胃と腸42巻12号

2007年11月発行

今月の主題 非ステロイド性抗炎症薬（NSAID）起因性消化管病変 主題

NSAID起因性消化管病変の発生機序

著者： 平田一郎¹

所属機関： ¹藤田保健衛生大学消化管内科

ページ範囲：P.1685 - P.1689

要旨　NSAIDはarachidonic acid cascadeにおけるcyclooxygenaseの作用を阻害することで，prostaglandinやthromboxaneの合成を抑制し抗炎症作用，鎮痛・解熱作用を発揮する．NSAIDの副作用として最も多いのは胃腸傷害である．NSAIDによる消化管病変の発生機序として，①消化管上皮に対する化学的傷害，②消化管粘膜内のprostaglandin合成阻害による粘膜防御因子低下，③消化管粘膜の免疫抑制異常，などが挙げられる．NSAIDを長期服用しているH. pylori感染患者に対する除菌は潰瘍治癒を遅延させる．このH. pyloriのNSAID潰瘍に対する拮抗作用は，H. pylori感染がCOX-2の発現を亢進させ，結果としてPGE2の産生を促し胃粘膜防御因子を亢進させることによる．一方，NSAID治療を初めて受けるH. pylori感染患者に除菌を行えば，潰瘍発生のリスクを減少させることができる．

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