062_052_070.pdf 1.15 MB
膵炎のうちもっとも頻度が高いアルコール性膵炎（AIP）の疫学，臨床像および発生機序に関する従来の知見を総括した。AIPの大多数は慢性膵炎である。通常は長期にわたる多量の飲酒を背景に発症するが，遺伝的素因および食事因子も重要な役割を演じる。発症初期には血中膵酵素の上昇をともなう腹痛が病像を支配するが，進展すると膵外分泌不全による消化吸収障害と膵内分泌不全による糖尿病が病像を支配するようになる。アルコール性慢性膵炎は非アルコール性慢性膵炎にくらべて確診時にすでに進展した症例が多く，合併症が多く，進行が早く，予後が悪い。死亡の主たる原因は癌の併発と糖尿病の合併症で，膵炎の急性増悪発作がこれにつぐ。併発する癌のなかでは膵癌よりもむしろ上部気道および上部消化管の癌が多い。発生機序としてはDuctal－Plug説とToxic－Metabolic説が有力であるが，最近は細 胞内膵酵素活性化説とFree Radical説も注目をあびている。
This paper is to review the literature on the epidemiology, clinical pictures and etiopathogenesis of alcohol-induced pancreatitis (AIP). The incidence of AIP has been increasing worldwide, paralleling the increase in alcohol consumption. AIP manifests itself following a longterm consumption of large amounts of alcohol. There is no known threshold value of alcohol consumption in terms of the risk of developing AIP, although the logarithm of the risk of developing AIP is lineally correlated with the amount of alcohol intake. Why some alcoholics develop pancreatitis whereas others with equal consumption of ethanol are spared remains to be explained. Therefore, two additional factors are considered to play important roles in developing AIP : genetic predisposition and diet. The majority of AIP IS chronic pancreatitis (AICP), although a minority can be acute pancreatitis (AIAP). AIAP shows somewhat higher morbidity and mortality than the common variety of acute pancreatitis. If recovered from an attack, AIAP shows morphological and functional restoration. AICP manifests itself with an acute attack of abdominal pain, insidious onset of abdominal pam, or a pain-free variety. An acute attack in AICP resemble that m AIAP ; often these two can be differentiated only by follow-up studies. AICP shows no morphological and functional restoration, and often shows progressive deterioration. Abdominal pain with elevated serum pancreatic enzymes is a predominant clinical picture m the early stage of AICP, whereas in the late stage symptoms and signs deriving from exocrine insufficiency (maldigestion) and endocrine insufficiency (pancreatic diabetes) begin to dominate the clinical pictures. AICP is in the more advanced stage and shows more complications than nonalcoholic chronic pancreatitis at the time of diagnosis. In addition, AICP shows more rapid progress and higher morbidity and mortality. The incidence of microangiopathy in pancreatic diabetes resemble that in primary diabetes, being higher in patients with a longer history of diabetes, those on insulin treatment and those under poorer control. Main causes of death are development of cancer in the upper respiratory and gastrointestinal tract and diabetic complications (hypoglycemic shock, renal failure, and intractable pneumonia), and acute attack of pancreatitis leads to death less frequently. Ductal-Plug theory and classical Toxic-Metabolic theory are most popular to explain the pathogenesis of AIP ; however, increasing evidence has been reported that oxygen free radicals and intracellular activation of zymogens by lysosomal enzymes may be involved in the pathogenesis.
アルコール性膵炎 (Alcohol－induced pancreatitis)
Institute for Environmental Medicine, Okayama University Medical Scool
Departmental Bulletin Paper
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