胃と腸40巻8号

2005年07月発行

今月の主題 免疫異常と消化管病変

主題

免疫異常状態における消化管炎症性病変の臨床像と画像診断

著者： 松本主之¹ 江崎幹宏¹ 中村昌太郎¹ 藤澤律子¹ 森山智彦¹ 中村滋郎¹ 平橋美奈子² 八尾隆史² 飯田三雄²

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²九州大学大学院医学研究院形態機能病理

ページ範囲：P.1135 - P.1145

文献概要

要旨　免疫不全と移植片対宿主病（GVHD）における消化管病変の臨床的特徴を概説した．先天性免疫不全の中でも，リンパ球機能低下における消化管病変の報告は少ないが，その多くは小腸の原虫・寄生虫感染症とそれによる吸収不良症候群である．これに対し，慢性肉芽腫症や糖原病などの好中球機能低下症では慢性の大腸病変が発生し，臨床像や画像所見は特発性慢性炎症性腸疾患に類似している．後天性免疫不全の中でもHIV感染症とHTLV-1感染症では原虫・寄生虫感染による小腸病変が認められる．また，後天性免疫不全では真菌感染による食道病変とウイルス感染による潰瘍性病変に遭遇することが多い．一方，医原性免疫過剰反応であるGVHDでは多彩な病変が消化管のいずれの部位にも発生するが，その基本は腺窩上皮の浮腫および粘膜脱落と考えられる．免疫異常状態における消化管病変の画像診断に際しては，消化管感染症の病態を熟知しておく必要がある．

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