ループスアンチコアグラント陽性肺非結核性抗酸菌症に対する肺切除術

Two Surgical Cases of Pulmonary Nontuberculous Mycobacterial Disease with the Lupus Anticoagulant

はじめに　ループスアンチコアグラント（lupus anticoagulant：LAC）は，抗リン脂質抗体（anti-phospholipid antibody：APL）の一つで，リン脂質依存性凝固経路を阻害し血液凝固能異常を引き起こす自己抗体である1，2）．全身性エリテマトーデス（systemic lupus erythematosus：SLE）に合併することが多く，全身での血栓症や習慣性流産を引き起こすことがある1，2）．われわれは，血漿中LACが陽性を呈した2例の肺Mycobacterium avium complex（MAC）症患者に対して肺切除術を施行したので報告する．

The lupus anticoagulant is one of the antiphospholipid antibodies that inhibit the phospholipid-dependent coagulation pathway. Lupus anticoagulant-positive patients are often associated with abnormal blood coagulation, which cause thrombosis or miscarriage. We report two surgical cases of pulmonary nontuberculous mycobacterial disease （M. avium） with the lupus anticoagulant. Both patients were women around 70 years of age with no past history, including thrombosis or miscarriage. Despite treatment, M. avium continued to be cultured from their sputum and eventually blood sputum appeared. They were performed surgical operations and the postoperative courses were uneventful without anticoagulation. Although the report of pulmonary nontuberculous mycobacterial disease with the lupus anticoagulant is extremely rare, the involvement of infection in the pathogenesis of the lupus anticoagulant has been reported. The further research between lupus anticoagulant and pulmonary nontuberculous mycobacterial infection is necessary.