長期経過例からみた腸型Behçet病と単純性潰瘍の病態

Pathogenesis of Intestinal Behçet's Disease and Simple Ulcer, Considered over a Long Clinical Course

　Behçet病と腸型Behçet病の比較では，前者ではsteroidの投与が半数であり，大部分が少量～中用量の投与であった．後者では全例に投与され，大部分が高用量であった．steroid投与の面からみると後者がより重症であった．腸型Behçet病完全型・不全型と腸型Behçet病疑い・単純性潰瘍の2群に分けて比較検討した．前者では眼病変や副症状がみられるが，後者では全くみられなかった．前者ではBehçet病の経過中に潰瘍が出現したのは2例みられたが，後者では全くみられなかった．腸の潰瘍は前者では大腸に広範囲にみられることが多く，後者では回盲弁上の下掘れ潰瘍が多かった．また，難治例はすべて後者に含まれていた．以上より，両者は病態が異なるものである可能性が高い．すなわち，前者はBehçet病があり，その1病変として腸の潰瘍が出現する，後者は腸病変が先にあり，腸管外症状としてBehçet病の兆候が出現するという可能性が考えられた．しかし，症例数が少なく，観察期間も短いため，今後のさらなる検討が必要である．

　When Behçet's disease is compared with suspected intestinal Behçet's disease, only half of the former cases were treated with corticosteroid, mostly at a low or middle dose. In contrast, corticosteroid was administered to all of the latter cases, mostly at a high dose. Considering the degree of corticosteroid administration, the latter was more serious.

　To perform a comparative study, subjects were divided into two groups, complete or incomplete Behçet's disease group and suspected intestinal Behçet's disease or simple ulcer group. Lesions in the eye and side symptoms were found in the former group, whereas no lesions were observed in the latter. In the former group, development of an ulcer was found in 2 cases during observation of the course of Behçet's disease, whereas no development of an ulcer was found in the latter group. In the former group, ulcers were frequently found in a wide area of the large intestine, while, in the latter, deep ulcer was frequently found on the ileocecal valve. All the intractable cases belonged to the latter group. These results seem to indicate that these two groups are different entities. That is, it was assumed that in the former group, ulcers in the intestine developed as one of the lesions of underlying Behçet's disease, while in the latter group, lesions in the intestine were present primarily and signs of Behçet's disease developed as symptoms outside the intestine. Since the number of cases examined was small and the observation period was short, further investigation is necessary in the future.