肝傷害時の糖代謝異常に関する研究

1. 血糖調節異常におよぼす肝性ならびに膵性因子の臨床的検討

抄録

In view of the central role of liver in the regulation of carbohydrate metabolism, deranged carbohydrate metabolism might be expected in both acute and chronic liver disease.
The present study was performed in order to investigate carbohydrate metabolism in 112 patients with a variety of liver diseases, including acute hepatitis 14, active chronic hepatitis 19, inactive chronic hepatitis 25, fatty liver 4, hepatoma 12 and cirrhosis 38. Blood glucose changes were studied following glucose or tolbutamide loading and after administration of glucagon. The followings were administered: glucose, 50gm. by mouth; tolbutamide, 50mg. per kilogram of body weight by mouth; and glucagon, 1mg. intravenously. Venous blood samples were withdrawn in the fasting state and at appropriate intervals following glucose, tolbutamide or glucagon administration.
Results are as follows:
1. Fasting blood glucose:
Values below 59mg. per 100ml were found in 12 per cent of 17 determinations in 14 patients with acute hepatitis, in 14 per cent of 35 determinations in 19 patients with active chronic hepatitis (p<0.05), in 12 per cent of 33 determinations in 25 patients with inactive chronic hepatitis, in 3 per cent of 80 determinations in 38 patients with cirrhosis and in 5 per cent of 109 determinations in 109 controls. None of patients with fatty liver and hepatoma showed the values below 59mg. per 100ml. Hyperglycemia above 120mg per 100ml. was not obtained in patients with liver disease except for cirrhotics, which showed hyperglycemia in 11 per cent of 80 determinations in 38 patients. (p<0.01)
2. Oral glucose tolerance:
Patients with liver disease were placed in one of three groups (i.e."mormal", "impaired"and"diabetic".) according to the result of the oral glucose tolerance test. The results were typically"diabetic"in 12 per cent of patients with acute hepatitis (p<0.05), in 7 per cent of patients with active chronic hepatitis (p<0.05), in 19 per cent of patients with inactive chronic hepatitis (p<0.01), in 39 per cent of patients with cirrhosis (p<0.01), in 43 per cent of patients with fatty liver (p<0.01), in 27 per cent of patients with hepatoma (p<0.01), and in 4 per cent of controls.
Hypoglycemia below 59mg. per 100ml. at 3 hours blood sugar level in glucose tolerance test was significantly increased in frequency in patients with acute hepatisis and active chronic hepatitis.
3. Hyperglycemic response to glucagon:
Glucagon was administered intravenously to 8 normal subjects, 49 patients with various liver diseases and 12 patients with diabetes mellitus. The decreased hyperglycemic response to glucagon was obtained in patients with acute hepatitis, active chronic hepatitis and cirrhosis of the liver. In contrast to the findings in the cirrhotic patients, the mean maximum hyperglycemic response to glucagon was significantly increased in patients with fatty liver. The hyperglycemic response in patients with diabetes mellitus without imparied liver function was similar to those of patients with fatty liver.
4. The maximum blood sugar decrease after the oral administration of tolbutamide was 56.8±9.0 per cent of fasting level in controls, 69.9±12.6 per cent of fasting level in cirrhotics with diabetic glucose tolerance(p<0.05), and 58.2±11.9 per cent of fasting level in cirrhotics without diabetic glucose tolerance.
5. Mechanism of impaired carbohydrate metabolism in liver disease was discussed.