Oshitani Nobuhide, Iimuro Masaki, Kawashima Daichi, Inagawa Makoto, Sogawa Mitsue, Jinno Yoshio, Yamagami Hirokazu, Hamasaki Naoko, Sawa Yoshinori, Hara Jyunichi, Nakamura Shiro, Matsumoto Takayuki, Seki Shuichi, Arakawa Tetsuo, Kitano Atsuo, Kuroki Tetsuo
Third Department of Internal Medicine, Osaka City University Medical School, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Hepatogastroenterology. 2002 Mar-Apr;49(44):317-21.
BACKGROUND/AIMS: Primary sclerosing cholangitis is often accompanied by inflammatory bowel disease in western countries. However, the incidence of primary sclerosing cholangitis in patients with ulcerative colitis appears to be much lower in Japan.
Between 1980 and 1998, a total of 402 patients with ulcerative colitis were seen in our department. The patients were evaluated by abdominal ultrasonography, endoscopic retrograde cholangiopancreatography, and/or magnetic resonance cholangiopancreatography when persisting abnormalities of biochemical findings suggested the presence of hepatobiliary diseases.
Of the 402 patients with ulcerative colitis, 3 patients with primary sclerosing cholangitis were found. There were 2 men and 1 woman. One patient had left-sided colitis while 2 had total colitis. Magnetic resonance cholangiopancreatography was done in 2 of these 3 patients and demonstrated diagnostic features of primary sclerosing cholangitis. All 3 patients had intra- and extrahepatic involvement by primary sclerosing cholangitis. One male patient died due to progressive hepatic failure. The other male patient was treated with ursodeoxycholic acid, but serum alkaline phosphatase level remained above the normal range. The female patient maintained normal serum alkaline phosphatase levels without specific medication.
Magnetic resonance cholangiopancreatography is the most safe and convincing tool for the diagnosis of coexistent primary sclerosing cholangitis in the patients with ulcerative colitis.
背景/目的：在西方国家，原发性硬化性胆管炎常伴有炎症性肠病。然而，在日本，溃疡性结肠炎患者中原发性硬化性胆管炎的发病率似乎要低得多。
1980年至1998年间，我科共诊治了402例溃疡性结肠炎患者。当生化检查结果持续异常提示存在肝胆疾病时，对患者进行腹部超声、内镜逆行胰胆管造影和/或磁共振胰胆管造影检查。
在402例溃疡性结肠炎患者中，发现3例原发性硬化性胆管炎患者。其中男性2例，女性1例。1例患者为左半结肠炎，2例为全结肠炎。这3例患者中的2例进行了磁共振胰胆管造影，显示出原发性硬化性胆管炎的诊断特征。所有3例患者均有原发性硬化性胆管炎引起的肝内和肝外病变。1例男性患者因进行性肝衰竭死亡。另1例男性患者接受了熊去氧胆酸治疗，但血清碱性磷酸酶水平仍高于正常范围。该女性患者未接受特殊药物治疗，血清碱性磷酸酶水平维持正常。
磁共振胰胆管造影是诊断溃疡性结肠炎患者并存原发性硬化性胆管炎最安全、最可靠的工具。
