肝疾患に於けるクエン酸代謝の研究 (原著)

抄録

Citrate metabolism was studied in control subjects and patients with liver diseases and nephritis, and following results were obtained.
1) The plasma citrate level in fasting state was 8.6-21.3 γ/cc (average 15.8) in 42 control subjects, 11.8-60.0 γ/cc on 62 determinations in 20 patients with hepatitis, (being parallel with icteric index), 15.2-41.8 γ/cc in 24 patients with liver cirrhosis, (being parallel with severity of cirrhosis), 7.2-20.1 γ/cc (average 13.6) in 6 patients with obstructive jaundice, and 9.521.5 γ/cc (average 15.2) in 11 patients with nephritis.
2) The amount of urinary citrate excreted in two hours at fasting state was 45.0 mg in control subjects and it was increased in patients with liver diseases, being parallel with its plasma level in most cases. After the intravenous administration of citrate, the amount of urinary citrate increased and its increment in two hours corresponded to 5.1-9.0% of administered citrate in control subjects, while it was greater in patients with liver diseases.
3) The citrate levels in blood plasma of peripheral artery, cubital vein, hepatic vein, and renal vein were compared and the concentration gradient was found to be as follows.
Cubital V.>Peripheral A.>Renal V.>Hepatic V.
4) According to the citrate tolerance test (intravenous administration of 20 mg per kg. as sodium citrate), plasma citrate level in control subjects returned to the previous level in one hour, but it was delayed in patients with hepatitis and liver cirrhosis, while in patients with obstructive jauttaide and nephritis the curve was similar to that of control subjects. When 10 mg of vitamine B1 was subcutaneously injected 30 minutes prior to citrate administration, citrate metabolism was accelerated in control subjects, but not in patients with liver diseases.
5) After the intravenous administration of citrate, α-ketoglutarate in blood was significantly elevated and its peak was at 15 minutes after administration in control subjects, but was at 30 minutes in patients with liver diseases.
6) It may be presumed that the citrate tolerance test is a reliable method for detecting the impairment of TCA cycle in liver.