慢性腎臓病を合併した関節リウマチ患者における持続性エリスロポエチン受容体活性化因子の有効性
目的：慢性腎臓病（CKD）を合併した関節リウマチ（RA）患者における持続性エリスロポエチン受容体活性化剤（CERA）の有用性の検討．方法：CERAを使用した37例のRA患者のうち，11例は12ヶ月以内に死亡していた．12ヶ月以上CERAを使用した26例（男性2例, 女性24例）について有用性を検討した．結果：患者年齢は77.4±7.0才，罹病期間は17.9±14.5年であった．血液尿素窒素25.8±10.6 mg/dl，血清クレアチニン（Cr）は1.2±0.5 mg/dl，推算糸球体濾過量は41.6±16.0 ml/min/1.73m2であった．血清鉄やフェリチンの低下はなく，不飽和鉄結合能は...
Saved in:
| Published in | 臨床リウマチ Vol. 33; no. 3; pp. 233 - 245 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床リウマチ学会
2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-8760 2189-0595 |
| DOI | 10.14961/cra.33.233 |
Cover
Loading…
| Abstract | 目的：慢性腎臓病（CKD）を合併した関節リウマチ（RA）患者における持続性エリスロポエチン受容体活性化剤（CERA）の有用性の検討．方法：CERAを使用した37例のRA患者のうち，11例は12ヶ月以内に死亡していた．12ヶ月以上CERAを使用した26例（男性2例, 女性24例）について有用性を検討した．結果：患者年齢は77.4±7.0才，罹病期間は17.9±14.5年であった．血液尿素窒素25.8±10.6 mg/dl，血清クレアチニン（Cr）は1.2±0.5 mg/dl，推算糸球体濾過量は41.6±16.0 ml/min/1.73m2であった．血清鉄やフェリチンの低下はなく，不飽和鉄結合能は上昇しておらず，平均赤血球容積の低下は認めなかった．血清エリスロポエチンの上昇は認めなかった．CERAの使用により（43.1±21.4μg/month），ヘモグロビン（Hb）は8.70±1.1 g/dlから10.0±1.2 g/dlに上昇していた（p<0.001）．鉄剤の使用やRAの治療強化のなかった15例でも，Hbは9.1±0.8g/dlから10.1±1.2 g/dlに上昇していた（p=0.028）．8例でCERAを中止でき，その後3例は再開したが，1例は再度中止することが可能であった．結論：RA患者においては，CKDが疑われる場合ではCrが低い場合でも，CERAを使用すべきと考えられた． |
|---|---|
| AbstractList | 目的：慢性腎臓病（CKD）を合併した関節リウマチ（RA）患者における持続性エリスロポエチン受容体活性化剤（CERA）の有用性の検討．方法：CERAを使用した37例のRA患者のうち，11例は12ヶ月以内に死亡していた．12ヶ月以上CERAを使用した26例（男性2例, 女性24例）について有用性を検討した．結果：患者年齢は77.4±7.0才，罹病期間は17.9±14.5年であった．血液尿素窒素25.8±10.6 mg/dl，血清クレアチニン（Cr）は1.2±0.5 mg/dl，推算糸球体濾過量は41.6±16.0 ml/min/1.73m2であった．血清鉄やフェリチンの低下はなく，不飽和鉄結合能は上昇しておらず，平均赤血球容積の低下は認めなかった．血清エリスロポエチンの上昇は認めなかった．CERAの使用により（43.1±21.4μg/month），ヘモグロビン（Hb）は8.70±1.1 g/dlから10.0±1.2 g/dlに上昇していた（p<0.001）．鉄剤の使用やRAの治療強化のなかった15例でも，Hbは9.1±0.8g/dlから10.1±1.2 g/dlに上昇していた（p=0.028）．8例でCERAを中止でき，その後3例は再開したが，1例は再度中止することが可能であった．結論：RA患者においては，CKDが疑われる場合ではCrが低い場合でも，CERAを使用すべきと考えられた． |
| Author | 石川, 肇 坂井, 俊介 村澤, 章 黒澤, 陽一 阿部, 麻美 中園, 清 成田, 一衛 長谷川, 絵理子 小林, 大介 伊藤, 聡 大谷, 博 岡林, 諒 |
| Author_xml | – sequence: 1 fullname: 阿部, 麻美 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 石川, 肇 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 坂井, 俊介 organization: 新潟大学大学院 医歯学総合研究科 腎・膠原病内科分野 – sequence: 1 fullname: 長谷川, 絵理子 organization: 新潟大学大学院 医歯学総合研究科 腎・膠原病内科分野 – sequence: 1 fullname: 村澤, 章 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 黒澤, 陽一 organization: 新潟大学大学院 医歯学総合研究科 腎・膠原病内科分野 – sequence: 1 fullname: 中園, 清 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 成田, 一衛 organization: 新潟大学大学院 医歯学総合研究科 腎・膠原病内科分野 – sequence: 1 fullname: 大谷, 博 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 伊藤, 聡 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 岡林, 諒 organization: 新潟県立リウマチセンター – sequence: 1 fullname: 小林, 大介 organization: 新潟大学大学院 医歯学総合研究科 腎・膠原病内科分野 |
| BookMark | eNpFkEtLAlEcxS9RkJmrPsfY3LnzXLQI6QVCm1oPdx63FLOYcdPOO8NgmZQlKPTGoKLQFj1Awk9zndG-RZMFLc7_8P9xOIszAyaLu0UbgDnIp6GoyXDedHAaobSA0ARICFDVOF7SpEmQ4DUocqoi89Mg5bo5g-dFnoeaKiRAJQraUflhFByPKo1hK2DeWVg_GPTfGW0xevPVbA9fysx_Yt4986-ZTyPvblQOGH1mtMroKfOOohodfpzHJcx7HCd7zO8w_2r8Uua_hietsNsb9BvR22ccC2vN8OI27NQZ7UaXh2G1F8NZMEVwwbVTf54Em8tLG5lVLru-spZZzHJ5qCiYgzYRkWVaBjFF2YSxsGYrCEqGLBmKYRrYhoiIYgyJpgkWUYksiBZUFdvCKiEoCRZ-e_NuCW_Z-p6T28HOvo6dUs4s2Hq8oY6Qjn5OPOQ_38aOnsfoG4i6new |
| ContentType | Journal Article |
| Copyright | 2021 一般社団法人日本臨床リウマチ学会 |
| Copyright_xml | – notice: 2021 一般社団法人日本臨床リウマチ学会 |
| DOI | 10.14961/cra.33.233 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2189-0595 |
| EndPage | 245 |
| ExternalDocumentID | article_cra_33_3_33_233_article_char_ja |
| GroupedDBID | ALMA_UNASSIGNED_HOLDINGS JSF KQ8 RJT |
| ID | FETCH-LOGICAL-j177a-1ef43dcdbfc46c146ca9e7315b65b7bcbae13f449e7f992df8f624d187eda8ff3 |
| ISSN | 0914-8760 |
| IngestDate | Wed Sep 03 06:30:42 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 3 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j177a-1ef43dcdbfc46c146ca9e7315b65b7bcbae13f449e7f992df8f624d187eda8ff3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/cra/33/3/33_233/_article/-char/ja |
| PageCount | 13 |
| ParticipantIDs | jstage_primary_article_cra_33_3_33_233_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2021 |
| PublicationDateYYYYMMDD | 2021-01-01 |
| PublicationDate_xml | – year: 2021 text: 2021 |
| PublicationDecade | 2020 |
| PublicationTitle | 臨床リウマチ |
| PublicationTitleAlternate | 臨床リウマチ |
| PublicationYear | 2021 |
| Publisher | 一般社団法人 日本臨床リウマチ学会 |
| Publisher_xml | – name: 一般社団法人 日本臨床リウマチ学会 |
| References | 12） Locatelli F, Choukroun G, Truman M, et al. Once-monthly continuous erythropoietin receptor activator （C.E.R.A.） in patients with hemodialysis-dependent chronic kidney disease: pooled data from phase III trials. Adv Ther 33: 610-625, 2016. 8） Iino N, Goto S, Kazama JJ, et al. The effects of between Darbepoetin alfa and C.E.R.A. in the treatment of renal anemia for pre-dialysis patients. Kidney and dialysis 75: 599-603, 2013 （in Japanese）. 16） Kato Y, Takagi C, Tanaka J, et al. Effect of daily subcutaneous administration of chronic anemia in rheumatoid arthritis. Intern Med 33: 193-197, 1994. 27） Kuroda T, Tanabe N, Harada T, et.al. Long-term mortality outcome in patients with reactive amyloidosis associated with rheumatoid arthritis. Clin Rheumatol 25: 498-505, 2006. 1） Vreugdenhil G, Wognum AW, van Eijik HG, et al. Anemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann Rheum Dis 49: 93-98, 1990. 3） Noė G, Augustin J, Hausdorf S, et aal. Serum erythropoietin and transferrin receptor levels in patients with rheumatoid arthritis, Clin Exp Rheumatol 13: 445-451, 1995. 20） Marti-Carvajal AJ, Agreda-Pėrez LH, Solὰ I, et al. Erythropoesis-stimulating agents for anemia in rheumatoid arthritis. Cocrane Database Syst Rev 2013 Feb 28;（2）: CD000332. Doi: 10.1002/14651858.CD000332.pub3. 4） Wolfe F, Michaud K. Anemia and renal function in patients with rheumatoid arthritis. J Rheumatol 33: 1516-22, 2006. 6） Sato H, Kuroda T, Tanabe N, et al. Cystatin C is a sensitive marker for detecting a reduced glomerular filtration rate when assessing chronic kidney disease in patients with rheumatoid arthritis and secondary amyloidosis. Scand J Rheumatol 39: 33-7, 2010. 11） A package insert of continuous erythropoietin receptor activator. 15） Pettersson T, Rosenlöf K, Friman C, et al. Successful treatment of the anemia of rheumatoid arthritis with subcutaneously administered recombinant human erythropoietin. Slower response in patients with more severe inflammation. Scand J Rheumatol 22: 188-193, 1993. 23） Agnihotri P, Telfer M, Butt Z, et al. Chronic anemia and elderly patients: results of a randomized, double-blind, placebo-controlled, crossover exploratory study with epoetin alfa. J Am Geriatr Soc 55: 1557-1565, 2017. 25） Kaltwasser JP, Gottschalk R. Erythropoietin and iron. Kidney Int 55 Suppl 69: 61-66, 1999. 18） Peters HRM, Jongen-Lavrencic, M, Bakker CH, et al. Recombinant Human Erythropoietin Improves Health-Related Quality of Life in Patients With Rheumatoid Arthritis and Anaemia of Chronic Disease; Utility Measures Correlate Strongly With Disease Activity Measure. Rheumatol Int 18: 201-206, 1999. 22） Hochberg MC, Arnold CM, Hogans BB, et al. Serum immunoreactive erythoropoietin in rheumatoid arthritis: impaired response to anemia. Arthritis Rheum 31: 1318-1321, 1998. 13） Macdougall IC, Walker R, Provenzano R, et al. C.E.R.A corrects anemia in patients with chronic kidney disease not on dialysis: results of a randomized clinical trial. Clin Am Soc Nephrol 3: 337-347, 2008. 10） Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis Rheum 62: 2569-81, 2010. 14） Hayashi T, Uemura Y, Kumagai M, et al. Effect of achieved hemoglobin level on renal outcome in non-dialysis chronic kidney disease （CKD） patients receiving epoetin beta pegol: MIRcerA Clinical evidence on Renal Survival in CKD patints with renal anemia （MIRACLE-CKD Study）. Clin Exp Nephrol 23: 349-361, 2019. 5） Hayashi T, Ito S, Goto D, et al. Elevated level of serum cystatin-C concentration is a useful predictor for myelosuppression induced by methotrexate for treatment of rheumatoid arthritis. Mod Rheumatol 20: 548-555, 2010. 7） Nozawa Y, Sato H, Wakamatsu A, et al. Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy. Clinica Chimica Acta 487: 299-305, 2018. 29） Hirose S. Evaluation of renal function in RA. J Chubu Rheum Assoc 41: 36-37, 2011. 2） Bloxham H, Vagadia V, Scott K, et al. Anemia in rheumatoid arthritis: can we afford to ignore it? Pstgrad Med J 87: 596-600, 2011. 17） Peters HRM, Jongen-Lavrencic, M, Vreugdenhil G, et al. Effect of recombinant human erythropoietin on anemia and disease activity in patients with rheumatoid arthritis and anemia of chronic disease: a randomized placebo controlled double blind 52 weeks clinical trial. Ann Rheum Dis 55: 739-744, 1996. 9） Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31: 315-324, 1988. 19） Kaltwasser JP, Kessler U, Gottschalk R, et al. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 28: 2430-2436, 2001. 28） Saisho K, Yoshikawa N, Sugata K, et al: Prevalence of chronic kidney disease and administration of RA-related drugs in patients with RA: The NinJa 2012 study in Japan. Mod Rheumatol 26: 331-335, 2016. 24） Sunder-Plassman G, Hoerl WH. Importance of iron supply for erythropoietin therapy. Nephrol Dial Transplant 10: 2070-2076, 1995. 21） Nordström D, Lindroth Y, Marsal L, et al. Availability of iron and degree of inflammation modifies the response to recombinant human erythropoietin when treating anemia of chronic diseases in patients with rheumatoid arthritis. Rheumatol Int 17: 67-73, 1997. 30） Yamamto H, Nishi S, Tomo T, et al. 2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease. Renal Replacement Therapy（2017）3: 36 DOI 10.1186/s41100-017-0114-y. 26） Ito S, Abe A, Otani H, et al. The regional medical liaison in Niigata Rheumatic Center. Clin Rheumatol Rel Res 29: 85-97, 2017 （in Japanese）. |
| References_xml | – reference: 6） Sato H, Kuroda T, Tanabe N, et al. Cystatin C is a sensitive marker for detecting a reduced glomerular filtration rate when assessing chronic kidney disease in patients with rheumatoid arthritis and secondary amyloidosis. Scand J Rheumatol 39: 33-7, 2010. – reference: 22） Hochberg MC, Arnold CM, Hogans BB, et al. Serum immunoreactive erythoropoietin in rheumatoid arthritis: impaired response to anemia. Arthritis Rheum 31: 1318-1321, 1998. – reference: 16） Kato Y, Takagi C, Tanaka J, et al. Effect of daily subcutaneous administration of chronic anemia in rheumatoid arthritis. Intern Med 33: 193-197, 1994. – reference: 1） Vreugdenhil G, Wognum AW, van Eijik HG, et al. Anemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann Rheum Dis 49: 93-98, 1990. – reference: 8） Iino N, Goto S, Kazama JJ, et al. The effects of between Darbepoetin alfa and C.E.R.A. in the treatment of renal anemia for pre-dialysis patients. Kidney and dialysis 75: 599-603, 2013 （in Japanese）. – reference: 14） Hayashi T, Uemura Y, Kumagai M, et al. Effect of achieved hemoglobin level on renal outcome in non-dialysis chronic kidney disease （CKD） patients receiving epoetin beta pegol: MIRcerA Clinical evidence on Renal Survival in CKD patints with renal anemia （MIRACLE-CKD Study）. Clin Exp Nephrol 23: 349-361, 2019. – reference: 11） A package insert of continuous erythropoietin receptor activator. – reference: 29） Hirose S. Evaluation of renal function in RA. J Chubu Rheum Assoc 41: 36-37, 2011. – reference: 17） Peters HRM, Jongen-Lavrencic, M, Vreugdenhil G, et al. Effect of recombinant human erythropoietin on anemia and disease activity in patients with rheumatoid arthritis and anemia of chronic disease: a randomized placebo controlled double blind 52 weeks clinical trial. Ann Rheum Dis 55: 739-744, 1996. – reference: 3） Noė G, Augustin J, Hausdorf S, et aal. Serum erythropoietin and transferrin receptor levels in patients with rheumatoid arthritis, Clin Exp Rheumatol 13: 445-451, 1995. – reference: 26） Ito S, Abe A, Otani H, et al. The regional medical liaison in Niigata Rheumatic Center. Clin Rheumatol Rel Res 29: 85-97, 2017 （in Japanese）. – reference: 4） Wolfe F, Michaud K. Anemia and renal function in patients with rheumatoid arthritis. J Rheumatol 33: 1516-22, 2006. – reference: 27） Kuroda T, Tanabe N, Harada T, et.al. Long-term mortality outcome in patients with reactive amyloidosis associated with rheumatoid arthritis. Clin Rheumatol 25: 498-505, 2006. – reference: 23） Agnihotri P, Telfer M, Butt Z, et al. Chronic anemia and elderly patients: results of a randomized, double-blind, placebo-controlled, crossover exploratory study with epoetin alfa. J Am Geriatr Soc 55: 1557-1565, 2017. – reference: 18） Peters HRM, Jongen-Lavrencic, M, Bakker CH, et al. Recombinant Human Erythropoietin Improves Health-Related Quality of Life in Patients With Rheumatoid Arthritis and Anaemia of Chronic Disease; Utility Measures Correlate Strongly With Disease Activity Measure. Rheumatol Int 18: 201-206, 1999. – reference: 20） Marti-Carvajal AJ, Agreda-Pėrez LH, Solὰ I, et al. Erythropoesis-stimulating agents for anemia in rheumatoid arthritis. Cocrane Database Syst Rev 2013 Feb 28;（2）: CD000332. Doi: 10.1002/14651858.CD000332.pub3. – reference: 5） Hayashi T, Ito S, Goto D, et al. Elevated level of serum cystatin-C concentration is a useful predictor for myelosuppression induced by methotrexate for treatment of rheumatoid arthritis. Mod Rheumatol 20: 548-555, 2010. – reference: 10） Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis Rheum 62: 2569-81, 2010. – reference: 13） Macdougall IC, Walker R, Provenzano R, et al. C.E.R.A corrects anemia in patients with chronic kidney disease not on dialysis: results of a randomized clinical trial. Clin Am Soc Nephrol 3: 337-347, 2008. – reference: 15） Pettersson T, Rosenlöf K, Friman C, et al. Successful treatment of the anemia of rheumatoid arthritis with subcutaneously administered recombinant human erythropoietin. Slower response in patients with more severe inflammation. Scand J Rheumatol 22: 188-193, 1993. – reference: 21） Nordström D, Lindroth Y, Marsal L, et al. Availability of iron and degree of inflammation modifies the response to recombinant human erythropoietin when treating anemia of chronic diseases in patients with rheumatoid arthritis. Rheumatol Int 17: 67-73, 1997. – reference: 30） Yamamto H, Nishi S, Tomo T, et al. 2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease. Renal Replacement Therapy（2017）3: 36 DOI 10.1186/s41100-017-0114-y. – reference: 19） Kaltwasser JP, Kessler U, Gottschalk R, et al. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 28: 2430-2436, 2001. – reference: 28） Saisho K, Yoshikawa N, Sugata K, et al: Prevalence of chronic kidney disease and administration of RA-related drugs in patients with RA: The NinJa 2012 study in Japan. Mod Rheumatol 26: 331-335, 2016. – reference: 7） Nozawa Y, Sato H, Wakamatsu A, et al. Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy. Clinica Chimica Acta 487: 299-305, 2018. – reference: 2） Bloxham H, Vagadia V, Scott K, et al. Anemia in rheumatoid arthritis: can we afford to ignore it? Pstgrad Med J 87: 596-600, 2011. – reference: 24） Sunder-Plassman G, Hoerl WH. Importance of iron supply for erythropoietin therapy. Nephrol Dial Transplant 10: 2070-2076, 1995. – reference: 9） Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31: 315-324, 1988. – reference: 25） Kaltwasser JP, Gottschalk R. Erythropoietin and iron. Kidney Int 55 Suppl 69: 61-66, 1999. – reference: 12） Locatelli F, Choukroun G, Truman M, et al. Once-monthly continuous erythropoietin receptor activator （C.E.R.A.） in patients with hemodialysis-dependent chronic kidney disease: pooled data from phase III trials. Adv Ther 33: 610-625, 2016. |
| SSID | ssib004001982 ssj0003304618 ssib029852172 ssib058494229 |
| Score | 2.2232857 |
| Snippet | 目的：慢性腎臓病（CKD）を合併した関節リウマチ（RA）患者における持続性エリスロポエチン受容体活性化剤（CERA）の有用性の検討．方法：CERAを使用した37例のRA患者のうち，11例は12ヶ月以内に死亡していた．12ヶ月以上CERAを使用した26例（男性2例,... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 233 |
| SubjectTerms | chronic kidney disease continuous erythropoietin receptor activator renal anemia rheumatoid arthritis serum creatinine |
| Title | 慢性腎臓病を合併した関節リウマチ患者における持続性エリスロポエチン受容体活性化因子の有効性 |
| URI | https://www.jstage.jst.go.jp/article/cra/33/3/33_233/_article/-char/ja |
| Volume | 33 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 臨床リウマチ, 2021, Vol.33(3), pp.233-245 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR1Na9RANJR68SKKit_04Jxka5JJMjPHSZtSFAWhhd6WZJMgPVQp7cVTs0up1qLVQgt-U0FFaT34AUX6L_wH6W7rv_C9yaSbVsHay_Dy5n2_yc6bYWdiGJeFFZos4W4NSvu0BvO1VwtpwmpxyE07tqKUCzyNfOOmNzzqXBtzx3p6f1b-tTQ9FfU37v31XMlhsgo4yCuekv2PzO4KBQTAkF9oIcPQHijHJPAId4m0FWASyUjAEcMDBTAiKAmgZYgMKOE2EUDsEmESzkngEH-Q-EWXhWQaGCKBIMJTkhmRQygcuyiRUsuRnsaIQAPAiGZAF1XazVKpRaSvAS5LFZaWw33FNaDYGfE9ImTFnUIX36_dFyVmsDRjcD8xtzTgU3SZDykHIVyBYle-Y3w84gPsV5S6aA-4j4HyiTQV1yAGTbsTILEAm4UilkqgZq-W-zoLaJJLfFm6_48wli-BSgInvsoGMnF8IfABRKHBEK4Act2lZ5i6wl2fYUgUPVdxZl0yF7sAhzGQRLgFmYOa0EIVDe7vMUMJBEm-qYA98hkOIRxFTI0rbzdc1S0lu7uZpDSoAYKmcSIH1Chz0Bsd8iItFPUWRvryioo50Lk6-Mh2mPBq87ALREOiZXW_2nJw6i5MTxQOylNRg_WBW53Oi3tV9M8Wrc7Nuqco8-ziFtM_KghHeFhCNCbDfkr7d3n2XMmuX_g6ENUprVNsgLK-i78dTtbHYdV2xGbMwrn2-i1enTUt0b1Ryhbcxa_Elc-wIhCOrRctWE9S9VEEVVKWMdAHjdHWq11LoYgehyVl-XdUVSGPHDeO6aVtnyzMO2H0jIcnjbnO7Gpn5v3O7KOduaXtldm8-bS9eH9r81uereTZ61_Lq9ufZ_LWx7z5Lm-9yltZp_l2Z2Y2zz7l2XyePcmbDzsL2fb3ZyAkb35QlBt5ay1vvVSPWd760n680l7f2Npc6nz9AWTtheX28zfttcU8W--8eNCe3wDkKWN0KBgZGK7pj7_Uxi3GwpqVpA6NG3GUNhyvAfVcIxQJo5YbeW7EokYUJhZNHQeQqRB2nPLUs53Y4iyBeSZN6Wmjd-LORHLG6PMYi3nY8EIOxYcZhZGIY-FSN6KmmSRheNbwirjV7xY3_NQPmOBzh2U8bxzF967Yyr1g9E5NTicXYXEzFV1SY-U3_WAXCg |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E6%85%A2%E6%80%A7%E8%85%8E%E8%87%93%E7%97%85%E3%82%92%E5%90%88%E4%BD%B5%E3%81%97%E3%81%9F%E9%96%A2%E7%AF%80%E3%83%AA%E3%82%A6%E3%83%9E%E3%83%81%E6%82%A3%E8%80%85%E3%81%AB%E3%81%8A%E3%81%91%E3%82%8B%E6%8C%81%E7%B6%9A%E6%80%A7%E3%82%A8%E3%83%AA%E3%82%B9%E3%83%AD%E3%83%9D%E3%82%A8%E3%83%81%E3%83%B3%E5%8F%97%E5%AE%B9%E4%BD%93%E6%B4%BB%E6%80%A7%E5%8C%96%E5%9B%A0%E5%AD%90%E3%81%AE%E6%9C%89%E5%8A%B9%E6%80%A7&rft.jtitle=%E8%87%A8%E5%BA%8A%E3%83%AA%E3%82%A6%E3%83%9E%E3%83%81&rft.au=%E9%98%BF%E9%83%A8%2C+%E9%BA%BB%E7%BE%8E&rft.au=%E7%9F%B3%E5%B7%9D%2C+%E8%82%87&rft.au=%E5%9D%82%E4%BA%95%2C+%E4%BF%8A%E4%BB%8B&rft.au=%E9%95%B7%E8%B0%B7%E5%B7%9D%2C+%E7%B5%B5%E7%90%86%E5%AD%90&rft.date=2021&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E8%87%A8%E5%BA%8A%E3%83%AA%E3%82%A6%E3%83%9E%E3%83%81%E5%AD%A6%E4%BC%9A&rft.issn=0914-8760&rft.eissn=2189-0595&rft.volume=33&rft.issue=3&rft.spage=233&rft.epage=245&rft_id=info:doi/10.14961%2Fcra.33.233&rft.externalDocID=article_cra_33_3_33_233_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0914-8760&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0914-8760&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0914-8760&client=summon |