肝硬変症における膵病態に関する研究

第1編 肝硬変症の膵外分泌機能について

抄録

This study was undertaken to examine the exocrine pancreatic function in 54 patients with liver cirrhosis. The pancreatic function tests included were serial determinations of serum amylase, determination of volume, amylase output, maximal bicarbonate concentration of duodenal drainage following secretin, and ¹³¹I-triolein test. In 5 patients, the pancreas was examined histologically, and the exocrine pancreatic function and the morphological changes were compared.
1) Hyperamylasemia was in 35% of the patients with liver cirrhosis. No direct relationship could be found between the hyperamylasemia and the exocrine pancreatic dysfunction which was seen in these patients.
2) The abnormal result of the secretin test was found in 56% of the patients. Markedly increased duodenal volume was obserbed in 28% of them. The decreased maximal bicarbonate concentration was most frequently found in these patients. Low maximal bicarbonate concentrations were found in all of three cases associated with interstitial pancreatitis or marked pancreatic fibrosis. Therefore the low bicarbonate concentration in secretin test was considered to be a most reliable index of pancreatic dysfunction in cirrhosis.
3) The abnormal result of the secretin test was found more frequently in the cases with excessive iron and fat deposition in liver cell, decreased tolerance to glucose, and elevated serum iron than the cases without them. Steatorrhoe was present in 32% of the patients. This could be attributed to the portal hypertension rather than to the pancreatic dysfunction.