|Budget Amount *help
¥1,200,000 (Direct Cost : ¥1,200,000)
Fiscal Year 2000 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 1999 : ¥600,000 (Direct Cost : ¥600,000)
Aim : Crohn's disease is the intractable inflammatory bowel disease which often needs surgical treatment for fibrotic intestinal stricture or fistula. High postoperative recurrence is well known and surgical indication, which is perforating type and non perforating type, was reported as one of the risk factors. Collagen type in the intestinal stricture of Crohn's disease was reported to be different from that of normal intestine. The aim of study was to analyze collagen type in the different type of lesion in the resected specimen of Crohn's disease and to examine correlation between collagen type in different morphological lesion and postoperative recurrence.
Patients and method : Type of collagen (I, III, V) was analyzed in resected specimen of Crohn's disease (stricture : 10, ulcer : 20, fistula : 21, thick bowel wall : 11, edema : 3, macroscopically normal intestine : 48 ) and 12 normal control intestine with colorectal cancer patients.
Results : 1) Type I, III collagen content : The
re were no difference between control and whole Crohn's disease group, control and each Crohn's disease group. No difference was also found in type I, III collagen contents among each Crohn's disease group.
Type V collagen content : Type V collagen content was 10% in control, 8.5% in macroscopically normal intestine of Crohn's disease, 7.1% in stricture, 8.3% in ulcer, 7.97% in fistula, 6.9% in thick bowel wall, 7.9% in edematous intestine. Type V collagen content was lower in whole Crohn's disease group, in each Crohn's disease group than control with statistically significance. However, content in fistula site and non fistula site (stricture, ulcer, thick bowel wall, edematous intestine) was 7.97%, 7.66% respectively, without statistical difference.
Conclusion : Intestinal collagen content in Crohn's disease was different from that of normal bowel in terms of low type V collagen content. Collagen content of Crohn's disease intestine had no influence on postoperative recurrence because of no difference between perforating and non perforating lesion, which is thought to be one of the risk factor for postoperative recurrence.
2)Type V:平均含有率は対照群10%、クローン病の肉眼的正常部8.5%、狭窄部7.1%、潰瘍部8.3%、瘻孔部7.97%、肥厚部6.9%、浮腫を認める部位7.9%であった。対照群とクローン病全体、及び各病変群のtype V含有率は対照群に比べて有意に低値であった。瘻孔と非瘻孔部(狭窄部、潰瘍部、肥厚部、浮腫)のtype V平均含有率はそれぞれ7.97%、7.66%で有意差は認めなかった。
結語:クローン病の腸管壁は肉眼的正常部も含めて正常対照群と比べてコラーゲン分画のうち、type Vが有意に減少しており、この結果は従来の報告とは異なるが、クローン病患者腸管のコラーゲン代謝が正常と異なることが示された。術後再発に関与すると考えられる腸管病変の形態とコラーゲン分画に差がなかったことから、病変腸管局所のコラーゲン分画は術後再発の有無に関与しないと考えられた。今回の結果からは今後更に測定症例を増やして各病変部のコラーゲン分画の特徴を分析し、クローン病腸管の病態を解明及び術後再発との関連を検討する必要があると考えられる。 Less