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京都分類による内視鏡胃炎診断とHelicobacter pylori感染、胃癌リスク指標との関連性の研究

豊島, 治 東京大学 DOI:10.15083/0002006123

2023.03.20

概要

【別紙 2】
審査の結果の要旨
氏名 豊島 治
本研究は京都分類を用いた内視鏡胃炎所見診断と血清 Helicobacter pylori (H. pylori)抗体、
胃癌関連一塩基多型(single nucleotide polymorphism: SNP)である Prostate Stem Cell

Antigen (PSCA) rs2294008 や Mucin 1 rs4072037 との関連性を検討したものであり、下記
の結果を得ている。
1.

内視鏡的胃炎所見の京都スコアは以下①~⑤のスコアの総計であり、0~8 と定義さ

れている。①萎縮スコア:木村竹本分類による「なしと C1」が 0、
「C2 と C3」が 1、
「O1
から O3」が 2。②腸上皮化生スコア:「なし」が 0、「前庭部に限局する」場合 1、
「体部ま
で及ぶ」場合 2。③皺襞腫大スコア:
「なし」が 0、
「あり」が 1。④鳥肌スコア:
「なし」が
0、
「あり」が 1。⑤びまん性発赤スコア:
「なし」が 0、
「軽度、あるいは、regular arrangement
of collecting venules (RAC)+」が 1、
「高度」が 2。京都スコアは H. pylori 抗体価と正の相
関を示した。
2.

京都スコアを構成する内視鏡的胃炎所見である萎縮、腸上皮化生、皺襞腫大、鳥

肌、びまん性発赤、RAC は全てが H. pylori 抗体価と関連していた。

H. pylori 抗体陽性者において、高抗体価(E プレート‘栄研’H.ピロリ抗体 II;

3.

50.0U/mL 以上)は内視鏡的鳥肌と内視鏡的萎縮と年齢 40-59 歳と関連していた。

H. pylori 抗体判定上陰性だが抗体価高値 (E プレート‘栄研’H.ピロリ抗体 II;

4.

3.0-9.9U/mL)例において、H. pylori 感染診断は重要である。本グループにおいて、京都ス
コア 2 以上は H. pylori 感染の予測に有用であった。

H. pylori 感染診断には多数の modality を用い、総合的に判断することが重要であ

5.
る。
6.

京都スコアは胃癌のリスクである PSCA SNP rs2294008 と関連していたが、
Mucin

1 SNP rs4072037 とは関連していなかった。
7.

PSCA SNP rs2294008 は H. pylori 感染―胃炎進展―胃癌発生経路の、内視鏡的(内

視鏡的萎縮)、病理学的(背景胃粘膜の好中球活動の地勢学的分布)
、血清学的(ペプシノゲ
ン I/II 比)胃炎の進展に関与していると推定される。PSCA SNP は H. pylori 感染自体や重
度胃炎から胃癌への進展には関与していなかった。
8.

一部の遺伝的素因が内視鏡所見に表現されていることが示された。
以上、本論文は京都分類を用いた胃内視鏡所見診断が H. pylori 感染や胃癌リスクの指標

と関連していることを明らかにした。より侵襲的な手技である生検を行わず、H. pylori 感
染や胃癌リスクを的確に推定できることは意義があるため、本研究は実臨床に重要な貢献
1

をなすと考えられる。
よって本論文は博士(医学)の学位請求論文として合格と認められる。

2

この論文で使われている画像

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