大腸の炎症性疾患の診断に注腸X線検査は必要か―X線を重視する立場から

Radiographic Examination in Patients with Inflammatory Bowel Disease

要旨　炎症性腸疾患の診断にX線検査が有用であるかについて概述した．活動期Crohn病に対する栄養療法による短期緩解導入の予測因子として，患者背景などの諸因子にX線所見を加え多変量解析を行った．経腸栄養療法の検討では，栄養療法治療歴，CDAI，顕血便の3要因に加え，大腸隆起スコアも有意かつ独立の要因であった．完全静脈栄養療法では，赤沈値，血小板数と病変範囲の3要因が選択された．いずれの検討においてもX線所見は非緩解要因に挙がっており，X線検査はCrohn病の診療に有用であった．活動期潰瘍性大腸炎における無前処置注腸検査の有用性を検討した．X線検査による全大腸の評価は病勢と有意の相関を示し，活動期潰瘍性大腸炎の病勢把握にX線検査は有用であった．炎症性腸疾患の診断はX線検査と内視鏡検査および病理学的な所見を組み合わせて行うことが原則であり，X線か内視鏡かのどちらか単独で診断することは考えられない．ただし，X線検査は病変の立体的認識に寄与し，病変の拡がりや管腔の伸展性の描出能に優れていることから，炎症性大腸疾患の診療には必須の検査法であると考えられる．

　We investigated usefulness of radiographic examination for diagnosing of inflammatory bowel disease. It became possible to evaluate a statistical analysis, using a scoring of radiographic findings. A multiple logistic regression analysis was performed to clarify an independent prognostic factor for the short term remission of patients with Crohn's disease who had been treated with nutritional therapy. Clinical characteristics and radiographic findings were used for these prognostic factors. ESR, diarrhea, and scoring of colonic ulcers were selected as the significant factors associated with resistance to remission. Four factors (times of previous nutritional treatment, IOIBD, WBC, polyposis score of the colon) in enteral nutrition cases, and three factors (ESR, platelets, extent of Crohn's disease) in total parenteral nutrition cases were selected as independent prognostic factors. In each investigation, radiographic findings were selected as the significant factors. We suggested that radiographic findings were useful for the management of patients with Crohn's disease. The usefulness of non preparative radiographic examination for patients with active ulcerative colitis was also investigated and it was compared with findings of sigmoidscopy. Endoscopic findings in sigmoid colon and rectum were not reflected in clinical activity. On the other hand, findings of total colonic radiography were reflected in the activity, showing that this examination was useful for the evaluation of activity in patients with ulcerative colitis. A diagnosis of inflammatory bowel disease should be based on a combination study of radiologic, endoscopic and pathologic findings. To diagnose independently using radiographic examination alone or in endoscopic examination alone would be impossible. However, radiographic examination helps to recognize three dimensional lesions and it is superior for showing the extent of inflammation and flexibility. Therefore, radiographic examination is indispensable procedure for the diagnosis of inflammatory bowel disease.