臨牀消化器内科 Vol.13 No.9(10)


特集名 胃の炎症
題名 NSAIDsと胃の炎症
発刊年月 1998年 08月
著者 富永 和作 大阪市立大学医学部第三内科
著者 樋口 和秀 大阪市立大学医学部第三内科
【 要旨 】 non-steroidal anti-inflammatory drugs(NSAIDs)は,胃粘膜に炎症をもたらし粘膜傷害を惹起するとして知られており,その機序として,第一義的にプロスタグランジンの低下というアラキドン酸カスケードの破綻が重要であることが証明されてきた.さらに,近年,炎症性細胞浸潤とその活性化,炎症性サイトカインの産生,微小循環系あるいは粘膜バリアーの破綻など多岐にわたり,それらが複雑かつ巧妙に関係してこの病態を形成していることも明らかになりつつある.しかしながら,胃という臓器を背景とした種々の炎症も,それら炎症のケミカルメディエーターの観点からは類似点も多いが,最終的な炎症の組織学的像は相違点も多く,それぞれの胃の炎症の特徴を表現しているともいえる.これらのメカニズムに関してはまだ不明な点が多く,今後の課題と考えられる.
Theme Inflammation of Gastric Mucosa
Title Characteristics of the Gastritis Induced by Non-steroidal Anti-inflammatory Drugs
Author Kazunari Tominaga Third Department of Medicine, Osaka University School of Medicine
Author Kazuhide Higuchi Third Department of Medicine, Osaka University School of Medicine
[ Summary ] The investigation of gastric mucosal inflammation, known as gastritis, has been focused on the initial pathogenesis leading to mucosal damage caused by non-steroidal anti-inflammatory drugs (NSAIDs), even though they have a potent anti-inflammatory effect on other inflammatory locations. Therefore, it is important to elucidate the mechanisms of gastric mucosal inflammation induced by NSAIDs. Prostaglandin (PG) E2 and I2, and leukotriene (LT) C4 and B4, metabolites of arachidonic acid, are involved in the homeostasis of gastric tissues such as the mucosal defence system which reacts against some topical irritants and the maintenance of gastric mucosal blood flow in stressed conditions. Recently, an imbalance in PG/LT synthesis via NSAIDs, the most potent inhibitors of PG synthetase, has been reported to be associated with gastric inflammation.In this chapter, we will discuss in the metabolism of arachidonic acid, in particular we will review the current knowledge available about the involvement of microcirculation of the gastric mucosa, inflammatory cytokines, adhesion molecules, and polymorphonuclear cells in the pathophysiological and molecular biological mechanisms affecting gastric mucosal inflammation, caused by NSAIDs.
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