血清蛋白漏失と過分泌過酸症を伴った胃粘膜の巨大皺襞症（メネトリエ病）

Giant Hypertrophy of the Gastric Mucosa with Protein-loss and Hyperacidity (Ménétrier's Disease)

　血清蛋白漏失と過分泌過酸症を伴った胃粘膜の巨大皺襞症を経験し，胃全摘出術により臨床像の改善を得たので報告し，メネトリエ病，肥厚性胃炎，肥厚性過分泌性胃症と本症例との関連について若干の考察を行なった．

症例

　患　者：132707　38歳　男　事務系会社員

　主　訴：胸やけと水様性下痢．

　現病歴：10数年前より，時々空腹時に胸やけを自覚していたが，食事や市販の胃散を内服することにより症状は軽快ないし消失していた．約2年前より，食後に胃部のもたれ感を覚えるようになった．この頃より，軟便傾向となり，月に2～3回程度水様下痢便をきたすようになったが，腹痛を伴うことはなかった．この間，体重は不変であった．従兄2人が胃癌で死亡したので，胃腸症状が気になり，精査を希望して北里大学病院外来を受診した．（初診1974年8月5日）．上部消化管X線造影ならびに胃内視鏡検査で胃粘膜の巨大皺襞症が指摘され，一般検査で低蛋白血症がみとめられたので，精査と加療のため入院となった．（入院1974年10月7日）．

　既往歴：立ちくらみ（小学生時より）．副鼻腔炎手術（16歳時）．虫垂炎手術（25歳時）．腰椎分離症手術（31歳時）．輸血歴（－）．

　家族歴：姉が胃十二指腸潰瘍で外来治療中（巨大皺襞症はない）．従兄2人が胃癌で死亡．

　入院時現症：体格中等度身長166cm．体重57kg．皮膚粘膜に貧血，黄疸なく，異常色素斑なし．表在リンパ節触知せず．甲状腺腫大なし．血圧100～66mmHg，脈拍52/分整．心音清．呼吸音肺胞性．腹部平坦，圧痛なく，肝脾腎ならびに腫瘤触知せず．腹水なし．浮腫なし．

　A 38-year-old male was admitted with complaints of heartburn, epigastric discomfort, and recurrent watery diarrhea for the past two years. Upper gastrointestinal X-ray series and gastroscopies revealed gaint hypertrophy of the gastric mucosa. Laboratory studies disclosed hypoproteinemia, decreased IgG level and hyperacidity. Serum total protein level was as low as 4.3～4.6 g/dl (Alb. 59.6%, Glb. α₁ 4.3, α₂ 13.0, β 15.0, γ 7.9%) and IgG 500 mg/dl. Gastric juice analysis with gastrin stimulation revealed BAO 25.3 mEq/h and MAO 55.9 mEq/h. Gastric juice contained excessive proteins, 11.0 mg/dl in basal juice and 13.0 mg/dl after gastrin stimulation. A¹³¹ I PVP test revealed 3.8% of the administered dose present in the stool which was collected for three days (normal ＜0.8%). A lipoprotein paper electrophoresis demonstrated some increase of pre-β-lipoprotein. Liver, renal, cardiovascular and respiratory function tests were within normal limits. Endocrine disorders and malignancy were also clinically excluded.

　As a case of giant hypertrophy of the gastric mucosa with protein-loss and hyperacidity, total gastrectomy was recommended.

　The gross appearance of the extirpated stomach opened along the lesser curvature resembled cerebral convolutions. The thickened gastric mucosa was comprised of full thickening of the fundic mucosa without foveolar hyperplasia. Parietal cell mass was increased microscopically.

　It is interesting to note that the stomach of the patient was compatible with hypertrophic glandular gastritis (Schindler) histologically and endoscopically, and hypertrophic hypersecretory gastropathy (Stempien) functinally. Serum proteins returned to normal after surgery.