コレラ空腸の形態学的研究―内視鏡的，光顕・電顕的検討

Morphologic Study on the Jejunal Mucosa in Human Cholera: Endoscopic, Light and Electron Microscopic Approaches

　コレラはコレラ菌（Vibrio cholerae）の腸内感染によって起こる急性感染症であり，大量の水様下痢，脱水症状，アシドーシスを呈する典型的小腸性下痢疾患である．

　ヒトコレラ腸症の急性期に空腸内視鏡検査を行い，空腸生検材料を光顕的・電顕的に検索し，下痢の機序における空腸粘膜の形態学的変化の意義を検討した．

　In order to study the mechanism of diarrhea, we have made endoscopic examinations of the jejunum in patients with cholera who suffered from typical diarrhea from the small intestine. Light and electron microscopic studies of the biopsy specimens from the jejunum have also been made. The subjects of our study were eight patients with cholera (six males and two females aged 23 to 28) admitted to San Lazaro Hospital, Manila, and five control cases.

　Endoscopy was pertormed in the cholera patients within 24 hours of admission and control subjects fasted overnight. Jejunal mucosa 10 to 20 cm beyond the ligament of Treitz was observed using a small intestinal fiberscope, Olympus SIF type B. Reddening and edema of the mucosal surface were seen in all cases (100%); reticular pattern suggesting accelerated permeability of the capillaries in 75%, hypermotility in 50% and hypersecretion in 100%. Furthermore, erosions were observed in all cases (100%).

　The jejunal mucosa obtained with biopspy instrument (Crosby-Kugler) revealed histological changes of degeneration and desquamation of the epithelium of villi. Also were seen numerous vacuoles in the epithelial cells, uneaveness of epithelial staining, loss of definition of brush border, scalloped epithelial lining, widened lymphatic vessels, infiltration of small round cells into the lamina propria, and hypersecretion of goblet cells. Electron microscopy showed edematous changes both of absorptive epithelial cells and crypt cells, pseudopod-like cytoplasmic projection, and widened interepithelial spaces. Many cystic vacuoles in the cytoplasm of epithelial cells, the swelling of mitochondria, disappearance of their cristae, increase in the number of vesicles of the Golgi apparatus, dilatation and vesiculation of endoplasmic reticulum were also seen.

　We have clarified the pathologic changes including erosions in the jejunal mucosa of patients with cholera. These changes as well as c-AMP, GMP and intestinal glucagon are important in the mechanism of infection of cholera and diarrhea.