Helicobacter pyloriに起因しないとされる胃粘膜病変の形態―薬剤による胃粘膜病変：NSAIDs，低用量アスピリン起因性について

Examination of Drug-Induced Ulcers, Especially NSAIDs and Low Dose Aspirin

要旨　高齢化社会を迎え，虚血性心疾患，脳血管障害の患者が増加しており，2次予防として，低用量アスピリンの使用が増加している．最近当院で経験した消化性潰瘍を，低用量アスピリン（以下A群），アスピリン以外のNSAIDs（以下N群），非アスピリン・非NSAIDs（以下C群）に分け，比較検討した．内訳はA群，N群，C群で各々7％，18％，75％であり，NSAIDs（A群＋N群）が1/4を占めていた．吐血，下血，貧血などの出血症状は，A群，N群，C群で各々53.6％，45.2％，31.2％であり，A群で高率であった．発生部位は，N群は前庭部に多かったが，A群はC群と差がなかった．大きさは，A群はN群より小さい傾向を認めた．数は各群間で差がなかった．Helicobacter pylori陽性率は，A群はC群と差がなかったが，N群はC群に比して低率であった．病理組織像は，前庭部の多核白血球浸潤の程度がA群，N群ではC群に比して軽かった．

　With the advent of our aging society, the number of patients with ischemic heart disease and cerebrovascular disease has increased. This has resulted in the widespread use of low-dose aspirin. In this study we classified peptic ulcers diagnosed recently at our hospital by endoscopy, into low dose aspirin induced (Group A), non-aspirin NSAIDs induced (Group N) and non-aspirin, non-NSAIDs induced (Group C). The proportion of ulcers in each group (A, N, and C) was 7％, 18％, and 75％ respectively. Bleeding events such as hematemesis, melena and anemia occurred in 53.6％, 45.2％, and 31.2％ of the subjects in each group (A, N and C) respectively, and the frequency of these events was higher in Group A. The ratio of ulcers located in the antrum in each group (A, N, and C) was 24％, 32％, and 16％ respectively. The ratio of antral ulcers was higher in Group N than in Group C. There was no significant difference between Groups A and C. With regard to the size of ulcers, those in Group A tended to be smaller than those in Group N. There was no difference in the number of ulcers among the groups. There was no difference in the prevalence of H. pylori between Group A and C. However, prevalence was significantly lower in Group N than in Group C. The score of multi nuclear white blood cell infiltration in the antral mucosa was lower in Group A and N than in Group C.