関西医科大学雑誌
Online ISSN : 2185-3851
Print ISSN : 0022-8400
ISSN-L : 0022-8400
51 巻 , 2-4 号
選択された号の論文の6件中1~6を表示しています
  • 田中 浩三, 西川 光重
    1999 年 51 巻 2-4 号 p. 125-131
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    血液透析によるhemoglobin Al(HbAl)代謝への影響を明らかにする為に,透析前後の赤血球をインキュベ-トし,HbAzとその分画を測定した.また,グリコシレーションやカルバミレーションと,腎性貧血の要因としての溶血との関連を検討する為にr全血をin vitroでブドウ糖あるいは尿素を負荷してインキュベートした.更に,低張食塩水で培養血球を部分溶血し,HbAlを比較測定した.対象は慢性腎不全透析例と健常人で,HbAlはモニターGカラムを用いたミクロカラム法で測定した.ブドウ糖含有あるいは非含有透析液による,4-5時間の重曹透析によって透析前後のHbAiおよびその分画は変化しなかったが,透析前と透析後の赤血球をそのまま培養すると,前血液でより高値となった.HbAiおよびその分画は,赤血球を透析前血漿で培養した方が透析後血漿で培養した場合より大であった.ブドウ糖濃度200mg/dl含有透析液による透析では,透析中のグリコシレーションがおこり得ると考えられた.Invitroのブドウ糖あるいは尿素負荷で,幼若赤血球は,HbAIおよびその分画がより強く上昇した。以上により,透析はHbA1代謝に影響を与えており,透析液至適ブドウ糖濃度に関しての長期観察が必要と考えられた.また,幼若赤血球はグリコシレーションやカルバミレーションを受けやすく,十分な透析をすることがこれらの変化を抑制するのに必要と考えられた。
  • 田中 浩三, 西川 光重
    1999 年 51 巻 2-4 号 p. 132-140
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    腎不全が進むにつれて尿素窒素(BUN)は上昇し,腎性貧血があらわれてくる.ヘモグロビン(Hb)と尿素由来のシアン酸塩との縮合産物であるカルバミレートヘモグロビンは,BUNが上昇するにつれて増加する.本研究では,まずHbA1と腎機能あるいは腎性貧血との関係を検討した.慢性血液透析患者は,透析により尿素除去だけでなく透析液ブドウ糖濃度によりブドウ糖負荷ないしは喪失があり,HbA1は影響を受けることが考えられる.そこで,次にHbA1と透析の影響について検討したHbA1はモニターGカラムを用いたミクロカラム法で測定した.その結果,非糖尿病性慢性腎不全患者のHb1A+bはBUNやクレアチニンと相関した.Hb1a+b/HbA1はBUNと正相関した.このことは,ヘモグロビンカルバミレーションが,腎不全におけるHbA1増加の重要な役割を持つことを示した.又,腎不全の進行につれてHbの低下とHbA1a+bは逆相関し,腎性貧血の要因にカルバミレーションによる溶血の増悪が関与していることを示唆した.非糖尿病性腎不全透析患者において,5~6時間の酢酸透析でHbA1a+bは減少した.透析患者では透析前BUNの変動よりHbA1a+bの変動は小さく,このことより,HbA1a+bは,適性透析の指標として有効であると思われた.
  • Toshiko Nagata, Yukihisa Umeda, Masaya Urakami, Mitsuo Inada
    1999 年 51 巻 2-4 号 p. 141-149
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    The aim of this study was to assess the role of urin ary dipeptidyl aminopeptidase N (DAP IV) in early diabetic nephropathy and impaired glucose tolerance (IGT). We compared urinary DAP N activity, N-acetyl-b-D-glucosaminidase (NAG) activity, and albumin levels between healthy subjects, non-insulin-dependent diabetic (NIDDM) subjects that did not show clinical proteinuria, and IGT subjects. In healthy subjects, a significant difference in the excretion of urinary DAP IV occurred with age. Therefore, we focused mainly on the results of the forties of each group. Urinary DAP IV activity in NIDDM subjects, and IGT subjects was significantly higher than that in controls (1 1.8 ± 5.3,7.2 ±1.4,5.7 ± 0.8 U/g creatinine (Cr), respectively, p <0.0 0 1). No statistically significant difference in urinary NAG activity was observed compared with controls (NIDDM; 4.5 ± 2.7, IGT; 3.7 ± 1.7, control; 2.9 ± 1.2 U/g Cr). A significant correlation was observed between urinary DAP N and urinary NAG in NIDDM and IGT groups. In both groups, some subjects showed elevated DAP N activity despite normal NAG activity, while no subjects showed both normal DAP IV activity and higher NAG activity. Urinary albumin levels in NIDDM subjects also were higher than those in controls (p < 0.0 1), but this difference was less pronounced than that for DAP IV activity (p < 0.0 0 1). We conclude that measurement of urinary DAP N activity is a useful tool for detecting early diabetic nephropathy.
  • Toshiko Tokoro, Norio Yoshikawa, Akira Shouzu, Mitsushige Nishikawa
    1999 年 51 巻 2-4 号 p. 150-158
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    To clarify the pathophysiology of the uremia-related immunodeficiency, we measured the lymphocytes subsets and their activation in autologous mixed lymphocyte reaction (AMLR), and evaluated the effect of recombinant erythropoietin (Epo) treatment in patients with chronic renal failure on hemodialysis (HD). We also engrafted their peripheral blood mononuclear cells (PBMC) to severe combined immunodeficient (SCID) mice to investigate PBMC function independently of the uremic milieu. Patients with HD had normal percentages of CD3+, CD4+ and CD8+ lymphocytes populations, but CD19+ cells decreased in number. However, serum interleukin-6 (IL-6) concentrations and the percentage of helper Ti (Thl) subpopulation increased, and the activation of CD3+ and CD4+ cells to AMLR reduced. After the treatment of Epo, the reduced activation of CD3 + and CD4 + cells in the AMLR was normalized. In SCID mice to which human PBMC were engrafted, human immunoglobulin and IL-6 concentrations in serum were not different between those with PBMC from patients on HD and mice with PBMC from normal controls. These data suggest that (1) the number of B lymphocytes decreases and that of Thl cells increase in patients on HD, (2) their CD3+ and CD4 + cell activation in the AMLR is reduced and that (3) the immunological abnormality can be returned to normal in several weeks when anemia or the uremia-related milieu is improved.
  • Masaya Urakami, Yukihisa Umeda, Yoko Yamane
    1999 年 51 巻 2-4 号 p. 159-167
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    We examined the effects of smoking on plasma and platelet arginine vasopressin (AVP) levels, platelet aggregation with AVP, and AVP binding to platelets in normal subjects. Plasma and platelet AVP levels increased to the peak level at 5 to 10 min after the start of smoking, and decreased thereafter in parallel with plasma nicotine levels. A good correlation was found between plasma nicotine levels and plasma AVP levels, and also between plasma and platelet AVP levels. These results suggest that platelets rapidly take up endogenously released AVP from plathna. We also observed a decreased platelet aggregation with AVP ex vivo when the plasma and platelet AVP levels were elevated in vivo after somking. Binding experiments of washed platelets did not demonstrate any change in receptor number or affinity before and after smoking. These findings indicate that endogenously released AVP taken up by platelets desensitizes platelets to AVP without loss of AVP receptor number or modification of receptor affinity for AVP.
  • Masaya Urakami, Yukihisa Umeda, Yoko Yamane
    1999 年 51 巻 2-4 号 p. 168-174
    発行日: 1999/12/20
    公開日: 2013/02/19
    ジャーナル フリー
    We found 3 subjects whose platelets lacked an aggregation response to arginine vasopressin (AVP) out of 36 healthy subjects. These 3 subjects (Non-Responders; NR) were compared with 8 subjects whose platelets responded completely to AVP (Responders; R). All cases were young healthy men without bleeding disorders or tendencies. Platelet function was evaluated by aggregation response to AVP, adenosine diphosphate (ADP), collagen, and epinephrine. Resting and AVP-stimulated [Ca2+]i in platelets were also measured. We measured AVP levels in platelet free plasma (PFP) and in platelets, and characterized AVP receptor on platelets. There were no significant differences in platelet aggregation with ADP, collagen, and epinephrine between the 2 groups. Addition of AVP to platelets showed a rapid but transient increase in [Ca2+]i in both groups, but the peak level was extremely low in NR. The binding experiment demonstrated that maximal binding capacity (B max) of AVP receptor on platelets was significantly reduced in NR (B max; 213 ± 12 SEM sites/cell in N vs.30 ± 4 sites/cell in NR). PFP and platelet AVP levels did not differ between the 2 groups. These results indicate that the selective lack of platelet aggregation with AVP is caused probably by congenitally reduced B max of AVP receptor.
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