胃と腸42巻13号

2007年12月発行

今月の主題 新しい治療による炎症性腸疾患（IBD）の経過―粘膜治癒を中心に 主題

炎症性腸疾患の病理像からみた難治要因―潰瘍性大腸炎を中心に

著者： 田中正則¹

所属機関： ¹弘前市立病院臨床検査科

ページ範囲：P.1903 - P.1910

要旨　潰瘍性大腸炎(UC)患者の17～38％は薬物治療に難治で，外科的治療が選択されている．難治症例の内視鏡的・組織学的特徴は，“高度かつ広範な炎症”と“UCとしては非典型的な炎症”に要約される．前者に関連する具体的所見は，罹患範囲が広いこと，陰窩膿瘍が多いこと，潰瘍が広範で深いことである．一方，後者が意味する所見には，縦走する帯状潰瘍，patchyな炎症，近位大腸での難治性病変，relative rectal sparingなどのCrohn病類似病変がある．好酸球浸潤が軽微であることも活動期UCとしては非典型的である．難治症例を早期に予測するという観点から，上記の肉眼的所見を加えた新たな内視鏡的重症度分類の作成が望まれる．陰窩膿瘍と好酸球浸潤はUCの鑑別診断には寄与しないが，それらの密度は難治を予測する情報として病理報告書に盛り込まれるべきである．

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