高齢者非腫瘍性疾患の特徴―虚血性大腸炎と虚血性直腸炎

Ischemic Colitis and Ischemic Proctitis

要旨　虚血性大腸炎280例について高齢者（109例）と若年者（47例）の比較と狭窄型（20例）と一過性型（260例）の比較を行った．虚血性大腸炎は高齢者に多かったが，若年者にも比較的多くみられ，高齢者特有の疾患ではなかった．血管側因子は狭窄型で有意に多かったが，腸管側因子は狭窄型，一過性型で差がなかった．これらのことより，虚血性大腸炎の病因として腸管側因子が本質的なものと考えられた．また，虚血性直腸炎4例について臨床的検討を行った．4例とも65歳以上の高齢者であり，3例は男性であった．虚血性直腸炎は高齢者男性に多く，動脈硬化や腹部血管の手術と密接に関係する疾患であり，血管側因子が重要と考えられている．今回経験した4例中2例は重度の動脈硬化性疾患をもっていたが，2例は高血圧のみであった．4例中3例では腸管側因子が誘因と考えられた．虚血性直腸炎は血管側因子が強く関与しているが，その一部には腸管側因子が関与する症例がみられることが明らかとなった．

　We compared clinical features of 280patients with ischemic colitis. They were divided into a young adult group, under 40years old（47cases）and an elderly group, over 65years old（109cases）. And, they were divided into stricture type group（20cases）and transient type group（260cases）. An elderly group had this disease more than a young adult group, but ischemic colitis was not characteristic disease of an elderly group. The vascular factors were found with significantly higher frequency in the patients with stricture type of ischemic colitis than in the patients with transient type of ischemic colitis. The intestinal factors were found almost equally in the stricture type and the transient type. The results suggested that the intestinal factors play an essential role in the pathogenesis of ischemic colitis.

　We examined clinical features of four patients with ischemic proctitis. The age of the four patients were over 65years old. Three were men, and one was woman. One case had severe arteriosclerosis-related diseases and a history of abdominal aortic surgery. One case had severe arteriosclerosis-related diseases. Other two cases had only hypertension. Three cases had triggers of intestinal factors. Ischemic proctitis has been thought to occur mainly because of vascular factors, but the findings of our three cases are considered valuable because they indicate that the disease occur mainly because of intestinal factors.