腸管Behçet病・単純性潰瘍の長期経過

Long-term Clinical Outcome and Treatment Response of Intestinal Behçet's Disease and Simple Ulcer

要旨　腸管Behçet病（BD）と単純性潰瘍（SU）の臨床徴候や腸病変の特徴，自然経過，および両疾患の異同を明らかにする目的で，長期経過観察しえたBD 30例，SU 11例の臨床像（再発率，手術率），内視鏡所見（病変形態と病変局在）の推移を検討した．BDの経過観察中に病型が進展したのが16.7％の症例にみられたが，SUの経過観察中にBDへ診断が変わった例はなかった．BDは病型にかかわらず，多彩な病変を呈し病変が進展することが多いが，SUでは発症初期の活動性が落ち着けば，比較的病勢が落ち着く傾向がみられた．しかし，SUにおいては口腔内アフタ（＋）例が（－）症例に比し再発率は高かった．病変形態ではBDで回盲部打ち抜き潰瘍周囲に小潰瘍が併存する例が再発率71.4％，SUでは回盲部打ち抜き潰瘍（＋）症例で66.7％と難治であった．また長期経過例ではステロイド治療が中心になっており，感染症の併発も認めるため，可能な限りステロイド減量を図るためアザチオプリンやインフリキシマブの導入を考慮に入れる必要があると考えられた．

　We examined the clinical characteristics the intestinal lesions（their forms and the localities）in BD（intestinal Behçet's disease）and SU（simple ulcer）. During follow-up it was found in 16.7％cases that the forms of BD cases progressed, but there was no evidence of SU progression to BD.

　The BD presented various lesions without any particular form and the lesions were often advanced. On the other hand, the condition of SU cases calmed down relativerly frequently, if activity during the early days of onset had calmed down. However, there was a high rate of recurrence in intraoral aphthous（＋）cases in comparison with cases of SU（－）.

　As regards the form of lesions of BD, small ulcers surrounded the punched out ileocecal ulcers and the recurrence rate was 66.7％. As regards SU, 66.7％of ileocecal（＋）ulcers were very hard to cure.

　It should also be added that since steroids are mainly used for there long-lasting lesions, infection may occur, and as far as possible, to reduce the use of steroids by using azathioprine and infliximab should be kept in consideration.