{"id":254324,"date":"2025-01-21T22:45:01","date_gmt":"2025-01-21T21:45:01","guid":{"rendered":"https:\/\/r3i.org\/%e3%83%95%e3%82%a9%e3%83%bc%e3%82%ab%e3%82%b9-%e5%bf%83%e8%a1%80%e7%ae%a1%e3%83%aa%e3%82%b9%e3%82%af%e3%81%8c%e9%ab%98%e3%81%84%e3%81%93%e3%81%a8%e3%82%92%e7%a4%ba%e3%81%99%e3%83%88%e3%83%aa\/"},"modified":"2025-02-16T22:18:55","modified_gmt":"2025-02-16T21:18:55","slug":"%e3%83%95%e3%82%a9%e3%83%bc%e3%82%ab%e3%82%b9-%e5%bf%83%e8%a1%80%e7%ae%a1%e3%83%aa%e3%82%b9%e3%82%af%e3%81%8c%e9%ab%98%e3%81%84%e3%81%93%e3%81%a8%e3%82%92%e7%a4%ba%e3%81%99%e3%83%88%e3%83%aa","status":"publish","type":"page","link":"https:\/\/r3i.org\/ja\/%e3%83%95%e3%82%a9%e3%83%bc%e3%82%ab%e3%82%b9-%e5%bf%83%e8%a1%80%e7%ae%a1%e3%83%aa%e3%82%b9%e3%82%af%e3%81%8c%e9%ab%98%e3%81%84%e3%81%93%e3%81%a8%e3%82%92%e7%a4%ba%e3%81%99%e3%83%88%e3%83%aa\/","title":{"rendered":"\u30d5\u30a9\u30fc\u30ab\u30b9 &#8211; \u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u3053\u3068\u3092\u793a\u3059\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u306e\u4e0a\u6607"},"content":{"rendered":"\n[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;1px|||||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; header_2_text_color=&#8221;gcid-primary-color&#8221; header_5_text_color=&#8221;gcid-secondary-color&#8221; text_orientation=&#8221;center&#8221; width=&#8221;99%&#8221; custom_margin=&#8221;|-147px||||&#8221; custom_padding=&#8221;|0px||||&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22quote_text_color%22,%22quote_text_color%22,%22quote_text_color%22,%22header_2_text_color%22%93,%22gcid-secondary-color%22:%91%22header_5_text_color%22%93}&#8221; sticky_enabled=&#8221;0&#8243;]<h2>\u30d5\u30a9\u30fc\u30ab\u30b9 &#8211;<span>\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u3053\u3068\u3092\u793a\u3059\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u306e\u4e0a\u6607<\/span><\/h2>\n<h5><span>13 2023\u5e744\u6708<\/span><\/h5>\n<p><em>\u7c73\u56fd\u306e\u9000\u5f79\u8ecd\u4eba40\u4e07\u4eba\u8fd1\u304f\u3092\u542b\u3080\u5927\u898f\u6a21\u30b3\u30db\u30fc\u30c8\u7814\u7a76\u306b\u304a\u3044\u3066\u3001\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\uff08TG\uff09\u306e\u4e0a\u6607\u306f\u3001\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u65e2\u5f80\u306e\u3042\u308b\u4eba\u3001\u3042\u308b\u3044\u306f\u7cd6\u5c3f\u75c5\u306e\u307f\u3067\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u304c\u6b8b\u5b58\u3057\u3066\u3044\u308b\u4eba\u3092\u540c\u5b9a\u3059\u308b\u306e\u306b\u5f79\u7acb\u3063\u305f\u3002<\/em><\/p>\n<p><em>\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u5024\u304c\u4e2d\u7b49\u5ea6\u306b\u9ad8\u304f\u3001\u30b9\u30bf\u30c1\u30f3\u6295\u4e0e\u3067LDL-C\u5024\u304c\u826f\u597d\u306b\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3055\u308c\u3066\u3044\u308b\u7c73\u56fd\u9000\u5f79\u8ecd\u4eba\u306b\u304a\u3051\u308b\u6b8b\u5b58\u5fc3\u8840\u7ba1\u7cfb\u30ea\u30b9\u30af\u306e\u5897\u52a0\u3002Front Cardiovasc Med 2022; 9:982815.   <\/em><\/p>\n<p><b>\u7814\u7a76\u6982\u8981<\/b><\/p>\n<table border=\"0\" width=\"100%\" cellspacing=\"1\" cellpadding=\"3\" bgcolor=\"#CCCCCC\">\n<tbody>\n<tr valign=\"middle\">\n<td bgcolor=\"#E9E9E9\" width=\"17%\"><strong>\u76ee\u7684<\/strong><\/td>\n<td align=\"left\" bgcolor=\"#FFFFFF\" width=\"83%\">\u30b9\u30bf\u30c1\u30f3\u6295\u4e0e\u3067\u4f4e\u6bd4\u91cd\u30ea\u30dd\u86cb\u767d\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\uff08LDL-C\uff09\u5024\u304c\u826f\u597d\u306b\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3055\u308c\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306eTG\u5024\u304c\u9ad8\u5024\uff081.7-5.6mmol\/L\u307e\u305f\u306f150-499mg\/dL\uff09\u3067\u3042\u3063\u305f\u88ab\u9a13\u8005\u3068\u3001TG\u5024\u304c\u6b63\u5e38\uff08&lt;1.7mmol\/L\u307e\u305f\u306f150mg\/dL\uff09\u3067\u3042\u3063\u305f\u88ab\u9a13\u8005\u306e\u6b8b\u5b58\u5fc3\u8840\u7ba1\u7cfb\u30ea\u30b9\u30af\u3092\u8abf\u67fb\u3059\u308b\u3053\u3068\u3002<\/td>\n<\/tr>\n<tr valign=\"middle\">\n<td bgcolor=\"#E9E9E9\"><strong>\u7814\u7a76\u30c7\u30b6\u30a4\u30f3<\/strong><\/td>\n<td align=\"left\" bgcolor=\"#FFFFFF\">\u89b3\u5bdf\u7684\u5f8c\u308d\u5411\u304d\u30b3\u30db\u30fc\u30c8\u7814\u7a76<\/td>\n<\/tr>\n<tr valign=\"middle\">\n<td valign=\"top\" bgcolor=\"#E9E9E9\"><strong>\u7814\u7a76\u5bfe\u8c61\u8005<\/strong><\/td>\n<td align=\"left\" bgcolor=\"#FFFFFF\">\u7c73\u56fd\u9000\u5f79\u8ecd\u4eba\u5c40\uff08VA\uff09\u306e\u96fb\u5b50\u30ab\u30eb\u30c6\u30c7\u30fc\u30bf\u30d9\u30fc\u30b9\u306b\u767b\u9332\u3055\u308c\u305f18\u6b73\u4ee5\u4e0a\u3067\u3001LDL-C\u5024\u304c\u826f\u597d\u306b\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3055\u308c\u3066\u304a\u308a\uff081.0\uff5e2.6mmol\/L\u307e\u305f\u306f40\uff5e100mg\/dL\uff09\u30012010\u5e74\u306b\u5c11\u306a\u304f\u3068\u30821\u56de\u306eTG\u6e2c\u5b9a\u304c\u884c\u308f\u308c\u305f\u88ab\u9a13\u8005\u3002\u88ab\u9a13\u8005\u306fTG\u4f4e\u4e0b\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3044\u306a\u304b\u3063\u305f\u3002 <\/td>\n<\/tr>\n<tr valign=\"middle\">\n<td bgcolor=\"#E9E9E9\"><strong>\u8a66\u9a13\u6210\u7e3e<\/strong><\/td>\n<td align=\"left\" bgcolor=\"#FFFFFF\">&#8211; \u4e3b\u8981\u6709\u5bb3\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\uff08MACE\uff09\uff1a\u975e\u81f4\u6b7b\u7684\u5fc3\u7b4b\u6897\u585e\uff08MI\uff09\u3001\u975e\u81f4\u6b7b\u7684\u8133\u5352\u4e2d\u3001\u4e0d\u5b89\u5b9a\u72ed\u5fc3\u75c7\u3001\u51a0\u52d5\u8108\u8840\u884c\u518d\u5efa\u8853\u3001\u5fc3\u8840\u7ba1\u6b7b\u306e\u8907\u5408\u3002<\/td>\n<\/tr>\n<tr valign=\"middle\">\n<td bgcolor=\"#E9E9E9\"><strong>\u65b9\u6cd5<\/strong><\/td>\n<td align=\"left\" bgcolor=\"#FFFFFF\">\u88ab\u9a13\u8005\u30923\u3064\u306e\u30ea\u30b9\u30af\u7fa4\u306b\u5c64\u5225\u5316\u3057\u305f\uff1a(1)\u7cd6\u5c3f\u75c5\u306a\u3057\u3001\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u65e2\u5f80\u306a\u3057\u3001(2)\u7cd6\u5c3f\u75c5\u3042\u308a\u3001\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u65e2\u5f80\u306a\u3057\u3001(3)\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u65e2\u5f80\u3042\u308a\u3002\u30c7\u30fc\u30bf\u306f\u5e74\u9f62\uff0c\u6027\u5225\uff0c\u53ce\u7e2e\u671f\u8840\u5727\uff0c\u63a8\u7b97\u7cf8\u7403\u4f53\u6ffe\u904e\u91cf\uff0c\u4f53\u91cd\u3067\u88dc\u6b63\u3057\u305f\u7c97\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u7387\uff0c\u767a\u751f\u7387\u6bd4\uff0c\u30a4\u30d9\u30f3\u30c8\u767a\u751f\u7387\u6bd4\u306b\u3064\u3044\u3066\u89e3\u6790\u3055\u308c\u305f\u3002 <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><strong>\u7d50\u679c<\/strong><\/p>\n<p>\u3053\u306e\u30b3\u30db\u30fc\u30c8\u306b\u306f\u3001TG\u4f4e\u4e0b\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3044\u306a\u3044396,189\u4eba\u304c\u542b\u307e\u308c\u3001\u305d\u306e\u3046\u3061109,195\u4eba\uff0828\uff05\uff09\u304cTG\u4e0a\u6607\u3067\u3042\u3063\u305f\u3002TG\u9ad8\u5024\u8005\u306fTG\u4f4e\u5024\u8005\u3088\u308a\u82e5\u304f\uff08\u5e73\u5747\u5e74\u9f6273\u6b73\u5bfe77\u6b73\uff09\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u80a5\u6e80\u5ea6\uff08BMI\u300131.3\u5bfe28.3kg\/m2\uff09\u3001\u8840\u5727\u3001\u7dcf\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u3001LDL-C\u3001\u30d8\u30e2\u30b0\u30ed\u30d3\u30f3A1c\uff087.2\u5bfe6.7\uff05\uff09\u304c\u9ad8\u304b\u3063\u305f\u3002   <\/p>\n<p>\u5408\u8a08\u3059\u308b\u3068\u3001TG\u306e\u4e0a\u6607\u306fMACE\u306e\u767a\u751f\u7387\u30925\uff05\u5897\u52a0\u3055\u305b\u308b\u3053\u3068\u3068\u95a2\u9023\u3057\u3066\u3044\u305f\uff08\u88dc\u6b63\u5f8c\u767a\u751f\u7387\u6bd41.05\u300195\uff05\u4fe1\u983c\u533a\u9593[CI] 1.03\u301c1.06\uff09\u3002\u5fc3\u8840\u7ba1\u6b7b\u3092\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u304b\u3089\u9664\u5916\u3059\u308b\u3068\u3001TG\u9ad8\u5024\u306fMACE\u767a\u751f\u7387\u306e16\uff05\u4e0a\u6607\u3068\u95a2\u9023\u3057\u3066\u3044\u305f\uff08\u7387\u6bd41.16\u300195\uff05\u4fe1\u983c\u533a\u95931.13\uff5e1.18\uff09\u3002TG\u5024\u3068MACE\u8ee2\u5e30\u3068\u306e\u95a2\u9023\u306f\u4eba\u7a2e\u3084\u30b9\u30bf\u30c1\u30f3\u5f37\u5ea6\u306b\u3088\u308b\u5dee\u306f\u306a\u304b\u3063\u305f\u30023\u3064\u306e\u30ea\u30b9\u30af\u7fa4\u3054\u3068\u306e\u88dc\u6b63\u5f8c\u306e\u767a\u751f\u7387\u6bd4\u3092\u4ee5\u4e0b\u306b\u8981\u7d04\u3059\u308b\uff08\u88681\uff09\u3002     <\/p>\n<p><strong>\u88681. MACE\u304a\u3088\u3073\u975e\u81f4\u6b7b\u7684MACE\u306e\u30ea\u30b9\u30af\u7fa4\u5225\u8abf\u6574\u7387\u6bd4<\/strong><\/p>\n<table class=\"study-table\">\n<tbody>\n<tr>\n<td width=\"131\">\n<p>CVD\u307e\u305f\u306f\u7cd6\u5c3f\u75c5\u306e\u65e2\u5f80\u306a\u3057\uff08n=119,756\uff09<\/p>\n<\/td>\n<td width=\"131\">\n<p>\u7cd6\u5c3f\u75c5\u3092\u4f34\u3046CVD\u65e2\u5f80\u306a\u3057\uff08n=83,546\uff09<\/p>\n<\/td>\n<td width=\"131\">\n<p>CVD\u306e\u65e2\u5f80\uff08n=192,887\uff09<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"131\">\n<p>MACE\u3001n (%)<\/p>\n<p>TG\u4e0a\u6607<\/p>\n<p>\u30ce\u30fc\u30de\u30ebTG<\/p>\n<\/td>\n<td width=\"131\">\n<p>&nbsp;<\/p>\n<p>3,514 (13.1%)<\/p>\n<p>12,189 (13.1%)<\/p>\n<\/td>\n<td width=\"131\">\n<p>&nbsp;<\/p>\n<p>4,150 (14.9%)<\/p>\n<p>7,894 (14.2%)<\/p>\n<\/td>\n<td width=\"131\">\n<p>&nbsp;<\/p>\n<p>14,516 (26.6%)<\/p>\n<p>34,679 (25.1%)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"131\">\n<p>MACE\u3001\u8abf\u6574\u7387\u6bd4*\uff0895\uff05CI\uff09<\/p>\n<\/td>\n<td width=\"131\">\n<p>0.98 (0.94, 1.01)<\/p>\n<\/td>\n<td width=\"131\">\n<p>1.05 (1.01, 1.09)<\/p>\n<\/td>\n<td width=\"131\">\n<p>1.05 (1.03, 1.07)<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"131\">\n<p>\u975e\u81f4\u6b7b\u7684MACE\u3001\u8abf\u6574\u7387\u6bd4*\uff0895\uff05CI\uff09<\/p>\n<\/td>\n<td width=\"131\">\n<p>1.07 (1.00, 1.15)<\/p>\n<\/td>\n<td width=\"131\">\n<p>1.20 (1.12, 1.27)<\/p>\n<\/td>\n<td width=\"131\">\n<p>1.15 (1.11, 1.18)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><span>* 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width=\"540\">TG\u5024\u304c\u4e0a\u6607\u3057\u3001\u30b9\u30bf\u30c1\u30f3\u6295\u4e0e\u3067LDL-C\u304c\u5341\u5206\u306b\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3055\u308c\u3066\u3044\u308b\u60a3\u8005\u3067\u306f\u3001TG\u5024\u304c\u6b63\u5e38\u306e\u60a3\u8005\u3068\u6bd4\u8f03\u3057\u3066\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u767a\u751f\u306f\u7de9\u3084\u304b\u3067\u3042\u3063\u305f\u3002TG\u5024\u306e\u4e0a\u6607\u306f\u3001\u78ba\u7acb\u3057\u305f\u5fc3\u8840\u7ba1\u75be\u60a3\u3092\u6709\u3059\u308b\u60a3\u8005\u3068\u7cd6\u5c3f\u75c5\u60a3\u8005\u306e\u307f\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306e\u5897\u52a0\u3068\u95a2\u9023\u3057\u3066\u304a\u308a\u3001\u9ad8\u30ea\u30b9\u30af\u306e\u4e00\u6b21\u4e88\u9632\u3068\u4e8c\u6b21\u4e88\u9632\u306e\u74b0\u5883\u306b\u304a\u3044\u3066\u3001TG\u5024\u306e\u4e0a\u6607\u306f\u540c\u7a0b\u5ea6\u306e\u6b8b\u5b58\u30ea\u30b9\u30af\u3068\u95a2\u9023\u3057\u3066\u3044\u308b\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u305f\u3002 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     <\/p>\n<\/div>\n<table border=\"0\" width=\"100%\" cellspacing=\"1\" cellpadding=\"3\" bgcolor=\"#CCCCCC\">\n<tbody>\n<tr>\n<td valign=\"top\" bgcolor=\"#E9E9E9\" width=\"13%\"><strong>\u53c2\u8003\u6587\u732e<\/strong><\/td>\n<td valign=\"top\" bgcolor=\"#FFFFFF\" width=\"87%\">1.Nordestgaard BG\u3002Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology.Circ Res 2016;118:547-63.<br>2.Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society.Eur Heart J 2021;42:4791-806.<br>3.Bhatt DL, Steg PG, Miller M, et al. \u9ad8\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u8840\u75c7\u306b\u5bfe\u3059\u308b\u30a4\u30b3\u30b5\u30da\u30f3\u30c8\u30a8\u30c1\u30eb\u306b\u3088\u308b\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u4f4e\u4e0b\u3002N Engl J Med 2019;380:11-22.<br>4.Nicholls SJ, Lincoff AM, Garcia M, et al. \u9ad8\u7528\u91cf\u30aa\u30e1\u30ac3\u8102\u80aa\u9178vs\u30b3\u30fc\u30f3\u6cb9\u306e\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u306e\u9ad8\u3044\u60a3\u8005\u306b\u304a\u3051\u308b\u4e3b\u8981\u6709\u5bb3\u5fc3\u8840\u7ba1\u30a4\u30d9\u30f3\u30c8\u306b\u5bfe\u3059\u308b\u52b9\u679c\uff1aSTRENGTH\u7121\u4f5c\u70ba\u5316\u81e8\u5e8a\u8a66\u9a13\u3002jama 2020;324:2268-80.<br>5.Pradhan AD, Glynn RJ, Fruchart JC, et al. \u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u8efd\u6e1b\u306e\u305f\u3081\u306e\u30da\u30de\u30d5\u30a3\u30d6\u30e9\u30fc\u30c8\u306b\u3088\u308b\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u4f4e\u4e0b\u3002New Engl J Med 2022; DOI: 10.1056\/NEJMoa2210645.<br>6.Ginsberg HN, Goldberg IJ.APOC3 \u3068 ANGPTL3 (Angiopoietin-Like Protein 3)\u3092\u6a19\u7684\u3068\u3057\u305f\u8102\u8cea\u7570\u5e38\u75c7\u6cbb\u7642\u306e\u5e45\u3092\u5e83\u3052\u308b\u3002Arterioscler Thromb Vasc Biol 2022; doi: 10.1161\/ATVBAHA.122.317966.            <\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#E9E9E9\"><strong>\u30ad\u30fc\u30ef\u30fc\u30c9<\/strong><\/td>\n<td valign=\"top\" bgcolor=\"#FFFFFF\">\u4e2d\u6027\u8102\u80aa, \u6b8b\u7559\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af, \u30b3\u30db\u30fc\u30c8\u7814\u7a76<\/td>\n<\/tr>\n<\/tbody>\n<\/table>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"<p>\u30d5\u30a9\u30fc\u30ab\u30b9 -\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\u304c\u9ad8\u3044\u3053\u3068\u3092\u793a\u3059\u30c8\u30ea\u30b0\u30ea\u30bb\u30ea\u30c9\u306e\u4e0a\u6607 13 2023\u5e744\u6708 \u7c73\u56fd\u306e\u9000\u5f79\u8ecd\u4eba40\u4e07\u4eba\u8fd1 [&hellip;]<\/p>\n","protected":false},"author":258497325,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_crdt_document":"","footnotes":""},"class_list":["post-254324","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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