Target trial emulationの概要

1&$0ͷઌ΁ɻ ϦαʔνΫΤενϣϯఆࣜԽͷ৽͍͠ϑϨʔϜϫʔΫɿ 5BSHFUUSJBMFNVMBUJPO ࠤ౻ढ़ଠ࿕ ௕࡚େֶපӃྟচݚڀηϯλʔ TIVOUBSPTBUP!OBHBTBLJVBDKQ

ຊ೔ͷྲྀΕ 2 w ҼՌޮՌͷ͓͞Β͍ w ؍࡯ݚڀͰੜ͡ΔόΠΞε w ަབྷ w ෆࢮ࣌ؒόΠΞε
w %FQMFUJPOPGTVTDFQUJCMFTCJBT w طଘॲํऀόΠΞε w 5BSHFUUSJBMFNVMBUJPO w 5JNF[FSP w *OUFOUJPOUPUSFBUޮՌɺ1FSQSPUPDPMޮՌ w ࣮ྫ w Ͳͷ͙Β͍࢖ΘΕ͍ͯΔ͔ʁ

5BSHFUUSJBMFNVMBUJPOͷ֓ཁ 3 3FTFBSDI2VFTUJPO ϥϯμϜԽൺֱࢼݧʢ3$5ʣ ؍࡯ݚڀ ࣮ࡍ͸࣮ࢪͰ͖ͳ͍ w ద֨ج४ w Ξ΢τΧϜ
w հೖʢରরʣ w ஌Γ͍ͨޮՌ w ϑΥϩʔͷํ๏ ΋͠3$5ΛσβΠϯ͢ΔͳΒ Ͳ͏૊Ή͔ʁ w ద֨ج४ w Ξ΢τΧϜ w հೖʢରরʣ w ஌Γ͍ͨޮՌ w ϑΥϩʔͷํ๏ 5BSHFUUSJBM ࢖͑ΔσʔλͰߟ͑Δ &NVMBUJPO ໛฿͢Δ

ຊ೔ͷ໨ඪ 4 ᶃ5BSHFUUSJBMFNVMBUJPOͷίϯηϓτΛ஌Δ w ͳͥඞཁ͔ʁ w ԿΛ͍ͯ͠Δͷ͔ʁ ᶄ5BSHFUUSJBMFNVMBUJPOΛ࢖͍ͬͯΔ࿦จΛಡΊΔΑ͏ʹͳΔ ᶅ5BSHFUUSJBMFNVMBUJPOΛ࢖ͬͨݚڀΛͰ͖ΔΑ͏ʹͳΔ ͜͜·Ͱ

ҩֶݚڀͷ෼ྨ 5 %FTDSJQUJPO &YQMPSJOH BTTPDJBUJPOT 1SFEJDUJPO $BVTBMJOGFSFODF %JBHOPTUJD QFSGPSNBODF FWBMVBUJPO
هड़ ؔ࿈ͷ୳ࡧ ༧ଌ ҼՌਪ࿦ ਍அͷੑೳධՁ ม਺͸ͲΜͳ෼෍͔ʁ Ͳͷม਺͕Ξ΢τΧϜʹ ؔ࿈͢Δ͔ʁ Ξ΢τΧϜΛ༧ଌ͢Δ ॲஔ͕Ξ΢τΧϜʹ Өڹ͢Δ͔ʁ ೚ҙͷධՁํ๏ͷ ਍அੑೳ͸ʁ w )FSOÂO." )TV+ )FBMZ#"4FDPOE$IBODFUP(FU$BVTBM*OGFSFODF3JHIU"$MBTTJ fi DBUJPOPG%BUB4DJFODF5BTLT$IBODF+BO r w 7JUUJOHIP ff & (MJEEFO%7 4IJCPTLJ4$ .D$VMMPDI$&3FHSFTTJPONFUIPETJOCJPTUBUJTUJDTMJOFBS MPHJTUJD TVSWJWBM BOESFQFBUFENFBTVSFTNPEFMT4QSJOHFS4DJFODF#VTJOFTT .FEJB ຊ೔ѻ͏ͷ͸ ͜͜

ҼՌਪ࿦ʢ$BVTBMJOGFSFODFʣ 6 " : w ॲஔ"͸ɺΞ΢τΧϜ:ʹӨڹ͢Δ͔ʁ w Ξ΢τΧϜ:ʹର͢Δॲஔ"ͷޮՌ͸ʁ
ݪҼ ॲஔʢ5SFBUNFOUʣ հೖʢ*OUFSWFOUJPOʣ മ࿐ʢ&YQPTVSFʣ ݁Ռ Ξ΢τΧϜʢ0VUDPNFʣ

7 ަབྷΛ౷੍͢Ε͹ɺ ؍࡯ݚڀͰ΋ҼՌޮՌΛਪఆͰ͖Δʁ

8 ໰୊ఏى

3$5ͱ؍࡯ݚڀͷ݁Ռʹҧ͍͕͋Δ 9 ຫੑਛଁױऀʹର͢Δɺಁੳͷ։࢝࣌ظ͸༧ޙʹӨڹ͢Δ͔ʁ 3$5ʢ*%&"-ࢼݧʣ ؍࡯ݚڀ $PPQFS #" #SBOMFZ 1 #VMGPOF
- $PMMJOT +' $SBJH +$ 'SBFOLFM .# )BSSJT " +PIOTPO %8 ,FTTFMIVU + -J ++ -VYUPO ( 1JMNPSF " 5JMMFS %+ )BSSJT % $ 1PMMPDL $" *%&"-4UVEZ "SBOEPNJ[FE DPOUSPMMFEUSJBMPGFBSMZWFSTVT MBUFJOJUJBUJPOPGEJBMZTJT5IF/FX&OHMBOE+PVSOBMPG.FEJDJOF rͷ 'JHVSF# ༧ޙʹࠩ͸ͳ͍ ޙظ։࢝ͷํ͕༧ޙ͕ྑ͍ 4VTBOUJUBQIPOH 1 "MUBNJNJ 4 "TILBS . #BML &. 4UFM 74 8SJHIU 4 +BCFS #- ('3BUJOJUJBUJPOPGEJBMZTJTBOENPSUBMJUZJO$,%BNFUBBOBMZTJT "NFSJDBO+PVSOBMPG,JEOFZ%JTFBTFT5IF0 ff i DJBM+PVSOBMPGUIF/BUJPOBM,JEOFZ 'PVOEBUJPO rͷ'JHVSF

10 ަབྷҎ֎ʹ΋όΠΞε͕͋Δ

ෆࢮ࣌ؒόΠΞεʢ*NNPSUBMUJNFCJBTʣ 11 ૣظಁੳ։࢝ ױऀ͸ɺമ࿐͕͸͡·Δ·Ͱ΋௥੻ɾ؍࡯͞Εଓ͚͍ͯΔ $,%ױऀ ؍࡯։࢝ ͜ͷ࣌఺͔Βίϗʔτͷ ϑΥϩʔ͕͸͡·Δ ܈͕ܾ·͍ͬͯͳ͍ ޙظಁੳ։࢝
ෆࢮ࣌ؒ ෆࢮ࣌ؒ മ࿐·Ͱ௥੻Ͱ͖͍ͯΔͱ͍͏͜ͱ͸ɺͦΕ·ͰΞ΢τΧϜΛൃੜ͍ͯ͠ͳ͍ ෆࢮ͕࣌ؒ௕͍ํʹ༗ར

%FQMFUJPOPGTVTDFQUJCMFTCJBTʢײडੑͷރׇόΠΞεʣ 12 മ࿐͕͸͡·͔ͬͯΒ؍࡯Λ࢝ΊΔ જࡏతʹίϗʔτʹΤϯτϦʔ͞ΕΔਓͷத͔ΒɺϦεΫͷߴ͍ਓ͔ΒૣظʹΞ΢τΧϜΛൃ঱͢Δ ؍࡯։࢝࣌఺Ͱɺ܈ؒͰϦεΫ͕ҟͳΔ $,%ױऀ ޙظಁੳ։࢝ ϋβʔυ ૣظಁੳ։࢝

طଘॲํऀόΠΞεʢ1SFWBMFOUVTFSCJBTʣ 13 ؍࡯։࢝લ͔Βɺैདྷ࣏ྍΛ͓͜ͳ͍ͬͯΔਓΛ૊ΈೖΕΔ $,%ױऀ ैདྷ࣏ྍ ϦεΫ͕ߴ͍ਓ͸ɺ؍࡯։࢝લ·ͰʹΞ΢τΧϜΛੜ͍ͯ͡Δ ؍࡯։࢝࣌఺ͰɺϦεΫ͕௿͍ूஂ͕Ͱ͖Δ ؍࡯։࢝ ৽ن࣏ྍ ϋβʔυ
ϋβʔυ

ަབྷͷΈௐ੔ͯ͠΋όΠΞε͸࢒Δ 14 'V &- 5BSHFU5SJBM&NVMBUJPOUP*NQSPWF$BVTBM*OGFSFODFGSPN0CTFSWBUJPOBM%BUB8IBU 8IZ BOE)PX +PVSOBMPGUIF"NFSJDBO4PDJFUZPG/FQISPMPHZ+"4/
rͷ5BCMFΛվม

Ͳͷ͘Β͍ͷݚڀͰόΠΞε͕ੜ͍ͯ͡Δ͔ʁ 15 #ZLPW , 1BUPSOP & %`"OESFB & )F .
-FF ) (SB ff +4 'SBOLMJO +. 1SFWBMFODFPG"WPJEBCMFBOE#JBT*O fl JDUJOH.FUIPEPMPHJDBM1JUGBMMTJO3FBM8PSME4UVEJFTPG .FEJDBUJPO4BGFUZBOE& ff FDUJWFOFTT$MJOJDBM1IBSNBDPMPHZBOE5IFSBQFVUJDT rͷ5BCMFΛվม

16 Ͱ͸Ͳ͏͢Δʁ

17 5BSHFUUSJBMFNVMBUJPO

5BSHFUUSJBMFNVMBUJPOͷ֓ཁ 18 3FTFBSDI2VFTUJPO ϥϯμϜԽൺֱࢼݧʢ3$5ʣ ؍࡯ݚڀ ࣮ࡍ͸࣮ࢪͰ͖ͳ͍ w ద֨ج४ w Ξ΢τΧϜ
w հೖʢରরʣ w ஌Γ͍ͨޮՌ w ϑΥϩʔͷํ๏ ΋͠3$5ΛσβΠϯ͢ΔͳΒ Ͳ͏૊Ή͔ʁ w ద֨ج४ w Ξ΢τΧϜ w հೖʢରরʣ w ஌Γ͍ͨޮՌ w ϑΥϩʔͷํ๏ 5BSHFUUSJBM ࢖͑ΔσʔλͰߟ͑Δ &NVMBUJPO ໛฿͢Δ

Ͳ͏͍͏σʔλΛ࢖͏ͷ͔ʁ 19 ݚڀͷͨΊʹߏங͞Εͨσʔλϕʔε ݚڀͷͨΊʹߏங͞Εͳ͔ͬͨσʔλϕʔε w Ӹֶݚڀσʔλ w ױऀϨδετϦσʔλ w όΠΦόϯΫ
w ిࢠΧϧςσʔλ w ߦ੓σʔλ w ࣏ࣗମ͕อ༗͢Δݸਓͷଐੑσʔλ w อݥ੥ٻσʔλ w σʔλͷਫ਼౓͸ߴ͍ w ଌఆޡ͕ࠩগͳ͍ w ݚڀͷͨΊʹߏங͞Εͳ͔ͬͨ σʔλϕʔεͱൺֱͯ͠ɺσʔ λྔ͕গͳ͍ w σʔλྔ͕গͳ͍ w ܽଌ͕ଟ͍ w ଌఆޡࠩ΋͋Δ͔΋͠Εͳ͍ w ࢖͑Δσʔλͷछྨ΋੍ݶ͞ΕΔ͔΋͠Ε ͳ͍

5BSHFUUSJBMFNVMBUJPOͷϑϨʔϜϫʔΫ 20 )FSOÂO." 3PCJOT+.6TJOH#JH%BUBUP&NVMBUFB5BSHFU5SJBM8IFOB3BOEPNJ[FE5SJBM*T/PU"WBJMBCMF"N+&QJEFNJPM"QS r ཁૉ 5BSHFUUSJBMͰͷܭը ؍࡯ݚڀσʔλͰ໛฿͢ΔͳΒ ద֨ج४
ʢ&MJHJCJMJUZDSJUFSJBʣ ࣏ྍܭը ʢ5SFBUNFOUTUSBUFHJFTʣ ࣏ྍׂΓ౰ͯ ʢ"TTJHONFOUQSPDFEVSFTʣ ؍࡯ظؒ ʢ'PMMPXVQQFSJPEʣ Ξ΢τΧϜ ʢ0VUDPNFʣ ؔ৺ͷ͋ΔҼՌޮՌ ʢ$BVTBMDPOUSBTUTPGJOUFSFTUʣ ղੳܭը ʢ"OBMZTJTQMBOʣ w ໛฿͢Δ3$5͕͋ΔͳΒɺ ͦͷ3$5ͷ৘ใΛهࡌ͢Δ w ͳ͍ͳΒɺ ߟ͑ͯ৘ใΛهࡌ͢Δ w 5BSHFUUSJBMʹ४ͯ͡ هࡌ͢Δ w ར༻Ͱ͖ΔσʔλͰɺ ՄೳͳݶΓࣅΔΑ͏ʹ͢Δ

5JNF[FSPɿ5BSHFUUSJBMFNVMBUJPOͷΩʔϙΠϯτ 21 R 3$5 ؍࡯ݚڀ 5JNF[FSP w ద֨ج४ͷ൑அ w ܈ͷܾఆ
w ؍࡯։࢝ ؍࡯։࢝ w ద֨ج४ͷ൑அ w ܈ͷܾఆ w ద֨ج४ͷ൑அ w ܈ͷܾఆ w ؍࡯։࢝ *NNPSUBMUJNFCJBT %FQMFUJPOPGTVTDFQUJCMFTCJBT

؍࡯ݚڀͰ΋5JNF[FSPΛఆΊΔ 22 ؍࡯։࢝ w ద֨ج४ͷ൑அ w ܈ͷܾఆ w ద֨ج४ͷ൑அ w
܈ͷܾఆ w ؍࡯։࢝ 5JNF[FSP w ద֨ج४ͷ൑அ w ܈ͷܾఆ w ؍࡯։࢝ w 5JNF[FSPΛἧ͑ΒΕͳ͍৔߹΋͋Δ w σβΠϯ΍ղੳํ๏Ͱରॲ *NNPSUBMUJNFCJBT %FQMFUJPOPGTVTDFQUJCMFTCJBT

5BSHFUUSJBMFNVMBUJPOͷྫʢʣ 23 'V &- &WBOT . $BSSFSP ++ 1VUUFS )
$MBTF $. $BTLFZ '+ 4[ZND[BL . 5PSJOP $ $IFTOBZF /$ +BHFS ,+ 8BOOFS $ %FLLFS '8 WBO%JFQFO . 5JNJOH PGEJBMZTJTJOJUJBUJPOUPSFEVDFNPSUBMJUZBOEDBSEJPWBTDVMBSFWFOUTJOBEWBODFEDISPOJDLJEOFZEJTFBTFOBUJPOXJEFDPIPSUTUVEZ#.+ Fͷ4VQQMFNFOUBSZ5BCMF" ཁૉ 5BSHFUUSJBMͰͷܭը ؍࡯ݚڀσʔλͰ໛฿͢ΔͳΒ ద֨ج४ w ࡀҎ্ w F('3͕N-NJON 5BSHFUUSJBMͱಉ͡ ࣏ྍܭը ಁੳͷಋೖ࣌ظΛɺF('3Λ͔ΒͷൣғΛ NࠁΈͰͷ۠෼ʹ෼͚Δ 5BSHFUUSJBMͱಉ͡ ࣏ྍׂΓ౰ͯ ϥϯμϜׂ෇͚ ಛघͳղੳख๏ʢDMPOJOHʣʹΑΓϥϯμϜԽΛ໛฿ ؍࡯ظؒ ϥϯμϜԽ࣌఺Ͱ؍࡯Λ։࢝͠ɺࢮ๢ɺ৺݂؅Πϕϯ τɺ೥݄·Ͱɺ·ͨ͸೥ؒ௥੻ͷ͍ͣΕ͔ૣ ͍࣌఺Ͱऴྃ͢Δ ͢΂ͯͷద֨ج४Λຬ͔ͨͯ͠Βɺ௥੻։࢝ Ξ΢τΧϜ શࢮ๢ɺओཁ༗֐৺݂؅Πϕϯτ w UBSHFUUSJBMͱಉ༷ w ৺݂؅Πϕϯτ͸*$%ίʔυͰఆٛ ؔ৺ͷ͋ΔҼՌޮՌ *OUFOUJPOUPUSFBUޮՌɺ1FSQSPUPDPMޮՌ 1FSQSPUPDPMޮՌ ղੳܭը ͦΕͧΕͷޮՌʹదͨ͠ղੳํ๏ ޮՌʹదͨ͠౷ܭղੳख๏ *%&"-ࢼݧΛΑΓৄࡉʹͨ͠΋ͷΛ5BSHFUUSJBMʹ͢Δ

24 *OUFOUJPOUPUSFBUޮՌʁ 1FSQSPUPDPMޮՌʁ

஌Γ͍ͨޮՌ͸Կʁ 25 3FTFBSDI2VFTUJPO ܕ౶೘පױऀʹ͓͚ΔୈҰબ୒ༀͱͯ͠ɺ 4(-5્֐ༀͱϝτϗϧϛϯ͸ͲͪΒ͕ྑ͍͔ʁ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ܕ%. ϝτϗϧϛϯ
4(-5્֐ༀ ࣏ྍ͕ܧଓతʹ࢖ΘΕͨͱ͖ͷޮՌ ϝτϗϧϛϯ 4(-5્֐ༀ ࣏ྍΛ։࢝ͨ͠ͱ͖ͷޮՌ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ

*OUFOUJPOUPUSFBUޮՌͱ1FSQSPUPDPMޮՌ 26 ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ࣏ྍ͕ܧଓతʹ࢖ΘΕͨͱ͖ͷޮՌ ϝτϗϧϛϯ
4(-5્֐ༀ ࣏ྍΛ։࢝ͨ͠ͱ͖ͷޮՌ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ 1FSQSPUPDPMޮՌ *OUFOUJPOUPUSFBUޮՌ *55ޮՌ ୯ʹ࣏ྍޮՌͱ͍͏ͱ͖͸ ͪ͜ΒΛΠϝʔδ͍ͯ͠Δ͜ͱ͕ଟ͍

ཧ૝తͳϥϯμϜԽൺֱࢼݧͱ*55ͷݪଇ 27 ױऀ ױऀ ױऀ #BTFMJOF N w ׂΓ෇͚ΒΕ࣏ͨྍΛ९क͠ w
୤མ͕ͳ͘ w ೋॏ໡ݕ͕อͨΕΔ ׂΓ෇͚ͨ ࣏ྍ Ξ΢τΧϜ ަབྷҼࢠ ױऀ N N R ৽ن ࣏ྍ ϓϥ ηϘ ࣏ྍΛׂΓ෇͚ΒΕͨױऀ͕ɺ 3$5 ະଌఆɾະ஌ͷҼࢠ΋ؚΉ ࣏ྍΛϥϯμϜʹׂΓ෇͚Δ͜ͱͰɺ࣏ྍͱަབྷҼࢠͱͷؔ܎Λ੾Δ *55ूஂʹ͓͚Δɺ Ξ΢τΧϜʹର͢ΔׂΓ෇͚࣏ͨྍͷޮՌ͸ɺ όΠΞεΛ͏͚ͳ͍ ׂΓ෇͚ͨूஂΛ͢΂ͯղੳʹ࢖͏ˠ*55 *OUFOUJPOUPUSFBU ͷݪଇ ަབྷͷ͜ͱ͸ߟ͑ͣɺൺֱత୯७ͳղੳͰਪఆͰ͖Δ *55෼ੳ

*55ޮՌɿ*55෼ੳ͔Βਪఆ͞ΕΔޮՌ 28 w ׂΓ෇͚࣏ͨྍ͕ɺෆ९क΍୤མʹΑΓ࣮ࡍͷ࣏ྍͱҟͳ͍ͬͯͨ৔߹Ͱ΋ɺ ׂΓ෇͚࣏ͨྍͷޮՌΛਪఆ͍ͯ͠Δ w ࣮ࡍͷݱ৔Ͱ͸ɺ९कঢ়گ͕ѱ͔ͬͨΓɺ࣏ྍΛଓ͚ΒΕͳ͍ױऀ͸Ұఆ਺͍Δ ͜ΕΒΛड͚ೖΕΔ*55ޮՌ͸ɺ࣮ྟচͰͷײ֮ʹ͋ͯ͸·ΔޮՌͱߟ͑ΒΕΔ͔΋͠Εͳ͍ ׂΓ෇͚ͨ ࣏ྍ
࣮ࡍͷ࣏ྍ Ξ΢τΧϜ ަབྷҼࢠ 㱠 ױऀ ױऀ ױऀ #BTFMJOF N ױऀ N N ৽ن ࣏ྍ ϓϥ ηϘ ୤མ ৽ن࣏ྍ )FSOÂO." )FSOÂOEF[%ÍB[4#FZPOEUIFJOUFOUJPOUPUSFBUJODPNQBSBUJWFF ff FDUJWFOFTTSFTFBSDI$MJO5SJBMT'FC r

؍࡯ݚڀͰ͸ɺͲͷΑ͏ʹ*55ޮՌΛਪఆ͢Δ͔ʁ 29 5JNF[FSPͰ ܾΊ࣏ͨྍ Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ ϕʔεϥΠϯʢ5JNF[FSP·Ͱʹܾ·ΔʣͷަབྷҼࢠͰௐ੔ 5JNF[FSPͰ ܾΊ࣏ͨྍ
Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ 5JNF[FSPͰ ܾΊ࣏ͨྍ Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ ௐ੔ ϚονϯάɺॏΈ෇͚

*55෼ੳͷ஫ҙ఺ 30 w ෆ९क΍୤མ͕͋Δ৔߹ɺ࣮ࡍͷ࣏ྍޮՌͱ͸ҟͳΔ w ϓϥηϘରরͷ3$5Ͱ͸ɺ*55ޮՌ͸࣮ࡍͷ࣏ྍޮՌΑΓอकతͳਪఆ஋ͱͳΔ ˠ෭࡞༻ͳͲͷ҆શੑΛΤϯυϙΠϯτʹͨ͠ࢼݧ΍ඇྼੑࢼݧͰ͸ɺ ɹա౓ʹʮ҆શʯͰ͋ͬͨΓɺʮඇྼੑʯʹͳΓ΍͘͢ͳΔ w ࣮ༀରরͷ3$5Ͱ͸ɺอकతʹͳΔͱ͸ݶΒͳ͍
ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍ Ξ΢τΧϜ ަབྷҼࢠ 㱠 )FSOÂO." )FSOÂOEF[%ÍB[4#FZPOEUIFJOUFOUJPOUPUSFBUJODPNQBSBUJWFF ff FDUJWFOFTTSFTFBSDI$MJO5SJBMT'FC r ࣮ࡍͷ࣏ྍޮՌͱ͸ʁ

֤ޮՌͷର৅ूஂɺൺֱ͢Δ܈ɺޮՌͷҙຯ 31 *55ޮՌ 1FSQSPUPDPMޮՌ ղੳର৅ूஂ ׂΓ෇͚ͨूஂ ׂΓ෇͚ͨूஂ ൺֱ͢Δ܈ ׂΓ෇͚ͨ܈ ࣮ࡍʹ͓͜ͳ࣏ͬͨྍʹैͬͨ܈
ޮՌͷҙຯ ׂΓ෇͚࣏ͨྍͷޮՌ ͢΂ͯͷ৘ใΛ࢖࣏ͬͨྍͷޮՌ खज़ ༀࡎ ैདྷ࣏ྍ खज़ ༀࡎ ैདྷ࣏ྍ खज़ ༀࡎ ैདྷ࣏ྍ खज़܈ ༀࡎ܈ खज़ ༀࡎ ैདྷ࣏ྍ खज़ ༀࡎ ैདྷ࣏ྍ खज़ ༀࡎ ैདྷ࣏ྍ खज़܈ ༀࡎ܈ ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍ ൺֱ͢Δ܈ ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍ ൺֱ͢Δ܈

1FSQSPUPDPMޮՌΛਪఆ͢Δͱ͖ͷόΠΞε 32 ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍ Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ ϥϯμϜׂΓ෇͚Ͱ͸ɺ ࣮ࡍͷ࣏ྍޮՌͱΞ΢τΧϜͱͷؒͷަབྷҼࢠ͸੍ޚͰ͖͍ͯͳ͍

࣏ྍ͕มΘΔͱɺ΋ͬͱେม 33 ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍʢ࣌఺ʣ Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ ަབྷҼࢠ ʢ࣌఺ʣ
࣮ࡍͷ࣏ྍʢ࣌఺ʣ ަབྷҼࢠ ʢ࣌఺ʣ

؍࡯ݚڀͰ͸ɺͲͷΑ͏ʹ1FSQSPUPDPMޮՌΛਪఆ͢Δ͔ʁ 34 ϕʔεϥΠϯʢ5JNF[FSP·Ͱʹܾ·Δʣ͚ͩͰͳ͘ 5JNF[FSPޙͷަབྷҼࢠ΋࢖ͬͯௐ੔ ׂΓ෇͚ͨ ࣏ྍ ࣮ࡍͷ࣏ྍʢ࣌఺ʣ Ξ΢τΧϜ ަབྷҼࢠ ʢϕʔεϥΠϯʣ
ަབྷҼࢠ ʢ࣌఺ʣ ࣮ࡍͷ࣏ྍʢ࣌఺ʣ ަབྷҼࢠ ʢ࣌఺ʣ

஌Γ͍ͨޮՌΛܾΊΔͱɺऩू͢Δσʔλ͢΂͖σʔλ΋ܾ·Δ 35 ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ 1FSQSPUPDPMޮՌ ϝτϗϧϛϯ
4(-5્֐ༀ *55ޮՌ ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ܧଓͯ͠౤༩͞Ε͍ͯΕ͹ɺ5JNF[FSP͚ͩͰ΋ྑ͍͕ ९कঢ়گ͸஌Γ͍ͨ 5JNF[FSPޙͷ৘ใ΋ඞཁ

ద֨ج४͸ϕʔεϥΠϯͰຬͨ͢ 36 ܕ%. ϝτϗϧϛϯ 4(-5્֐ༀ ϝτϗϧϛϯ 4(-5્֐ༀ 5JNF[FSP ద֨ج४ͷ൑அ 5JNF[FSPޙͷ৘ใ΋͋Δ͚Ͳɺ
ద֨ج४ͷ൑அʹ͸࢖Θͳ͍ બ୒όΠΞεͷൃੜ

5BSHFUUSJBMFNVMBUJPOͷϑϨʔϜϫʔΫ࠶ܝ 37 'V &- &WBOT . $BSSFSP ++ 1VUUFS )
$MBTF $. $BTLFZ '+ 4[ZND[BL . 5PSJOP $ $IFTOBZF /$ +BHFS ,+ 8BOOFS $ %FLLFS '8 WBO%JFQFO . 5JNJOHPG EJBMZTJTJOJUJBUJPOUPSFEVDFNPSUBMJUZBOEDBSEJPWBTDVMBSFWFOUTJOBEWBODFEDISPOJDLJEOFZEJTFBTFOBUJPOXJEFDPIPSUTUVEZ#.+ Fͷ4VQQMFNFOUBSZ5BCMF" ཁૉ 5BSHFUUSJBMͰͷܭը ؍࡯ݚڀσʔλͰ໛฿͢ΔͳΒ ద֨ج४ w ࡀҎ্ w F('3͕N-NJON 5BSHFUUSJBMͱಉ͡ ࣏ྍܭը ಁੳͷಋೖ࣌ظΛɺF('3Λ͔ΒͷൣғΛ NࠁΈͰͷ۠෼ʹ෼͚Δ 5BSHFUUSJBMͱಉ͡ ࣏ྍׂΓ౰ͯ ϥϯμϜׂ෇͚ ಛघͳղੳख๏ʢDMPOJOHʣʹΑΓϥϯμϜԽΛ໛฿ ؍࡯ظؒ ϥϯμϜԽ࣌఺Ͱ؍࡯Λ։࢝͠ɺࢮ๢ɺ৺݂؅Πϕϯ τɺ೥݄·Ͱɺ·ͨ͸೥ؒ௥੻ͷ͍ͣΕ͔ૣ ͍࣌఺Ͱऴྃ͢Δ ͢΂ͯͷద֨ج४Λຬ͔ͨͯ͠Βɺ௥੻։࢝ Ξ΢τΧϜ શࢮ๢ɺओཁ༗֐৺݂؅Πϕϯτ w UBSHFUUSJBMͱಉ༷ w ৺݂؅Πϕϯτ͸*$%ίʔυͰఆٛ ؔ৺ͷ͋ΔҼՌޮՌ *OUFOUJPOUPUSFBUޮՌɺ1FSQSPUPDPMޮՌ 1FSQSPUPDPMޮՌ ղੳܭը ͦΕͧΕͷޮՌʹదͨ͠ղੳํ๏ ޮՌʹదͨ͠౷ܭղੳख๏ ϑϨʔϜϫʔΫͷߏ੒ཁૉ͸͢΂ͯॏཁ

5BSHFUUSJBMFNVMBUJPOͷྫʢ$,%ʹର͢Δ3"4JͷޮՌʣ 38 ຫੑਛଁපױऀ ϨχϯɾΞϯδΦςϯγϯܥ્֐ༀʢ3"4JʣͷΈ Χϧγ΢Ϝ፰߅ༀʢ$$#ʣͷΈ ࠷௕೥ؒϑΥϩʔ Ξ΢τΧϜ w ਛ୅ସྍ๏ w
ಁੳ·ͨ͸ਛҠ২ w શࢮҼࢮ๢ w ओཁ༗֐৺݂؅Πϕϯτ $,% ຫੑਛଁපױऀʹ͓͚ΔɺΧϧγ΢Ϝ፰߅ༀͱൺֱͨ͠ ϨχϯɾΞϯδΦςϯγϯܥ્֐ༀͷ༧ޙʢಁੳ΍ࢮ๢౳ʣ΁ͷӨڹධՁ 'V &- 5BSHFU5SJBM&NVMBUJPOUP*NQSPWF$BVTBM*OGFSFODFGSPN0CTFSWBUJPOBM%BUB8IBU 8IZ BOE)PX +PVSOBMPGUIF"NFSJDBO4PDJFUZPG/FQISPMPHZ+"4/ r

5BSHFUUSJBMFNVMBUJPOͷྫʢ$,%ʹର͢Δ3"4JͷޮՌʣ 39 ཁૉ 5BSHFUUSJBMͰͷܭը ؍࡯ݚڀσʔλͰ໛฿͢ΔͳΒ ద֨ج४ w ࡀҎ্ w F('3N-NJON
w ਛҠ২ྺͳ͠ w աڈ೔ؒʹ3"4J·ͨ͸$$#Λ࢖͍ͬͯͳ͍ˠ ɹطଘॲํऀόΠΞεΛ๷͙໨త 5BSHFUUSJBMͱಉ͡ ࣏ྍܭը w 3"4JͷΈΛ։࢝ w $$#ͷΈΛ։࢝ 5BSHFUUSJBMͱಉ͡ ࣏ྍׂΓ౰ͯ ϥϯμϜԽɺ໡ݕԼͳ͠ w ద֨ऀ͸ϕʔεϥΠϯ࣌ʹɺ࣏ྍΛܾఆ w ϥϯμϜԽΛ໛฿͢ΔͨΊʹɺϕʔεϥΠϯͷަབྷ ҼࢠΛௐ੔ ؍࡯ظؒ ϥϯμϜԽ͔Β؍࡯։࢝ɺΤϯυϙΠϯτͷൃੜɺ ଧͪ੾Γɺ೥ؒ௥੻Ͱऴྃ ॲํ͕Ͱ͔ͯΒ։࢝ɺΤϯυϙΠϯτͷൃੜɺ ଧͪ੾Γɺ೥ؒ௥੻Ͱऴྃ Ξ΢τΧϜ w ਛ୅ସྍ๏ w શࢮҼࢮ๢ w ओཁ༗֐৺݂؅Πϕϯτ w 5BSHFUUSJBMͱಉ͡ w Ұ෦*$%ίʔυ͔Βಛఆ ؔ৺ͷ͋ΔҼՌޮՌ w *55ޮՌ w 1FSQSPUPDPMޮՌ 1FSQSPUPDPMޮՌ 'V &- 5BSHFU5SJBM&NVMBUJPOUP*NQSPWF$BVTBM*OGFSFODFGSPN0CTFSWBUJPOBM%BUB8IBU 8IZ BOE)PX +PVSOBMPGUIF"NFSJDBO4PDJFUZPG/FQISPMPHZ+"4/ rͷ5BCMFΛվม

5BSHFUUSJBMFNVMBUJPOͷྫʢ$07*%ʹର͢ΔεςϩΠυ࣏ྍͷޮՌʣ 40 w ೖӃͨ͠$07*%ױऀʹରͯ͠ɺεςϩΠυ࣏ྍ͕ࢮ๢ʹӨڹ͢Δ͔ධՁ͢Δࢼݧ w 5BSHFUUSJBMɿ3&$07&3:ࢼݧ w 3&$07&3:$PMMBCPSBUJWF(SPVQ )PSCZ1 -JN84
&NCFSTPO+3 .BGIBN. #FMM+- FUBM%FYBNFUIBTPOFJO)PTQJUBMJ[FE1BUJFOUTXJUI$PWJE/&OHM+.FE'FC r w )P ff NBO,- 4DIFODL&+ 4BUMJO.+ 8IBMFO8 1BO% 8JMMJBNT/ FUBM$PNQBSJTPOPGB5BSHFU5SJBM&NVMBUJPO'SBNFXPSLWT$PY3FHSFTTJPOUP&TUJNBUFUIF"TTPDJBUJPOPG $PSUJDPTUFSPJET8JUI$07*%.PSUBMJUZ+"."/FUX0QFO0DU FͷF5BCMFΛվม ཁૉ 5BSHFUUSJBMͰͷܭը ؍࡯ݚڀσʔλͰ໛฿͢ΔͳΒ ద֨ج४ w ੒ਓͷ$07*%ͷೖӃױऀ w ࣏ݧʹࢀՃͨ͠৔߹ʹେ͖ͳةݥʹ͞Β͞ΕΔՄೳੑ ͷ͋Δපྺͷͳ͍ױऀ w ੒ਓͷ$07*%ͷೖӃױऀ w ຫੑతʹεςϩΠυΛ࢖͍ͬͯͳ͍ ࣏ྍܭը w ௿༰ྔεςϩΠυ౤༩ ʢσΩαϝλκϯNHɺ೔ճ೔ؒʣʴඪ४࣏ྍ w ඪ४࣏ྍ w εςϩΠυʼNHLH೔ ʢॏ౓ͷ௿ࢎૉ঱ൃੜ͔࣌Β೔ؒʣʴඪ४࣏ྍ w ඪ४࣏ྍ ࣏ྍׂΓ౰ͯ ొ࿥࣌ʢ͓ͦΒ͘ೖӃ࣌ʣʹɺϥϯμϜׂ෇͚ ೖӃ࣌ʹϥϯμϜׂΓ෇͚͞ΕͨΑ͏ʹമ࿐ΛܾΊΔ ؍࡯ظؒ ϥϯμϜԽ࣌఺Ͱ؍࡯Λ։࢝͠ɺ೔·Ͱɺࢮ๢ɺ ·ͨ͸௥੻ෆೳͷ͍ͣΕ͔ૣ͍࣌఺Ͱऴྃ͢Δ മ࿐ܾఆ͔࣌Β؍࡯Λ։࢝͠ɺ೔·Ͱɺࢮ๢ɺ ·ͨ͸௥੻ෆೳͷ͍ͣΕ͔ૣ͍࣌఺Ͱऴྃ͢Δ Ξ΢τΧϜ ೔ࢮ๢ ೔ࢮ๢ ؔ৺ͷ͋ΔҼՌޮՌ *55ޮՌ 1FSQSPUPDPMޮՌ

41 5BSHFUUSJBMFNVMBUJPOͨ݁͠Ռ͸ɺ 5BSHFUUSJBMͷ݁ՌͱҰக͢Δʁ

5BSHFUUSJBMFNVMBUJPOͷ݁Ռʢ$,%ʹର͢Δ3"4JͷޮՌʣ 42 'V &- 5BSHFU5SJBM&NVMBUJPOUP*NQSPWF$BVTBM*OGFSFODFGSPN0CTFSWBUJPOBM%BUB8IBU 8IZ BOE)PX +PVSOBMPGUIF"NFSJDBO4PDJFUZPG/FQISPMPHZ+"4/
rͷ5BCMFΛվม

5BSHFUUSJBMFNVMBUJPOͷ݁Ռʢͷ3$5Λݕ౼ʣ 43 8BOH 47 4DIOFFXFJTT 4 3$5%61-*$"5&*OJUJBUJWF 'SBOLMJO +. %FTBJ
3+ 'FMENBO 8 (BSSZ &. (MZOO 3+ -JO ,+ 1BJL + 1BUPSOP & 4VJTTB 4 %`"OESFB & +BXBJE % -FF ) 1BXBS " 4SFFEIBSB 4, 5FTGBZF ) #FTTFUUF -( ʜ2VJOUP , &NVMBUJPOPG3BOEPNJ[FE$MJOJDBM5SJBMT8JUI/POSBOEPNJ[FE%BUBCBTF"OBMZTFT3FTVMUTPG $MJOJDBM5SJBMT+"."5IF+PVSOBMPGUIF"NFSJDBO.FEJDBM"TTPDJBUJPO r ͋Δఔ౓͍ۙ஋Λࣔ͢

44 5BSHFUUSJBMFNVMBUJPO͸ Ͳͷ͙Β͍࢖ΘΕ͍ͯΔ͔ʁ

5BSHFUUSJBMFNVMBUJPOͷใࠂ͕͋ΔྖҬ 45 4DPMB ( $IJT4UFS " #FBO % 1BSFFL /
&NTMFZ 3 -BOEBV 4 *NQMFNFOUBUJPOPGUIFUSJBMFNVMBUJPOBQQSPBDIJONFEJDBMSFTFBSDIBTDPQJOHSFWJFX#.$.FEJDBM 3FTFBSDI.FUIPEPMPHZ ͷ'JHVSFΛվม ॥؀ث খࣇ ൻ೘ث ൽෘ ࢈Պɾ්ਓՊ Ϧ΢Ϛν w 5BSHFUUSJBMFNVMBUJPOͷ είʔϐϯάϨϏϡʔ w ·Ͱͷௐࠪ ਫ਼ਆҩֶ ֎Պ ਆܦֶ ਛଁֶ ͕Μ ײછ঱ ɹɹɹ ෼໺ʹಛԽͨ͠5BSHFUUSJBM FNVMBUJPOͷղઆ࿦จ͋Γ ʢ؍࡯ൣғ಺Ͱ͢ʣ

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