胃と腸49巻10号

2014年09月発行

今月の主題 colitic cancerの初期病変─遡及例の検討を含めて 主題関連研究

潰瘍性大腸炎に合併する大腸腫瘍の診断と高危険群の拾い上げ

著者： 藤井茂彦¹ 藤盛孝博² 市川一仁³⁴ 冨田茂樹⁵ 日下利広¹ 國立裕之¹

所属機関： ¹京都桂病院消化器センター消化器内科 ²神鋼病院病理診断センター ³会津中央病院消化管内視鏡治療センター準備室消化器病センター（病理部門） ⁴福島県立医科大学地域医療支援センター ⁵順天堂大学医学部附属浦安病院病理診断科

ページ範囲：P.1487 - P.1499

要旨　大腸腫瘍発生の高危険群である長期罹患・広範囲罹患潰瘍性大腸炎（ulcerative colitis ; UC）は，大腸腫瘍の早期発見のため定期的な大腸内視鏡検査によるサーベイランスが推奨されているが，その内視鏡診断や組織学的診断は困難なことが少なくない．UCに合併する大腸腫瘍の診断には色素内視鏡検査やNBI（narrow band imaging）を併用した内視鏡検査，p53遺伝子異常の解析の有用性が報告されており，臨床的にも応用されている．しかし，増加傾向を示すUCに対して効率のよいサーベイランスを行うためには腫瘍発生がさらにハイリスクな症例を拾い上げる必要がある．そのため，慢性炎症性粘膜や血清，糞便中の遺伝子変化が新たな危険因子の候補として検討されており，臨床応用が可能となればサーベイランスの有用性の向上に寄与することが期待される．

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