Shin-ei Takano
2008
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Journal
Japanese Journal of Rhinology
Abstract
アレルギー性鼻炎は,スギ花粉症を代表として今や日 本の国民病と言われるくらいに罹患患者数も多い疾患の 一つである。 それに比べて血管運動性鼻炎は症状ではアレルギー性 鼻炎と同様であるが,抗原検索を行っても陰性であるの が特徴である。鼻粘膜の色調で,アレルギー性鼻炎の発 作時は蒼白であるとされ,血管運動性鼻炎の発作時は発 赤と蒼白がまだらになるのが特徴とされる。しかし, 鼻内所見は診察する医師の主観に左右されることが多く 確定診断の決め手にはなりにくい。 軟性内視鏡の発達および Narrow Band Imaging(以後 NBI)等の画像システムの発達により一定の鼻内所見が とれるようになってきた。今回アレルギー性鼻炎症例と 血管運動性鼻炎症例の鼻内所見を白色光および NBIで Examination of intranasal surface structures was performed with narrow band imaging(NBI)using white light in patients with allergic rhinitis and patients with vasomotor rhinitis. At the surface of the nasal mucosa, rather deep capillaries were visualized with a reticulate pattern. It is difficult to differentiate NBI findings in the nasal mucosa during an attack―free phase in allergic rhinitis and those in non―allergic rhinitis. During an allergy attack of the nasal obstruction type, rather deep capillaries in the inferior turbinate are visualized as being partially dilated, along with interstitial edema. The rather deep capillaries in the inferior turbinate are sparsely visualized during an allergy attack of the rhinorreheal type. The rather deep capillaries are seen mottled during an attack―free phase in vasomotor rhinitis, during which, the NBI demonstrates contracted capillary nets and dilated cavernous sinus blood vessels. The axon reflex is likely to be exaggerated during an attack of vasomotor rhinitis. Intranasal examination with NBI is of value for differentiation between allergic rhinitis and vasomotor rhinitis during an attack