Crohn病の長期経過―X線所見からみた予後予測

Long-term Course of Crohn's Disease, with Special Reference to Changes of Radiographic Findings

要旨　初診時非切除のCrohn病74例のX線所見を経時的に分析し，予後予測，特に合併症出現予測について検討した．X線所見の重症度を，敷石像，縦走潰瘍，その他の潰瘍を3段階，アフタを2段階に分類し，さらにそれらの病変の罹患範囲を求め，両者を掛け合わせて活動度とした．①初診時アフタのみから成る症例の半数以上が典型例へと進展した．初診時のアフタの部位や密度から進展するかどうかを予測することは困難であった．②瘻孔や狭窄が形成される部位には初診時に何らかの所見を認め，これらの合併症を確認する直前の検査では多くは敷石像を呈していた．③合併症の出現は，大腸敷石像で活動度が高い病変や，盲腸・上行結腸で起こりやすかった．また，大腸敷石像と小腸縦走潰瘍において，重症度3点で合併症を来しやすい傾向を認めた．④初診時の大腸敷石像は，3年以内の再燃時に不変・改善を示せば，合併症を来す確率は有意に低くなった．

　In 74 patients with non-resected Crohn's disease on the first visit, serial radiographic findings were analyzed in order to predict a long-term prognosis, especially development of complications (stenosis or fistula). For grading the severity of lesions, radiographic findings of cobblestone-like lesions, longitudinal ulcers and irregular-shaped ulcers were classified into three stages, those of aphthoid ulcers were divide into two stages. The activity score of the lesions were calculated by multiplying the stage and the size of the lesions. 1) More than half of cases with aphtha alone on the first visit had progressed to typical lesions of cobblestone appearance and/or longitudinal ulcers. It was difficult to predict progression by analyses of the location and the density of aphtha. 2) There found some lesions on the first examination where stenosis or fistula was developed later. Cobblestone appearance preceded stenosis or fistula. 3) Colonic cobblestone appearance with high activity score in the right-sided colon was prone to progress to stenosis and fistula. High severity score of colonic cobblestone-like lesions and ileal longitudinal ulcers tended to develop complications. 4) When colonic cobblestone-like lesions showed no changes or improvement on flare-up within the first three years, complications were less likely developed significantly.