白血球系細胞除去療法によるCrohn病の治療―臨床像と画像形態による評価

Cytapheresis Therapy for Crohn's Disease―Evaluation by Clinical Features and Intestinal Images

要旨　背景と目的 ; 白血球系細胞除去療法(cytapheresis;CAP)は，副腎皮質ステロイド剤などの従来法が奏功しない難治性潰瘍性大腸炎の追加的治療法と位置づけられている．本研究では，Crohn病(CD)に対するCAPの治療効果をみることを目的とした．対象と方法;栄養療法を主体とする従来型治療法に抵抗性がある活動期CD患者9例に行われた11回のCAPを対象とした．CAPは，成分栄養療法や経静脈栄養療法(TPN)などの従来法と併用され週1回，合計5～7回体外循環後治療が施行され，その効果をみた．治療効果の評価は，臨床像(CDAIと合併する肛門部病変などの他覚所見)と腸管病変の画像所見の2項目で行った．結果;①CDAIなどの臨床所見は9例11回の治療中，5例7回(63.6％)で明らかな改善がみられた．しかし，4例(36.4％)では臨床所見が改善しなかった．②画像所見は7例9回の治療で評価された．そのうち4例6回(66.7％)の治療で改善がみられた．4例では臨床所見と同時に画像所見が改善しなかった．したがって，CAPは4例で無効であった．病型をみると大腸型では有効性が高く(85.7％)，小腸病変が優位の例では有効性が低かった(25.0％)．結論;CAPは栄養療法などに不応の活動期CDに対して有効性が高く，臨床的有効率は治療回数でみると63.6％(7回/11回）であった．しかも安全であることから，今後従来型治療に対し難治の例で，特に大腸型に試みるべき治療法と考えられた．

　Background and Aim : Cytapheresis (CAP) has been successfully used to treat patients with intractable ulcerative colitis (UC). The aim of this study is to evaluate the efficacy of CAP in patients with Crohn's disease (CD), who are resistant to conventional therapies. Subjects and Methods : The subject of this study was11CAP sessions performed in9active CD patients who were refractory to conventional therapies such as nutrition therapy and drug therapies. CAP therapy was performed once a week with concomitant nutritional therapy or drug therapy and, totally, 5 to 7 CAP sessions were carried out before evaluation was attempted. The efficacy was evaluated by changes in clinical features using CDAI, changes in complications and also endoscopic and/or radiographic changes of intestinal lesions. Results : ① Clinical features including CDAI ameliorated in 7 sessions with5patients (63.6％) and 11sessions with 9patients. However, in 4 sessions (4 patients) clinical features did not improve (36.4％). ② Intestinal images ameliorated in6sessions (66.7％) with 4 patients. This means that 4 patients treated in only4sessions did not show improvement in clinical features and in intestinal images. With reference to disease type, colitis-type showed higher response (85.7％) than ileitis-type did (25.0％). Conclusion : CAP therapy was effective in refractory patients and the clinical effectivity rate was 63.6％ (7 sessions/11 sessions). Because CAP is a simple and safe maneuver, this therapy is recommended for colitis patients who are refractory to conventional treatment such as nutritional therapy.

　1) Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan