難治性潰瘍性大腸炎における血球成分除去療法

Leukocytapheresis Therapy of Refractory Ulcerative Colitis

要旨　難治性潰瘍性大腸炎に対して血球成分除去療法(cytapheresis；CAP療法)が有用とされている．しかしながらその適応や長期予後に関しては不明な点も多い．そこで内視鏡で難治性所見(打ち抜き潰瘍，縦走潰瘍，偽ポリポーシス)を伴った重症潰瘍性大腸炎をCAP有効群68例と手術移行群27例に分けて検討した．内視鏡所見では，両群の有効性に有意差は認めなかったが，通常の週1回法によるCAP療法では，完全な内視鏡的粘膜治癒に至らない症例が多く，今後重点治療などを含めた検討が必要と思われた．

　To make endoscopic findings and leukocytapheresis therapy (CAP) of refractory ulcerative colitis (UC) clear, we made an investigation of severe UC with refractory lesions (punched out ulcer, longitudinal ulcer, pseudopolyposis) in 68 patients (71.6％) who had CAP effective UC and in 27 patients who had undergone colectomy. CAP was efficient for treating patients with acute refractory ulcerative colitis, but was inefficient over a long term period. Endoscopic findings showed there had been little difference between patients who had received CAP and those who had undergone colectomy. The feasibility of CAP for severe ulcerative colitis was estimated from the condition of the mucosa. CT provides an additional noninvasive procedure for determination of disease activity with severe UC. A more appropriate selection of treatment options with CAP in UC needs to be scheduled.