p ＝ 0.005）が認知症発症に関連する因子であった．

　結語：2 型糖尿病患者において，頸動脈エコーのmax IMT と認知症発症との関連が示唆された．