潰瘍性大腸炎における局所動脈病変とその意義 : 心身医学的考察を含めて
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概要
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In ulcerative colitis, the occurrence of histological change in the colon is well known, but the change of the regional arteries is rerely described. Authors investigated 35 cases of ulcerative colitis histopathologically including the mesocolon, and found the following three kinds of typical change in the arteries of the region.1) Perinuclear vacuoles (PnV) named by Prof. Takeuchi were confirmed to be present in the exactly transected arteried, 100 to 600μ in diameter; there were many media-muscular cells with round vacuole compressing the nucleus to the periphery. The etastica interna was also tortuous intensively. Electron microscopic examination revealed that the cell plasm of a muscular cell encroached upon the neighboring cell plasm, resulting in maldistribution of the nucleus. This change has been proved experimentally to be an acute spasm of the artery, and to be reversible to the normal structure when the spasm disappeared.2) The arteriole less than 100μ in diameter showed simple thickening of its wall due to increasing number of media-muscular cells, and remarkable tortuous elastica interna. This seems to be a transitional stage shitfing to the following change of 3).3) Change of hyalinous or necrotic thickening was found also in arterioles less than 100μ; it was an evenly thickened and amorphous status.The conditions of 2) and 3) above are well known to be present in the artery of repeated spasm which is induced by means of electric stimulation and some drugs.Three kinds of arterial change mentioned above were observed frequently in all 35 cases of 3 months to 12 years duration. There is no doubt that spasm of the regional arteries occurs without interruption while ulcerative colitis is present. This fact seems to be related to the pathogenesis, progress and difficult curability of the lesion. This is also a good example that functional abnormality can be transferable to organic abnormality.It was very characteristic that changes mentioned above were limited only in the regional arteries of the large intestine but none is found in other arteries in autopsy cases. Many specialists point out a psychological factor or stress as one the causes ulcerative colitis. It is well known that vascular function is most susceptible to the patient's psychological conditons (for example, shyness appears selectively in facial vessels). We suppose, however, that patients of this lesion generate some specific emotional inclination frequently which may selectively induce spasms of colon arteries. We would like to have a chance to discuss in details the emotional inclination of this disease in the future.
- 日本心身医学会の論文
- 1982-08-01
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