Schönlein-Henoch紫斑病における十二指腸病変の特徴

Endoscopic and Radiographic Characteristics of Duodenal Lesions in Schönlein-Henoch Purpura

要旨　Schönlein-Henoch紫斑病（SHP）8例の臨床像と上部消化管病変を検討した．8例中2例で腹部症状が紫斑出現に先行していた．1例では小腸のみ罹患していたが，他の7例では十二指腸病変を認め，十二指腸と小腸の罹患率はほぼ同様であった．十二指腸病変は第2部に及び，粘膜発赤，浮腫，易出血性の程度は一定していなかったが，7例中6例では多発性の不整形潰瘍を認めた．さらに，4例では潰瘍底に暗赤色調の盛り上がりを認め，これら4例の生検組織中に血管炎が証明された．SHPでは，紫斑に先行して腹部症状が出現することもあるので，十二指腸病変の特徴を熟知しておく必要があると考えられた．

　Endoscopic, radiographic and histologic findings of the duodenal lesions were investigated in eight patients with Schönlein-Henoch purpura (SHP). Abdominal symptoms preceded typical skin rash in two patients. Duodenal mucosal lesions were found in seven of eight patients. The duodenal mucosal lesions extended to the second part of the duodenum in seven patients, and the distal part of the duodenum was predominantly involved in four patients. While the degrees of mucosal redness, edema and petechiae varied among the patients, multiple irregular ulcers were found in six of seven patients. Moreover, ulcerating lesions with hematoma-like protrusions were detected by endoscopy in four patients, in whom bioptic findings proved vasculitis with fibrinoid necrosis. These findings suggest that the duodenum is a site most frequently affected by SHP, and that endoscopic or radiographic findings may be a clue for the diagnosis of the disease in cases in which gastrointestinal involvement precedes other manifestations.