Crohn病小腸病変に対する治療効果―免疫調整薬の粘膜治癒効果

Mucosal Healing for the Lesions of the Small Intestine in Patients with Crohn's Disease Treated with Immunomodulators

要旨　免疫調整薬（6-MP，AZA）はCrohn病の寛解導入，維持，ステロイド減量効果に有用であるが，内視鏡的な粘膜治癒効果については明らかではない．今回筆者らは，小腸内視鏡を用いてCrohn病の術後再燃に対する治療効果について免疫調整剤を中心に解析した．術後吻合部に病変を有する割合は，吻合部以外の回腸や大腸よりも多かった．また，回腸病変の活動度と臨床的活動度には，相関関係は認められなかった．さらに，吻合部以外の回腸病変の活動性は，術後に免疫調整薬を使用された例のほうがインフリキシマブ使用例に比して高いことが確認された．一方，吻合部の病変の活動性は術後の治療法に関係なく認められた．ただし，短期間での評価であり，長期間免疫調整薬を投与した場合の粘膜治癒効果については今後の研究が必要であると考えられた．

　Immunomodulators such as 6-MP（6-mercaptopurine）and AZA（azathioprine）are effective for inducing and maintaining remission of CD（Crohn's disease）, and have also been used for steroid-dependent patients. However, it is unclear whether 6-MP/AZA leads to mucosal healing of the small intestine in CD patients. SBE（Single-balloon enteroscopy）was conducted in CD patients to evaluate postoperative recurrence within 6-12 months after surgery. Patient characteristics and clinical and endoscopic severity were assessed. Improvement of endoscopic recurrence using 6-MP/AZA was also evaluated. Incidence of lesions was higher at the anastomosis than at the ileum or the colon. The ileum CD activity index did not correlate with endoscopic severity in the ileum. We also confirmed that Ileal endoscopic severity（score）in postoperative CD patients treated with 6-MP/AZA was higher than those treated with infliximab. Further investigation about long-term prognosis for ileal mucosal healing in patients treated with 6-MP/AZA is necessary.