3)結節性多発動脈炎

Gastrointestinal Manifestations of Polyarteritis Nodosa

要旨　PNの消化管病変について過去10年間の本邦報告41症例の臨床病理学的特徴を概説る．PNの消化管病変は，中年男性に多く，臨床症状としては消化管出血が約6割，穿孔が約2割であった．病変部位では，従来の報告どおり小腸に多かった．消化管病変の原因の多くは閉塞性血管炎による虚血と考えられ，びらん，浮腫，潰瘍，重篤な場合は穿孔を来していた．上部消化管では，類円形潰瘍となることが多く消化性潰瘍との鑑別が問題であるが，非定型的な臨床経過に注目すべきである．小腸，大腸では不整形潰瘍を呈し，穿孔例を多く認めた．また，検査に関連したと考えられる穿孔例も散見され，臨床上注意すべきである．PNの消化管病変の診断や治療は困難であり，その特徴を熟知したうえでの臨床的対応が必要である．

　To elucidate clinicogastroenterological features in polyarteritis nodosa, we retrospectively reviewed and analyzed the data from the 41 cases of PN with gastrointestinal involvement (PNGI) reported during the last 10 years in Japan. The gastrointestinal lesions were found often in middle-aged male patients. Most of the patients with PNGI were suffering from gastrointestinal bleeding or perforation of the gastrointestinal tract. Although previous reports have noted the small intestine as the most common site of this bleeding or perforation in PNGI, our study indicated that the stomach and the large intestine were as frequently involved as the small intestine in PNGI. Because of underlying vasculitis, occlusion of the vessels developed, and induced ischemia of the gastrointestinal tract, resulting in erosions, edema, ulceration, and/or perforation. In the upper gastrointestinal tract, round or oval ulcers, which should be differentiated from peptic ulcers, were characteristic. In the lower gastrointestinal tract, irregularly-shaped ulcers or perforated ulcers were often seen. Deterioration of these gastrointestinal lesions during or after endoscopic examinations was also characteristic in PNGI. To make an early and accurate diagnosis of PNGI, clinicians should be familiar with its clinicogastroenterological features.