脊椎関節炎を伴った原発性硬化性胆管炎の1例

症例は73歳の女性. 多発関節痛と肝障害の精査加療目的に当科紹介入院となる. 胆道系酵素の上昇を主体とする肝機能異常と抗ミトコンドリア抗体陰性が認められ, ERCにて肝内胆管の数珠状変化および末梢肝内胆管枝の硬化像の所見があり, 肝生検組織では典型像を呈していないが原発性硬化性胆管炎と診断した. また, 炎症反応が比較的高度の血清リウマチ反応陰性の関節炎があり, 仙腸関節と末梢関節に病変が認められたことから脊椎関節炎と診断した. HLA B27は陰性で, 潰瘍性大腸炎の合併は認めなかった. これら疾患の合併は希であることから, 貴重な症例と考え報告した....

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Published in肝臓 Vol. 40; no. 7; pp. 404 - 408
Main Authors 東條, 淳, 黒田, 聖仁, 粕川, 禮司, 新澤, 穣太郎, 宮田, 昌之, 斉藤, 文子, 鈴木, 智浩, 西間, 木友衛, 大山, 仁, 大平, 弘正
Format Journal Article
LanguageJapanese
Published 一般社団法人　日本肝臓学会 25.07.1999
Subjects
原発性硬化性胆管炎
多発関節炎
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ISSN0451-4203
1881-3593
DOI10.2957/kanzo.40.404

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Abstract 症例は73歳の女性. 多発関節痛と肝障害の精査加療目的に当科紹介入院となる. 胆道系酵素の上昇を主体とする肝機能異常と抗ミトコンドリア抗体陰性が認められ, ERCにて肝内胆管の数珠状変化および末梢肝内胆管枝の硬化像の所見があり, 肝生検組織では典型像を呈していないが原発性硬化性胆管炎と診断した. また, 炎症反応が比較的高度の血清リウマチ反応陰性の関節炎があり, 仙腸関節と末梢関節に病変が認められたことから脊椎関節炎と診断した. HLA B27は陰性で, 潰瘍性大腸炎の合併は認めなかった. これら疾患の合併は希であることから, 貴重な症例と考え報告した.
AbstractList 症例は73歳の女性. 多発関節痛と肝障害の精査加療目的に当科紹介入院となる. 胆道系酵素の上昇を主体とする肝機能異常と抗ミトコンドリア抗体陰性が認められ, ERCにて肝内胆管の数珠状変化および末梢肝内胆管枝の硬化像の所見があり, 肝生検組織では典型像を呈していないが原発性硬化性胆管炎と診断した. また, 炎症反応が比較的高度の血清リウマチ反応陰性の関節炎があり, 仙腸関節と末梢関節に病変が認められたことから脊椎関節炎と診断した. HLA B27は陰性で, 潰瘍性大腸炎の合併は認めなかった. これら疾患の合併は希であることから, 貴重な症例と考え報告した.
Author 粕川, 禮司
西間, 木友衛
大山, 仁
鈴木, 智浩
大平, 弘正
斉藤, 文子
宮田, 昌之
新澤, 穣太郎
東條, 淳
黒田, 聖仁
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References 13) Kono K, Ohnishi K, Omata M, : Experimental portal fibrosis produced by intraportal injection of killed nonpathogenic Escherichia coli in rabbits. Gastroenterology 94 : 787-796, 1988
16) Schwimmbeck PL, Yu DTY, Oldstone MBA : Autoantibodies to HLA B27 in the sera of HLA B27 patients with ankylosing spondylitis and Reiter's syndrome. Molecular mimicry with Klebsiella pneumoniae as potential mechanism of autoimmune disease. J Exp Med 166 : 173-181, 1987
9) Takikawa H, Manabe T : Primary sclerosing cholangitis in Japan-analysis of 192 cases. J Gastroenterol 32 : 134-137, 1997
15) Seibold F, Slametschka D, Gregor M, : Neutrophil autoantibodies : a genetic marker in primary sclerosing cholangitis and ulcerative colitis. Gastroenterology 107 : 532-536, 1994
7) Helzberg JH, Petersen JM, Boyer JL : Improved survival with primary sclerosing cholangitis : A review of clinicopathologic features and comparison of sympatomatic and asymptomatic patients. Gastroenterology 92 : 1869-1875, 1987
8) Rabinovitz M, Gavaler JS, Schade RR, : Does primary sclerosing cholangitis occurring in the absence of inflammatory bowl disease? A study of sixty-six subjects. Hepatology 11 : 7-11, 1990
12) Hobson CH, Butt TJ, Ferry DM, : Enterohepatic circulation of bacterial chemotactic peptide in rats with experimental colitis. Gastroenterology 94 : 1006-1013, 1988
2) Tonolli-Serabian I, Sappa P, Grimaud JC, : Association of sclerosing cholangitis and ankylosing spondylitis (in French). Press Med 23 : 1401-1402, 1994
11) Greenstein AJ, Janowitz HD, Sachar DB : The extra-intestinal complications of Crohn's disease and ulcerative colitis. A study of 700 patients. Medicine 55 : 401-412, 1976
4) Calin A : Spondylarthropathies : an overview, Spondylarthropathies. Edited by A Calin. Orlando, Grune and Stratton, 1984, ppl-8
6) Taurog JD, Lipsky PE : New approaches to the molecular analysis of the spondyloarthropathies. Concepts Immunopathol 8 : 222-237, 1992
14) Mandal A, Dasgupta A, Jeffers L, : Autoantibodies in sclerosing cholangitis against a shared peptide in biliary and colon epithelium. Gastroenterology 106 : 185-192, 1994
10) Perret AD, Higgins G, Johnston H, : The liver in ulcerative colitis. Quart J Med 40 : 211-238, 1971
3) Pineau BC, Pattee LP, McGuire S, : Unusual presentation of primary sclerosing cholangitis. Can J Gastroenterol 11 : 45-48, 1997
5) Arnett Jr. FC, Khan MA, Willkens RF : A (1999) new look at ankylosing spondylitis. Patient Care 30 82-101, 1989
1) 柏原赳, 柴本茂樹, 藤森永二郎, 他 : 原発性硬化性胆管炎の2例-最近6年間の本邦報告55例の文献的考察. Gastroenterol Endosc 32 : 1194-1204, 1990
References_xml – reference: 4) Calin A : Spondylarthropathies : an overview, Spondylarthropathies. Edited by A Calin. Orlando, Grune and Stratton, 1984, ppl-8
– reference: 7) Helzberg JH, Petersen JM, Boyer JL : Improved survival with primary sclerosing cholangitis : A review of clinicopathologic features and comparison of sympatomatic and asymptomatic patients. Gastroenterology 92 : 1869-1875, 1987
– reference: 6) Taurog JD, Lipsky PE : New approaches to the molecular analysis of the spondyloarthropathies. Concepts Immunopathol 8 : 222-237, 1992
– reference: 14) Mandal A, Dasgupta A, Jeffers L, : Autoantibodies in sclerosing cholangitis against a shared peptide in biliary and colon epithelium. Gastroenterology 106 : 185-192, 1994
– reference: 3) Pineau BC, Pattee LP, McGuire S, : Unusual presentation of primary sclerosing cholangitis. Can J Gastroenterol 11 : 45-48, 1997
– reference: 5) Arnett Jr. FC, Khan MA, Willkens RF : A (1999) new look at ankylosing spondylitis. Patient Care 30 82-101, 1989
– reference: 12) Hobson CH, Butt TJ, Ferry DM, : Enterohepatic circulation of bacterial chemotactic peptide in rats with experimental colitis. Gastroenterology 94 : 1006-1013, 1988
– reference: 8) Rabinovitz M, Gavaler JS, Schade RR, : Does primary sclerosing cholangitis occurring in the absence of inflammatory bowl disease? A study of sixty-six subjects. Hepatology 11 : 7-11, 1990
– reference: 13) Kono K, Ohnishi K, Omata M, : Experimental portal fibrosis produced by intraportal injection of killed nonpathogenic Escherichia coli in rabbits. Gastroenterology 94 : 787-796, 1988
– reference: 15) Seibold F, Slametschka D, Gregor M, : Neutrophil autoantibodies : a genetic marker in primary sclerosing cholangitis and ulcerative colitis. Gastroenterology 107 : 532-536, 1994
– reference: 16) Schwimmbeck PL, Yu DTY, Oldstone MBA : Autoantibodies to HLA B27 in the sera of HLA B27 patients with ankylosing spondylitis and Reiter's syndrome. Molecular mimicry with Klebsiella pneumoniae as potential mechanism of autoimmune disease. J Exp Med 166 : 173-181, 1987
– reference: 11) Greenstein AJ, Janowitz HD, Sachar DB : The extra-intestinal complications of Crohn's disease and ulcerative colitis. A study of 700 patients. Medicine 55 : 401-412, 1976
– reference: 2) Tonolli-Serabian I, Sappa P, Grimaud JC, : Association of sclerosing cholangitis and ankylosing spondylitis (in French). Press Med 23 : 1401-1402, 1994
– reference: 1) 柏原赳, 柴本茂樹, 藤森永二郎, 他 : 原発性硬化性胆管炎の2例-最近6年間の本邦報告55例の文献的考察. Gastroenterol Endosc 32 : 1194-1204, 1990
– reference: 9) Takikawa H, Manabe T : Primary sclerosing cholangitis in Japan-analysis of 192 cases. J Gastroenterol 32 : 134-137, 1997
– reference: 10) Perret AD, Higgins G, Johnston H, : The liver in ulcerative colitis. Quart J Med 40 : 211-238, 1971
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Snippet 症例は73歳の女性. 多発関節痛と肝障害の精査加療目的に当科紹介入院となる. 胆道系酵素の上昇を主体とする肝機能異常と抗ミトコンドリア抗体陰性が認められ, ERCにて肝内胆管の数珠状変化および末梢肝内胆管枝の硬化像の所見があり, 肝生検組織では典型像を呈していないが原発性硬化性胆管炎と診断した. また,...
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SubjectTerms 原発性硬化性胆管炎
多発関節炎
Title 脊椎関節炎を伴った原発性硬化性胆管炎の1例
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