臨牀消化器内科 Vol.31 No.4(8-1)


特集名 消化管憩室の最近の話題
題名 大腸憩室 (1) 大腸憩室の疫学
発刊年月 2016年 04月
著者 山道 信毅 東京大学医学部消化器内科
著者 光島 徹 亀田総合病院附属幕張クリニック
著者 小池 和彦 東京大学医学部消化器内科
【 要旨 】 大腸憩室は欧米で頻度が高くアジア,アフリカで低いことが知られ,全世界で有病率が上昇している疾患である.現在の日本の有病率は25%を超え,憩室部位の分布は変わらないが,その頻度は30年以上にわたり増加している.大腸憩室は若年者では右側(盲腸~横行結腸)優位の分布を示すが,加齢とともに憩室数が増加し,左側(下行~S状結腸)憩室の頻度が高まっていく.われわれの解析では加齢以外に,男性・飲酒・成人後体重増加・喫煙・高HbA1c値・高中性脂肪値が,危険因子として同定された.大腸憩室はほとんどが後天性・圧出性の仮性憩室であり,こうした複合要因による腸管壁の脆弱化や内腔圧の上昇が,発症に寄与していると推測される.
Theme Topics of the Gastrointestinal Diverticula
Title Epidemiology of Colonic Diverticulosis
Author Nobutake Yamamichi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
Author Toru Mitsushima Kameda Medical Center Makuhari
Author Kazuhiko Koike Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo
[ Summary ] Diverticulosis is a well‒known common disease of the colon, the incidence of which has markedly increased worldwide. We reviewed the medical data of 62,503 general asymptomatic colonoscopy examinees (47,325 men and 15,178 women ; age, 52.1±9.2 years) from 1990 to 2010 in Japan. Diverticulosis was detected in 11,771 subjects (18.8 %), The incidence rates of diverticulosis in 1990‒2000 and 2001‒2010 were 13.0 % (3,771/29,071) and 23.9 % (8,000/33,432), respectively. The incidence of left‒sided colorectal diverticula markedly increased with age but did not significantly change with time. The most recent 3,327 colonoscopy examinees (age, 55.0±9.1 years) were further analyzed with 16 background factors. Diverticulosis was detected in 858 subjects (25.8 %), which comprised 734 men (29.5 % of 2,485 men) and 124 women (14.7 % of 842 women). In the multiple logistic analysis, the calculated odds ratios (ORs) indicated that age (OR=1.24‒1.96), male sex (OR=1.20), smoking (OR=1.15‒1.22), severe weight increase in adulthood (OR=1.17), HbA1c leve (l OR=1.15), alcohol drinking(OR=1.11), and serum triglyceride level (OR=1.10) were significantly positively associated with the development of diverticulosis. In conclusion, the large‒scale data of asymptomatic colonoscopy examinees indicated that the prevalence of diverticulosis continues to increase in Japan. Age, male sex, smoking, severe weight increase in adulthood, serum HbA1c level, alcohol drinking, and serum triglyceride level showed a significant positive association with diverticulosis.
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