Crohn病の内視鏡的重症度評価─大腸内視鏡下のスコアリングシステムとその問題点

Endoscopic Evaluation of Disease Severity in Crohn's Disease:Usefulness and Problems of Scoring System Using Ileocolonoscopy

要旨●抗TNFα抗体製剤による寛解導入後に内視鏡による治療効果判定を行い，その後の臨床経過が1年以上追えた大腸型もしくは小腸・大腸型Crohn病（CD）37例を対象に，臨床的二次無効予測に対するSES-CDの有用性を遡及的に評価した．その結果，SES-CD>10群ではSES-CD≦10群に比べて有意に二次無効率が高かった．一方，5mm以上の潰瘍性病変の有無で二次無効率を比較した場合，2群間で二次無効率に差を認めなかった．多数例を用いた前向き研究による検証が必要であるが，SES-CDによる内視鏡的活動性のスコアリングは抗TNFα抗体製剤治療における二次無効予測に有用である可能性が示唆された．

　We retrospectively investigated the clinical usefulness of SES-CD（simple endoscopic score for Crohn's disease）for predicting the loss of response to an anti-TNF-a antibody therapy in patients with Crohn's disease who subsequently achieved clinical remission and whose clinical course after endoscopic evaluation could be followed up for >1 year. A significantly higher recurrence rate was observed in patients with SES-CD of >10 than in those with SES-CD of 10. In contrast, no difference existed between patients with ulceration（>5mm）and those without ulceration with respect to the recurrence rate. Although further prospectively designed studies with a larger number of cases are necessary, SES-CD appears to be useful for predicting the loss of response to the anti-TNF-a therapy.