全身性エリテマトーデス患者にみられた腸病変

Intestinal Lesions in Patients with Systemic Lupus Erythematosus

要旨　腸病変を合併した全身性エリテマトーデス（SLE）5例を報告した．年齢は16～44歳（平均33歳）で，男性1例，女性4例であった．SLEの病悩期間は8か月～20年（平均7.2年）であった．合併腸病変は，虚血性腸炎型（3例），蛋白漏出性腸症型（1例），大腸多発潰瘍型（1例）の3型に分類できた．虚血性腸炎型では，突然の腹痛で発症し，X線上全小腸に及ぶ皺襞浮腫像（一部に母指圧痕像）が描出された．蛋白漏出性腸症型では，比較的緩徐に発症し，多発性結節状陰影を主体とするX線像を示した．大腸多発潰瘍型も比較的緩徐に発症し，直腸～S状結腸に類円形の多発小潰瘍を認めた．3例で施行できた生検では血管炎の所見は捉えられなかったが，腸病変がSLEの活動期に発生していること，副腎皮質ホルモンの投与あるいは増量によって症状および腸病変の改善を認めたことなどより，これらの病変がSLEによる血管炎に基づいて生じたものと推測された．以上の成績より，活動期SLEの患者では，腹部症状の出現に留意し，腸病変の早期発見と早期治療に努めるべきであると考えられた．

　Five patients with systemic lupus erythematosus and accompanying intestinal lesions were studied to find the characteristic clinical and radiographic findings. The average age of the patients was 33 years (range, 16 to 44 years). The male to female ratio was 1:4. The average period from onset of the disease to appearance of the intestinal lesion was 7.2 years, the range being 8 months to 20 years. The accompanying intestinal lesions were divided into three groups : ischemic enteritis form (3 cases), protein-losing enteropathy form (1 case), and colonic multiple ulcers form (1 case). In three patients of the ischemic enteritis form, the major symptom was abdominal pain of abrupt onset, and radiography revealed thickening of the Kerckring's folds and/or thumb-printing in the entire small intestine. In the one patient with protein-losing enteropathy who had diarrhea and edema of subacute onset, radiography demonstrated multiple nodular defects in the upper part of the small intestine. The remaining patient developed slight fever and lower abdominal pain of subacute onset and had multiple small ulcers in the sigmoid colon and rectum, the morphology of which was similar to that found in Behcet's disease. Histological findings from the biopsy specimens obtained from the jejunal or rectal lesions in three patients failed to reveal vasculitis. However, these intestinal lesions were considered to be caused by vasculitis because they occurred in the active stage of the disease and because of successful treatment with corticosteroids. Therefore, clinicians who deal with systemic lupus erythematosus must always keep in mind, during follow-up of this disorder, that the active stage of the disease may be complicated by these intestinal lesions.