急性胃粘膜病変（AGML）の成因―外科の立場から

Pathogenesis of Acute Gastric Mucosal Lesion

要旨　1971年7月より1987年12月までに北里大学病院で急性胃粘膜病変（AGML）と確診された症例は231例であった．これらの誘因をみると薬剤87例，精神的ストレス57例，不明51例の順で多く，身体的ストレスとしての手術侵襲，外傷，熱傷は各々9例，2例，3例であった．胃酸分泌亢進による攻撃因子増強などよりも，胃粘膜血流の低下や粘液産生の低下などの防御因子減弱をAGML発生の主因とする報告が多いが，外科の立場でのストレス潰瘍発生においては，ストレス刺激による迷走神経，内臓神経，副腎皮質の胃に対する作用がからみ合って生じる攻撃因子と防御因子のバランス失調を根本的な成因と考える．

　From July 1971 to December 1987, 231 cases of acute gastric mucosal lesions (AGML) diagnosed definitively by endoscopy were examined at Kitasato University Hospital. The main inducing factors of AGML were drugs (87 cases), emotional stress (57 cases) and unknown (51 cases). Physical stress causing AGML included surgical operation in nine patients, burn in three and trauma in two. On pathogenesis of AGML, there are many reports indicating defensive factors (mucosal blood flow, mucus production, etc) play more important role than aggressive factors (gastric acid and pepsin secretion). However, with respect to surgery-related stress ulcer caused by vagal stimulation, sympathetic stimulation and adrenocortical hypersecretion, it is considered essential that the balance between aggressive factors and defensive factors is disturbed.