難治性潰瘍性大腸炎に対するチオプリン製剤の寛解維持効果―再発関連因子の検討

Factors Associated with the Maintenance Effect of Thiopurines in Ulcerative Colitis

要旨　潰瘍性大腸炎の臨床経過を遡及的に検討し，チオプリンによる寛解維持効果と再発関連因子を評価した．（1）チオプリン投与109例における6か月および12か月後の累積寛解維持率は77％と57％であった．（2）再発関連因子の検討では，ステロイド抵抗性（p＝0.0008）と喫煙（p＝0.003）が再発と有意に関連していた．しかし，再発例と非再発例でチオプリン維持投与に先行する寛解導入前の再発時大腸内視鏡所見に差はなかった．（3）チオプリン投与開始前に内視鏡を施行した48例において，チオプリンの寛解維持効果と有意に関連する内視鏡所見はなかった．以上より，潰瘍性大腸炎に対するチオプリンの寛解維持効果はステロイド反応性や喫煙習慣などの臨床像により異なることが明らかとなった．

　We retrospectively investigated the maintenance effect of thiopurines in 109 patients with UC（ulcerative colitis）, and determined the factors associated with the disease recurrence under the treatment. Of the 109 patients, the cumulative rates of remission at 6 and 12 months were estimated to be 77％ and 57％, respectively. Steroid-refractory UC（p＝0.0008）and habitual smoking（p＝0.003）were factors associated with the disease recurrence under thiopurine therapy, but, other clinical features were not associated with the disease recurrence. No endoscopic findings indicate association with recurrence of the disease. Based on our results, the maintenance effect of thiopurines seems to be favorable in UC cases. However, clinical characteristics of the patients, particularly steroid-response and smoking habit, should be considered in cases of UC treated by thiopurines.