月経にともなう気胸は右に多い [医学関連]
以前の記事でコメント頂いたので、記事にさせて頂きます。
子宮内膜症と言う病気があります。子宮の内側を覆っている子宮内膜と言うものがあります。これはホルモンの影響を受け、増えたり、壊れたりします。壊れた物が外に出るのがいわゆる生理です。
何故か分かりませんが、その子宮内膜が子宮の内側の表面以外の所に出来る病気を子宮内膜症と言います。当然ですが、ホルモンの影響を受け、出血のようなことを起こします。が、子宮以外の所で出血すれば、、、、、厄介な事は分かりますよね。
それが胸膜に発生する事があり、生理の頃に気胸が起こる人がいます。それが月経随伴気胸と言う物です。UpToDateの「Thoracic endometriosis」には以下のようにあります。まず非常に稀な病気です。stargazerさんがコメント頂いたように、右に多いです。
Several hypotheses have been proposed to explain the pathogenesis of pelvic and thoracic endometriosis. So-called retrograde menstruation may cause movement of shed endometrial tissue through the fallopian tubes and into the peritoneal cavity [4]. Decreased apoptosis may contribute to the failure of the normal mechanisms that clear ectopic endometrial cells [5]. Alternatively, altered immune responses may contribute to the failure to clear peritoneal endometrial tissue, as suggested by genomewide transcriptional studies of endometriosis tissue that identified a gene signature consistent with an autoimmune profile [6]. Serum B lymphocyte stimulating protein (BLyS), also associated with autoimmune disease, is elevated in patients with endometriosis, but its role remains unclear [6]. Another theory is that ectopic endometrial tissue develops from a group of multipotential cells in the endometrial basal cell layer and that these cells are capable of transformation into endometrial cells with the appropriate hormonal stimulation [7,8].
The potential mechanism for migration of endometrial tissue from the pelvis to the thoracic cavity also remains uncertain. Possible routes include microembolization through the pelvic veins [1,9,10], and trans-diaphragmatic movement through diaphragmatic defects [11-13]. The hypothesis that microembolization might be a pathogenic mechanism has been questioned, as micro-embolization would be expected to affect both hemithoraces approximately equally, but TES has an overwhelming occurrence in the right hemithorax [14]. In addition, the relatively high prevalence of pelvic endometriosis in women of reproductive age suggests that a comparably high number of TES cases would occur, if micro-embolization were the mechanism [15]. Instead, the relatively low prevalence of TES makes microembolization a less likely explanation.
The relationship between the thoracic endometriosis syndrome (TES) and the presence of pelvic endometriosis is unclear. One study observed that peak incidence of TES occurs about five years after the peak incidence of pelvic disease, suggesting a link between the two processes [1]. However, a meta-analysis did not observe a statistically significant association between the presence of pelvic and thoracic endometriosis [14]. Based on this analysis it has been suggested that pelvic endometriosis and thoracic endometriosis can occur concurrently or independently [14].
The presence of diaphragmatic defects has been suggested by many authors as a mechanism for recurrent pneumothorax in TES [11,16-19]. However, in a meta-analysis of patients with TES, no increased risk of pneumothorax was noted among those with diaphragmatic defects. Furthermore, diaphragmatic defects were observed in similar proportions in subjects presenting with hemothorax or pneumothorax [14]. Additionally, the recurrence of pneumothorax after diaphragmatic repair and following hysterectomy is strong evidence against diaphragmatic defects being the cause for recurrent pneumothorax [11,20,21]. Thus, the diaphragmatic defects in some patients with TES may represent areas of involuted endometrial implants.
ちょっと意味の分からない単語も出てくるので日本語訳は断念しました。すみません。
どちらにしても何故右に多いのかと言う説明は出来ないようです。
子宮内膜症と言う病気があります。子宮の内側を覆っている子宮内膜と言うものがあります。これはホルモンの影響を受け、増えたり、壊れたりします。壊れた物が外に出るのがいわゆる生理です。
何故か分かりませんが、その子宮内膜が子宮の内側の表面以外の所に出来る病気を子宮内膜症と言います。当然ですが、ホルモンの影響を受け、出血のようなことを起こします。が、子宮以外の所で出血すれば、、、、、厄介な事は分かりますよね。
それが胸膜に発生する事があり、生理の頃に気胸が起こる人がいます。それが月経随伴気胸と言う物です。UpToDateの「Thoracic endometriosis」には以下のようにあります。まず非常に稀な病気です。stargazerさんがコメント頂いたように、右に多いです。
Several hypotheses have been proposed to explain the pathogenesis of pelvic and thoracic endometriosis. So-called retrograde menstruation may cause movement of shed endometrial tissue through the fallopian tubes and into the peritoneal cavity [4]. Decreased apoptosis may contribute to the failure of the normal mechanisms that clear ectopic endometrial cells [5]. Alternatively, altered immune responses may contribute to the failure to clear peritoneal endometrial tissue, as suggested by genomewide transcriptional studies of endometriosis tissue that identified a gene signature consistent with an autoimmune profile [6]. Serum B lymphocyte stimulating protein (BLyS), also associated with autoimmune disease, is elevated in patients with endometriosis, but its role remains unclear [6]. Another theory is that ectopic endometrial tissue develops from a group of multipotential cells in the endometrial basal cell layer and that these cells are capable of transformation into endometrial cells with the appropriate hormonal stimulation [7,8].
The potential mechanism for migration of endometrial tissue from the pelvis to the thoracic cavity also remains uncertain. Possible routes include microembolization through the pelvic veins [1,9,10], and trans-diaphragmatic movement through diaphragmatic defects [11-13]. The hypothesis that microembolization might be a pathogenic mechanism has been questioned, as micro-embolization would be expected to affect both hemithoraces approximately equally, but TES has an overwhelming occurrence in the right hemithorax [14]. In addition, the relatively high prevalence of pelvic endometriosis in women of reproductive age suggests that a comparably high number of TES cases would occur, if micro-embolization were the mechanism [15]. Instead, the relatively low prevalence of TES makes microembolization a less likely explanation.
The relationship between the thoracic endometriosis syndrome (TES) and the presence of pelvic endometriosis is unclear. One study observed that peak incidence of TES occurs about five years after the peak incidence of pelvic disease, suggesting a link between the two processes [1]. However, a meta-analysis did not observe a statistically significant association between the presence of pelvic and thoracic endometriosis [14]. Based on this analysis it has been suggested that pelvic endometriosis and thoracic endometriosis can occur concurrently or independently [14].
The presence of diaphragmatic defects has been suggested by many authors as a mechanism for recurrent pneumothorax in TES [11,16-19]. However, in a meta-analysis of patients with TES, no increased risk of pneumothorax was noted among those with diaphragmatic defects. Furthermore, diaphragmatic defects were observed in similar proportions in subjects presenting with hemothorax or pneumothorax [14]. Additionally, the recurrence of pneumothorax after diaphragmatic repair and following hysterectomy is strong evidence against diaphragmatic defects being the cause for recurrent pneumothorax [11,20,21]. Thus, the diaphragmatic defects in some patients with TES may represent areas of involuted endometrial implants.
ちょっと意味の分からない単語も出てくるので日本語訳は断念しました。すみません。
どちらにしても何故右に多いのかと言う説明は出来ないようです。
私も一度そういった患者さんを搬送した経験があります。
右だったかというのは覚えていないのですが、その時初めてそういった病気があると知りました。
by tsubaki (2011-04-26 15:18)
tsubakiさん、コメントありがとうございます。
私は実際に診療をさせてもらった事はありません。人間の身体は不思議ですね。
by Kim (2011-04-26 16:08)
非常にまれな疾患なんですか・・・
高校時代にそれになった女の子の友達がいました。
最初は肩が痛いって言ってましたね・・
by フィル (2011-04-26 20:01)
フィルさん、コメントありがとうございます。
そう言う友達がいたんですね。稀な疾患ですよ。
気胸は肩が痛くなる人も確かにいます。診断と言うのは難しいです。
by Kim (2011-04-26 20:40)
こんばんは。
私の妹が二年前に心不全と胸水で入院しました。
胸水穿刺をしたり、沢山の検査をして子宮内膜症という診断になりました。
内膜症が子宮以外で起きることにとても驚きました。生理周期に合わせて胸水が溜まり治療も大変でしたよ。しかも、心嚢水も長い年月かけて溜まり心膜が石灰化してたので、心膜もとりました。
ホント大変な病気で今でも治療しています。
何故このようなことが起きるのでしょうか？
by はるかけこ (2011-04-26 22:22)
Kim先生、ご教示いただいてありがとうございます。
横隔膜の欠陥が示唆されているような記載（？）の
ようですが、結局、明確な発症機序は不明なので
すね。いや～、人の体というのは本当に不思議で
すね！
そういえば、先日、ある外科の先生（20年弱のご
経験）に話を伺いました。その先生は今までに５件
遭遇した事があるとのことでしたが、そのすべてで
やはり「右」だったそうです。
ありがとうございました。
by stargazer (2011-04-26 22:31)
はるかけこさん、コメントありがとうございます。
妹さんがこの病気なんですね。大変ですね。原因は不明の様です。なかなかよくならないようですが、早く治療が終了することを祈っています！
by Kim (2011-04-27 11:17)
stargazersさん、コメント＆nice!ありがとうございます。
Facebookにも記事が自動的にアップされることになっているのですが、そちらでは両側の患者さんを診たことがあると言う先生がいました。
不思議ですね。
by Kim (2011-04-27 11:19)