胃と腸40巻10号

2005年09月発行

今月の主題 難治性潰瘍性大腸炎―診断と治療の新知見

主題研究

手術例からみた難治性潰瘍性大腸炎におけるサイトメガロウイルス感染

著者： 池田圭祐¹ 岩下明徳¹ 松井敏幸² 原岡誠司¹ 大重要人¹ 田邉寛¹ 太田敦子¹ 和田陽子² 高木靖寛² 長濱孝² 平井郁仁² 宗祐人² 八尾恒良² 二見喜太郎³

所属機関： ¹福岡大学筑紫病院病理部 ²福岡大学筑紫病院消化器科 ³福岡大学筑紫病院外科

ページ範囲：P.1401 - P.1410

文献概要

要旨　サイトメガロウイルス（CMV）感染は潰瘍性大腸炎（UC）の難治化要因として注目されているが，その病理組織学的特徴については不明な点が多い．今回，難治性UC切除連続例35例を対象として，CMV感染の病理組織学的特徴を明らかにするとともに，組織学的CMV感染と生検診断および血中抗原による臨床診断法との関連性について，臨床病理学的ならびに免疫組織化学的立場より比較検討し，以下の結果を得た．①CMV感染陽性率は切除標本上で51.4％（18/35）であり，そのCMV陽性細胞の存在部位は主として潰瘍部の肉芽組織の血管内皮細胞であった．②CMV陽性率は血中抗原で44.0（11/25），生検組織で15.4％（4/26）であった．そして，血中抗原陽性11例のうち10例（90.9％）と生検陽性4例のうち4例（100％）では切除標本上にもCMV陽性細胞を認めた．なお後者の陽性例はすべて肉芽組織が採取されており，免疫組織化学染色（IHC）法により明確に診断された．③CMV感染陽性者の臨床的特徴は陰性者と比較し有意に高齢であった（p＝0.0025）．④血中抗原の陽性細胞数と切除標本における組織学的感染細胞数とは相関しなかった．以上の結果から，難治性UCにおいてはCMV感染を常に念頭に置く必要があり，そのCMV感染診断の向上には，潰瘍底の肉芽組織から生検材料を採取すること，およびHE染色による組織診断法に加え免疫組織化学染色法と血中抗原測定法を併用することが重要であると結論した．

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