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		<h1 class="title">考える臨床検査（電子版のみ）<span class="version"></span></h1>
		<h2 class="subTitle">スクリーニング検査で異常値をみたら？</h2>

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					編集：松尾収二（天理医療大学医療学部臨床検査学科教授)
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				<ul class="property"><li class="disc">B5判・208頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-8157-8</li><li class="disc">2015年5月25日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">若手医師が求める日常診療のエッセンスをよりすぐり、かつ一歩進んだ知識を提供するムックシリーズ第17弾．研修医が入院患者にルーチン検査を行ったところ，検査の異常が見つかった（明らかに異常値だが，極端な異常値ではない）．そんなときどのように考え，対応するか，上級医に相談するタイミングはどこか，日常診療でよくみる異常値20項目についてポイントとピットフォールを解説．必ず現場で役立つ，臨床検査の実践的ガイド．<br>☆図版24点，表組68点，カラー写真21点，モノクロ写真7点</section><section class="preface">序文ー検査の心得<br><br>　検査は何故，行うのか，何故，行ったのか．この至極当然な問いかけは思考に深みを与える．電子媒体の発達により大量の患者情報が容易に，迅速に，かつどこでも入手できるようになった．しかし，これらの情報は自らキーボードを叩かないと見られない．検査をオーダーしていることを忘れていたら結果を見ることがないかもしれない．ましてや自らキーボードを叩いてまで他の医師の受け持ち患者の情報を入手することはない．情報化は個々の医師をブラックボックス化させているかもしれない．情報を深く読む力は落ち，異常値の見逃しはめずらしくない．そんな中，医師は自らに厳しくあるべきだ．<br>　検査をやったら，必ず患者に説明しよう！ 血液検査，尿検査などの日常的な検査について，説明しない医師は多い．片や，検査の説明がないことに不安，不満をもつ患者は多い．患者に説明することは結果を必ず見て，きちんと読むことにつながる．<br>　検査データの判読に限らず，何事も思い込み，先入観が強いと後で痛い目をみる．自分の必要とするところしか見ない，わかるところしか見ない，では痛い目に合う．予期せぬデータであっても，また臨床症状と合わなくても無視するな！ 検査情報も身体情報の1つである．異常値は意味がわからなくても書き留めておこう．<br>　回診やカンファレンスで「何故，この検査をやらなかったんだ」と，言われることがあるが，「何故，この検査をやったんだ」と問われることは少ない．検査への過剰な依存心は，検査に踊らされる，患者を診ない，話をきかない，などの弊害につながる．<br>　一方で，「検査をしてもしなくても一緒だ」「患者をちゃんと診ているので検査しなくても大丈夫だ」といったことをたまに耳にする．特に慢性疾患の長期フォロー中に多い．薬物療法による副作用や効果は臨床所見だけではわからない．慢性疾患の陰で別の病気が進行しているかも知れない．検査を上手に使うことは，上手に問診し理学的所見をとるのと同じである．<br>　臨床検査は研修医でもチェック1つで手に入る情報である．誰にも頭を下げる必要はない．まるで空気や水である．しかし容易に得られる情報であるがゆえにピットフォールも多い．そこで，今回は異常値の解釈だけでなく検査にまつわる諸々のことを取り上げた．臨床検査を上手に活用していただきたいという思いからである．<br>　まず臨床判断上，重要，かつ頻度の高い20項目の検査異常値について深読み・対処法を解説した．次に不適切な検体採取方法が起こす重要な異常値ピットフォールを通して，分析以外の原因が，臨床判断を狂わすほど，検査値に影響することを示した．そして，子どもの検査値，薬剤が引き起こす検査値異常などのミニレクチャー，症例から学ぶ病態深読み方法と続いている．何事も奥は深いことを感じとっていただければ幸甚である．<br><br>平成27年4月<br>天理医療大学医療学部臨床検査学科教授<br>松尾収二</section><section class="indexes">■第I章　異常値深読みグレードアップ<br>１. 貧血<br>２. 血小板減少<br>３. 白血球減少<br>４. 異型リンパ球の出現<br>５. 好酸球増加<br>６. CRP高値<br>７. PT・APTT延長<br>８. FDP，D-dimer高値<br>９. 尿素窒素高値<br>10. 尿酸高値<br>11. 総蛋白高値<br>12. LD高値<br>13. AST・ALT高値<br>14. ALP高値<br>15. アミラーゼ高値<br>16. Na低値<br>17. K低値<br>18. Ca低値<br>19. 尿蛋白・潜血陽性<br>20. 便潜血反応<br>■第II章　医師・看護師の誤った検体採取が起こす異常値ピットフォールランキング10<br>■第III章　ステップアップミニレクチャー<br>１. こどもの検査値<br>２. 薬剤が引き起こす検査値異常<br>３. 安全で優しい採血<br>４. 採血のタイミング・患者の体位で異なる検査値<br>５. 疑問に答える髄液・体腔液の検査<br>■第Ⅳ章　症例から学ぶ病態判読テクニック<br>１. 全身倦怠感と腹部膨満感を主訴に来院した50歳代男性<br>２. 肝障害の診断で紹介された80歳代女性<br>３. 顔面および下腿の浮腫の精査，加療のため入院となった50歳代男性<br>４. 全身倦怠感を主訴に来院した70歳代男性<br>５. 一過性の意識消失後，血尿をきたした60歳代女性<br>６. 痙攣発作で即日入院となった30歳代女性<br>７. 多発性硬化症治療中発熱，汎血球減少のため入院となった50歳代女性<br>８. 体重減少と腰背部痛を主訴に入院した80歳代女性<br>９. 腰背部痛および黄疸を主訴に入院となった70歳代女性<br>10. 路上に意識不明で倒れているところを発見され救急搬送された40歳代男性<br>11. 胃がんにて外来フォロー中細菌性肺炎にて緊急入院となった70歳代男性<br>■資料（付録）<br>Further Readings<br>● M e m o<br>多血症<br>偽性血小板減少時の血小板算定<br>偽性好中球減少症<br>副腎皮質ホルモン剤投与時の好中球増加<br>異型リンパ球のよび方<br>CRPの生理作用<br>PTおよびAPTTは試験管内の反応にすぎない<br>VTEの除外診断<br>尿素クリアランスによる腎機能評価<br>遺伝子変異と尿酸値<br>蛋白分画でみつかったM蛋白<br>Mサブユニット欠損症<br>CKをスクリーニング検査として活用しよう！<br>説明のできないAST単独の高値はマクロASTも考える！<br>測定法について<br>免疫グロブリン結合酵素異常<br>薬剤性の低カリウム血症<br>リンの調節に関与するFGF23<br>検査前因子の「検査誤差」への影響<br>便中ヘモグロビン<br>胆道系とはどこからどこまでか？<br>ネフローゼ症候群に特異性の高い円柱<br>糸球体性血尿に特異性の高い赤血球形態<br>血清蛋白分画検査の勧め<br>TTPとADAMTS13<br>破砕赤血球の“破砕”の形態は？<br>抗リン脂質抗体症候群の診断に使われる臨床検査<br>HPSの診断における骨髄検査の意義<br>低アミラーゼ血症〜軽視されがちな検査所見〜<br>アニオン・ギャップ<br>酸塩基平衡と血中K濃度<br>抗利尿ホルモン（ADH）測定の意義とSIADHの診断<br>低ナトリウム血症の原因と予後<br><br>索引</section></article>
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