肺結核患者における50gブドウ糖経口負荷試験時のインスリン動態に関する臨床的研究

抄録

Blood glucose and insulin response to 50g. oral glucose tolerance test (50g. OGTT) were observed in 75 patients with pulmonary tuberculosis consisting of 56 receiving initial treatment and 19 receiving the retreatment of antituberculous drugs. Same observations were performed in 34 normal subjects, 26 patients with diabetes and 39 diabetic patients with tuberculosis. In the groups of nondiabetic patients with tuberculosis, follow up studies of 50g. OGTT were carried out at six and twelve months after initial observations.
The results were as follows.
1) Response of blood glucose and insulin, and the values of insulinogenic index (ΔIRI/ΔBS at 30min. I. I.) showed essentially no significant difference between diabetic patients with and without pulmonary tuberculosis.
Their I. I. was significantly low and its values were less than 0.5.
On the other hand, the values of I. I. were normal range in the nondiabetic patients with tuberculosis.
2) In tuberculous patients without diabetes, the lowering of glucose tolerance at the time of admission was much greater in severe cases than in milder cases. Considerable number of these patients had a tendency to decrease glucose tolerance during hospitalization, and it was particularly marked in patients with older age, gain in body weight and having diabetic hereditability.
3) The response of insulin to 50g. OGTT in tuberculous patients as higher than normal subjects at the time of admission, and then lowered progressively but remained within normal range throughout the investigation period. Insulin response of the patients who gain more than 5kg. in weight during hospitalization, however, as significantly higher than normal subjects and the patients with constant body weight.
4) Decrease of glucose tolerance in nondiabetic patients with tuberculosis during hospitaliza tion and treatment of antituberculous drugs might be due to lack of exercise by bed rest and consequently gain in the body weight, and considered to be so-called secondary diabetes because they had no evidence of lowering insulin secretion. It should be noticed, however, that the patients with diabetic hereditability showed decreased glucose tolerance associated with low insulin response.
5) No significant effects of antituberculous drugs on glucose tolerance were observed in the present studies.