長期経過例からみた腸型Behçet病と単純性潰瘍の病態

Comparison of Serial Changes in Intestinal Lesions between Behçet's Disease and Simple Ulcer of the Intestine

　過去26年間に腸型Behçet病ないし単純性潰瘍と診断された31例を臨床症状からBehçet病確診(DBD)群，Behçet病疑い(SBD)群，非Behçet病(NBD)群に分類し，1.2～16.2年(平均7.4年)の腸病変の経過を比較した．6例は経過中にSBDからDBDへ移行したが，NBDからDBDやSBDへの進展例はなく，最終経過観察時にはDBD16例，SBD10例，NBD5例となった．消化管病変の再発率と腸切除率はDBD群で94％と50％，SBD群で70％と30％，NBD群で80％と20％で，いずれもDBD群で他の2群よりも高かった．非定型病変はDBD群の50％，SBD群の50％，NBD群の20％で認められた．DBD群の初回病変は定型病変10例，非定型病変4例，併存2例で，8例は定型病変のみ再発・改善を繰り返したが，6例では再発時に非定型病変を認めた．SBD群の初回病変は定型病変5例，非定型病変4例，併存1例で，初回病変と同一の病型で再発した．一方，NBD群では定型病変のみが認められ，3例は定型病変が再発し1例のみ再発時に定型病変と非定型病変が併存していた．以上より，腸型Behçet病と単純性潰瘍の腸病変はともに高率に再発するが，その経過は異なる可能性が示唆された．

　In order to clarify possible differences between intestinal Behçet's disease (BD) and simple ulcer of the intestine, serial changes in intestinal lesions were compared among patients with definite BD (DBD), suspected BD (SBD) and non-BD (NBD) groups. There were 16 patients in the BD group, 10 patients in the SBD group and 5 patients in the NBD group. There were no differences in recurrence and operation rates among the groups.

　However, atypical intestinal lesions such as wide-spread involvement and less severe intestinal lesions were found in 50 ％ of the patients in the DBD and SBD groups. The incidence of such findings was only 20 ％ in the NBD group. In eight patients in the DBD group, only the typical intestinal lesions recurred, while recurrence in 6 patients was characterized by accompanying or independent atypical involvement. In the SBD group, the patterns of involvement determined by typical and atypical lesions were similar both at the initial diagnosis and at the time of recurrence. In contrast, there was only one patient with atypical involvement in the NBD group. These observations suggest that the intestinal involvement and subsequent clinical course may be different according to whether the ulcers were due to intestinal Behçet's disease or were only simple ulcers of the intestine.