| 特集名 | 肝疾患の予後 | |
|---|---|---|
| 題名 | 原発性胆汁性肝硬変の予後と肝移植の適応 | |
| 発刊年月 | 1997年 10月 | |
| 著者 | 廣原 淳子 | 関西医科大学第三内科 |
| 著者 | 井上 恭一 | 関西医科大学第三内科 |
| 【 要旨 】 | 本邦での全国調査における原発性胆汁性肝硬変(PBC)のうち1980～1994年末までに登録された2,096例について診断時無症候性PBC(a-PBC)1,669例の平均生存期間は15.5年であったが，うち大部分は観察期間中生存しており，約12%が予後の悪い症候性PBC(s-PBC)へと進展した．a-PBCの大部分は健常対照群と生存率に差を認めなかったが，進行性のsubgroupが存在することが示唆された．一方，s-PBCの平均生存期間はs1-PBC 12年，s2-PBC 4.5年であった．また1990年以降のs2-PBCは以前の症例に比べて予後が良好であり，UDCAを含めた治療成績の向上によって最近の症例は予後は改善していると推測される．進行したPBCに対する肝移植の適応は，各予後予測モデルより余命1年以内と判断される時期あるいはコントロール不可能な合併症を有する場合に考慮するのが一般的である． | |
| Theme | Prognosis of Liver Diseases | |
|---|---|---|
| Title | Prognosis of and Indications for Liver Transplantation in Primary Biliary Cirrhosis | |
| Author | Junko Hirohara | Third Department of Internal Medicine, Kansai Medical University |
| Author | Kyoichi Inoue | Third Department of Internal Medicine, Kansai Medical University |
| [ Summary ] | The median survival of Japanese patients with asymptomatic primary biliary cirrhosis (PBC) was 15.5 years on follow-up for 20 years by the Research Group for Intractable Liver Disease sponsored by the Ministry of Health and Welfare of Japan. Symptoms developed in 12% of asymptomatic patients. Most asymptomatic patients remained symptom-free for many years, and their mortality rate was not significantly different from that of the normal age-and sex matched population. The median survivals of symptomatic-PBC with pruritus and jaundice were 12 and 4.5 years, respectively. The survival of patients with jaundice in the 1990's was improved as compared to former patients. This fact suggests that the effects of treatment with ursodeoxycholic acid and endoscopic therapy for G-I bleeding may influence the natural course of PBC. Our suggestions for the decision and timing of liver transplantation in PBC are as follows : one should consider liver transplantation in a PBC patient when the estimated survival in the absence of transplantation is less than one year by mathematical models. One should consider liver transplantation in a PBC patient who has variceal bleeding not controlled by sclerotherapy. |
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