胃と腸46巻13号

2011年12月発行

今月の主題 難治性潰瘍性大腸炎─診療・治療の新たな展開 主題

難治性潰瘍性大腸炎の組織学的特徴―初発時の生検組織像による難治化症例の予測

著者： 江頭由太郎¹ 藤井基嗣¹ 西田司¹ 阿倍洋介² 村野実之² 梅垣英次² 芥川寛¹ 樋口和秀²

所属機関： ¹大阪医科大学病理学教室 ²大阪医科大学第2内科

ページ範囲：P.1947 - P.1955

要旨　ステロイド治療に抵抗を示した難治性潰瘍性大腸炎（UC）24例とステロイド治療が奏効した非難治性UC 25例の初発時生検組織の病理学的因子を比較検討した．単変量解析にて潰瘍性大腸炎の難治化と有意な相関を示したのは“粘膜筋板肥厚”，“びらん”，“炎症細胞浸潤（高度～中等度）”，“好中球/好酸球≧1”，“杯細胞減少（高度～中等度）”，“虫垂開口部病変”，直腸炎型”であった．下線で示した4種の因子は難治化の危険因子で，他の3種の因子は難治化の抑制因子であった．多変量解析で，有意な独立性の認められた因子は“直腸炎型”だけであった．これらの結果よりUC難治化のリスク予測基準案を作成した．この基準の感度は100％，特異度は76.0％，総正診率は87.8％であり，精度の高い予測が可能となると考えられた．

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