小腸の非腫瘍性疾患—サイトメガロウイルス（CMV）小腸炎の臨床像と内視鏡像

Clinical Features and Endoscopic Findings of Cytomegalovirus Enteritis

要旨●自験サイトメガロウイルス（CMV）小腸炎7例の臨床像と内視鏡像についてCMV大腸炎53例と比較して検討した．罹患部位は空腸1例，回腸6例であった．CMV小腸炎は，CMV大腸炎に比べて絶対的免疫不全の割合が高い傾向がみられた．CMV小腸炎の臨床症状は出血と腹痛が多く，CMV大腸炎では出血と下痢が多かった．大量出血と穿孔の割合は，CMV大腸炎に比べてCMV小腸炎が多い傾向がみられた．CMV小腸炎の緊急手術率は43%であり，CMV大腸炎の9%に比べて高率であった．CMV小腸病変は，輪状傾向潰瘍と不整形潰瘍が多く，CMV大腸病変で多い類円形潰瘍は少なかった．CMV小腸炎と鑑別が必要な疾患として，腸結核，NSAIDs起因性腸炎，血管炎，腸管Behçet病などがある．

　We compared the clinical features and endoscopic findings between 7 cases of CMV（cytomegalovirus）enteritis and 53 cases of CMV colitis. The area affected by CMV enteritis was the jejunum in 1 and the ileum in 6 cases. The number of patients with CMV enteritis with absolute immunodeficiency was more than that of patients with CMV colitis with severe immunodeficiency. Patients with CMV enteritis primarily complained of massive bleeding and abdominal pain, whereas patients with CMV colitis primarily complained of diarrhea and bleeding. The rate of massive bleeding and perforation in patients with CMV enteritis was more than that in patients with CMV colitis. The rate of emergency surgery in patients with CMV enteritis（43%）was more than that in patients with CMV colitis（9%）. Endoscopic findings of patients with CMV enteritis mainly included irregular ulcers and annular ulcers. However, a few round ulcers that are typically detected in CMV colitis were also observed. Intestinal tuberculosis, NSAIDs-induced enteritis, vasculitis, and intestinal Behçet's disease are some of the diseases that should be differentiated from CMV enteritis.