アフタ様病変のみから成るCrohn病の長期経過

Long-term Clinical Course of Crohn's Disease of Aphthous Type

要旨　アフタ様病変のみから成るCrohn病（以下，A型CD）の長期経過を知る目的で，典型的Crohn病（以下，T型CD）に進展する頻度，進展例の臨床的特徴，X線所見，累積手術率などについて検討した．当院で診断，治療した22例（男性13例，女性9例，経過観察期間：102.1±61.3か月）を対象とした．〔結果〕T型CDへ進展したのは22例中13例（59.1％）であった．典型病変出現までの期間は44.0±37.8か月であり，13例中12例（92.3％）は60か月以内に進展した．進展例13例の最終病型は小腸型8例，大腸型2例，小腸大腸型3例であった．進展例と非進展例の比較では，初診時の炎症所見や活動指数には差を認めなかったが，診断時に上部消化管病変を合併した頻度が，進展例で非進展例より高かった．初回治療の内容や有効性には両者間に明らかな差を認めなかった．X線検査による進展例の特徴は，小腸病変では大型のアフタ様病変，高密度分布，また浮腫の存在，大腸病変では浮腫の存在であった．22例中4例（18.2％）が経過中に手術を受けていたが，累積手術率は小腸型CD，小腸大腸型CDと比べても，統計学的に明らかな差を認めなかった．〔結論〕A型CDのT型CDへの進展様式はある程度判明した．T型CDに進展した後には，特異的な臨床像や経過はなかった．進展を阻止するための治療法は見い出せず，今後，さらに検討が必要である．

　The aim of this study is to clarify the long-term clinical course of patients with Crohn's disease of aphthous type (type A Crohn's disease). Twenty-two patients (13 male, 9 female, observation period : 102.1±62.3 months) who were diagnosed with type A Crohn's disease at our hospital were studied. The period of follow-up by radiography was 88.1±66.5 months. Incidence of progress to typical Crohn's disease, clinical features, findings of X-ray examination, cumulative probability of the need for surgery were investigated. We compared clinical features and the findings of X-ray examination of the patients whose aphthous lesions progressed to typical lesions (longitudinal ulcer and cobblestone appearance) with patients whose lesions didn't progress in this way. Findings of X-ray examination were analyzed about type and number of aphthous lesions and the existence of edema.

　〔Conclusion〕Thirteen patients (59.1 ％) of 22 patients progressed to typical Crohn's disease. Period of progress after initial diagnosis was 44.0±37.8 months. Twelve patients (92.3 ％) of 13 patients progressed to this state within 60 months (5 years) after diagnosis. There were no significant differences between the progressive cases and non-progressive ones in inflammatory signs on laboratory examination, activity index (CDAI, IOIBD assessment score) and kind of first treatment. Progressive cases had significantly higher incidence of complication of upper gastrointestinal lesions at the time of diagnosis than non-progressive ones. The differences in findings of X-ray examination of progressive and non-progressive cases were recognized. As for small intestinal lesions, it was suggested that the number of aphthous lesions and existence of edema predicted the progress of the lesions. Four patients (18.2 ％) underwent the surgery. Type A Crohn's disease had lower cumulative probability of surgery than small intestinal and ileocolic type of Crohn's disease. These results can make at least a part of the clinical course of type A Crohn's disease clear. However, we concluded that more analysis is necessary because the clinical features and course of type A Crohn's disease are not uniform.