臨牀消化器内科 Vol.34 No.4(3-5)


特集名 肥満と消化器
題名 肥満と消化器疾患 (5) 肥満と膵疾患
発刊年月 2019年 04月
著者 下瀬川 徹 みやぎ県南中核病院消化器内科
【 要旨 】 肥満は糖尿病や心血管疾患と関連するばかりでなく,さまざまな消化器疾患の直接的原因あるいはリスク因子であることが知られており,膵疾患も例外ではない.肥満者では急性膵炎の発症率や重症化率が高く,膵癌発症の危険率も高いことが示されている.脂肪組織はアディポサイトカインと呼ばれる多彩な液性因子を分泌する内分泌器官と認識されており,肥満者では抗炎症性アディポサイトカインであるアディポネクチンの産生・分泌が低下し,炎症性アディポサイトカインであるレプチンの産生・分泌が亢進する.脂肪組織,とくに内臓脂肪の増加はこれらホルモンの不均衡を介して膵局所ならびに全身の炎症反応や免疫能に影響を与え,膵炎の重症化や膵癌の発症などに関与する分子機序が考えられている.
Theme Obesity and Digestive Organ
Title Obesity and Pancreatic Diseases
Author Tooru Shimosegawa Department of Gastroenterology, South Miyagi Medical Center
[ Summary ] Recent advances in the understanding of obesity reveal that obesity can directly or indirectly be a risk factor for the pathogenesis and pathophysiology of a wide range of digestive organs including the pancreas. Previous studies have shown a higher incidence of acute pancreatitis, development of more severe clinical conditions, and a higher incidence of pancreatic cancer in obese patients. Fat tissue is now recognized as an endocrine organ for its capacity to produce and secrete various humoral factors named adipocytokines. In obese patients, anti‒inflammatory cytokines called adiponectins show decreased production and secretion whereas leptin, a well‒known pro‒inflammatory adipocytokine, is excessively produced and secreted, thus causing a sustained local and/or systemic inflammatory condition in the body. Increased fat tissue, especially visceral fat, is known to correlate with the severity of acute pancreatitis and the risk of pancreatic cancer. This chapter discusses the clinical evidence for the influence of obesity on the pathogenesis and clinical course of pancreatic diseases and the molecular mechanisms which link the two pathological conditions.
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