胃切除者の代謝位相に関する研究

とくにグルコース負荷後の血糖, 血中インスリンならびにNEFA変動の異常とその機序について

抄録

Thirty patients with gastric ulcer and thirty-threegastrectomized patients were studied for the investigation of glucose metabolism in gastrectomized patients and for the elucidation of the mechanism of it's abnormality, or of its relation to diabetes mellitus.
They received 100 g oral glucose tolerance test, glucose tolerance test by puodenal tubing or intravenous glucose tolerance test. Blood sugar, serum IRI and NEFA were determined.
The following are the results of the present investigation:
1) The respnses of blood sugar after 100 g oral glucose loading in thirty patients with gastric ulcer were diabetic in fourteen cases, borderline hyperglycemic in thirteen cases and normoglycemic in only three cases.
2) The falling rate of blood sugar was significantly lower in the group with gastric ulcer than in the normal one. This finding suggests that the rate of utlization of glucose in the body is lower in the former group.
3) The response of blood sugar after glucose loading in gastrectomized patients was oxyhyperglycemic, and this tendency was more exaggerated in the patients more than three months than in those less than three months (after gastrectomy). There was no significant differerence in the response of blood sugar of the patients gastrectomized between by Billroth I and II methods, and in the patients elapsed many years after gastrectomy, no one showed prolonged hyperglycemic response of blood sugar.
4) The response of blood sugar in glucose tolerance test by duodenal tubing in the normal subjects showed more oxyhyperglycemic pattern than in oral glucose one, but the falling rate of blood sugar was not so rapid as in gastrectomized patients.
5) The change of serum IRI after glucose loading in gastrectomized patients was similar to that of blood sugar level. The level of serum IRI increased immediately after glucose loading and then decreased rapidly, and there was no significant difference in the response of serum IRI in the subjects operated between by Billroth I and II methods.
6) In gastrectomized patients, the response of serum insulin became higher in parallel with the development of the level of blood sugar among normal, oxyhyperglycemic and diabetic types. However, in diabetic subjects, the response of serum insulin became lower contrary to the increase of blood sugar.
7) The falling rate of NEFA after glucose loading ingastrectomized group was similar to that of normal one, but the value of NEFA in the former one began to increase already two hours after glucose loading.