回腸粘膜の萎縮

Atrophy of Ileal Mucosa

要旨　過去9か月間にわれわれの施設で192例に回腸内視鏡検査を施行し，うち17例は内視鏡観察下に粘膜色が淡い赤色あるいは灰色を呈し，光輝性が喪失し，光沢がなく，血管透見像ははっきりしていた．健常的なビロード様から平絨様（velveteen）となった．腸腔の多くが拡張していた．筆者らが工夫したIndia ink標識法を用いて，内視鏡下に生検標本を採取した41例の健常者と17例の回腸粘膜萎縮の回腸粘膜を定向（orientational）包埋し垂直に切り出し，光顕と走査電顕で観察した．健常回腸粘膜の絨毛の高さは370μmから500μmまで，平均416±22μmであるが，回腸粘膜萎縮の絨毛の高さは0から320μmまで平均185±164μmであった．両者の間には著明な差があった（p＜0.001）．絨毛萎縮の程度に基づいて，軽度萎縮，中等度萎縮，高度萎縮，および萎縮疑いに分けた．萎縮程度と炎症程度の間には有意差はなかった．走査電顕下では，軽度萎縮で絨毛が著明に短くなり，中等度萎縮で乳頭状となり，高度萎縮で顕著な絨毛構造がなく脳回状を呈していた．

　During a period of 9 months, 192 subjects with suspected lower intestinal disease and 41 normal volunteers were examined through ileoscopy with biopsy. In 17 of 192 subjects endoscopically, ileal mucosa seemed to be atrophied, and presented pale red or greyish-yellow or greyishw-hite color. There was loss of sheen, and little reflection of light. The texture ranged from velvet to velveteen, and dark red twiggy vessels were distinct. The lumen of the distal ileum was usually dilated. Histopathological and scanning electron microscopical study of the above 17 patients and 41 normal volunteers was carried out. Ileal bioptic samples were arranged and marked with India ink on the mucosal surface, and their direction was determined, and serially sectioned. The range of vinous height in the ileal mucosal atrophy group was 0-320 μm, averaging 185 ± 164 μm, whereas that of normal volunteers was 370-500, μm, averaging 416 ± 22 μm. The difference between control and ileal mucosal atrophy groups was significant, p＜0.001. Atrophied ileal mucosa could be divided into four grades according to its vinous height, our definition is as follows : grade 0-from lower limit of normal value to 300 μm is a height which suggests that mucosal atrophy might be present. Grade 1 ―300-200 μm is slight mucosal atrophy. Grade 2 ―200-100 μm is moderate mucosal atrophy. Grade 3 ―from 100 μm to disappearance of villi is severe mucosal atrophy. Vinous atrophy was not found to be in proportion to the degrees of mucosal inflammation. Atrophied villi under microscope study presented a shortened, battlement-like appearance. Sometimes the villi had disappeared. Under scanning electron microscope study, the villi appeared as shortend, papilla-like or gyrus-like.