解熱鎮痛剤過敏性喘息に関する臨床的研究 : その臨床像を中心として

Abstract

いわゆるアスピリン喘息の発作誘発物質がきわめて多種多様であることは, 今日では疑う余地もなく明白である。特に, アスピリン様の解熱鎮痛剤(酸性非ステロイド性消炎剤)は, いずれも強力な誘発物質として知られている。そこで本論文では, 解熱鎮痛剤による発作誘発歴が明らかに認められるか, あるいは解熱鎮痛剤の負荷試験により気道攣縮反応が陽性であることが確認された症例を解熱鎮痛剤過敏性喘息(AIA)として扱い, その臨床像の特徴を解明することを目的として, 臨床的検討を実施した。対象はAIA 40症例(AIA群)と, 対照群としてアトピー性喘息32症例(アトピー群)および内因型喘息27例(内因群)の計99例であった。アトピー群, 内因群の症例は, 少なくとも一種以上の解熱鎮痛剤負荷試験が陰性であることを確認した症例, すなわち非AIAと判定された症例とした。これら3群の症例について, 各種の問診および臨床検査項目の成績をまとめ, 群間比較を行ないつつ検討した結果, 次の成績を得た。

A term of antipyretic-analgesics-induced asthma (AIA) was used in this study instead of the so-called aspirin-induced asthma, as it is a well-known fact that the aspirin-like drugs are all potent provocative substances for this particular type of severe asthma. To clarify the clinical feature of AIA, 40 cases with AIA, and 32 cases with atopic asthma and 27 cases with intrinsic asthma as control groups were studied. The following resuts were obtained about AIA group. Age of the onset of asthma was widely distributed from childhood to old age, but the peak incidence was in the thirties and the asthma developed after 30 years old in most cases, occupying 72.5%. In the AIA group severity of asthma tended to be more severe than in the other two groups. The rate of positive family history of asthma in the AIA group was 40%, showing the degree of inbetween of the other two groups. Positive episodes of asthmatic attack provocated by antipyretic-analgesic drugs were found in approximately half of the cases. Patients having an experience of svere attack accompanied by clouding of consciousness were present in the ratio of one to four. The asthma attacks of AIA occurred perennially. Nasal polyposis and chronic sinusitis were found to be more frequent in this group than the others. In addition, AIA sometimes complicated with atopic asthma and the blood or sputum eosinophilia was not a finding peculiar to atopic asthma, but was a finding recognized generally in all groups of asthma. This research was partly supported by the Grant-in-Aid for Scientific Research (No. B-448207) of the Japanese Ministry of Education.