腸間膜静脈硬化症―漢方薬との関連性および長期経過

Mesenteric Phlebosclerosis:Long-term Clinical Course and Relationship with the Chinese Herbal Medicine

要旨　腸間膜静脈硬化症（以下MP）は，漢方薬の長期内服が発症と強い関連をもつと考えられる虚血性腸病変である．漢方薬が原因とする立場からその呼称をMPとした．MPは治療法や長期予後についても不明な点が多い．今回筆者らは，漢方薬内服歴のあるMP症例について検討した2論文において，MPと漢方薬の関連および長期予後を検討した．対象症例は平均10年以上の長期間の内服歴があった．なかでも，山梔子を含有する漢方薬を大半の症例で内服されていた．臨床症状がコントロール不良な症例は手術を必要とするが，軽症例は漢方薬の休薬と対症療法により，比較的予後良好であった．明確な治療法は不明であるが，漢方薬の休薬は必須であると考えられる．

　MP（mesenteric phlebosclerosis）is an ischemic intestinal lesion in which onset is strongly associated with long-term use of Chinese herbal medicine. This condition was termed MP due to the fact that it is caused by Chinese herbal medicine. Many aspects of the treatment and long-term prognosis of this condition remain unclear. We herein investigated the long-term prognosis of MP and the relationship between the lesion and Chinese herbal medicine in two studies that investigated cases of MP with a history of use of Chinese herbal medicine. The patients in these studies had a long history of Chinese herbal medicine use, with a mean of ≧10 years. In particular, the majority of patients had been using Chinese herbal medicine containing sanshishi（Gardeniae fructus）. While surgery is required in cases of poor control of clinical symptoms, prognosis was relatively favorable in mild cases with discontinuation of Chinese herbal medicine and palliative therapy. Although no clear treatment has been established, discontinuation of Chinese herbal medicine was considered necessary.