肝臓疾患とアンモニア代謝, 特にその障害因子の検討

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  • Studies on the ammonia metabolism in liver disease
  • カンゾウ シッカン ト アンモニア タイシャ , トクニ ソノ ショウガイ インシ ノ ケントウ

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(I) The blood ammonia level by Seligson-Bessman's methods and ketoacids level bySimizu's method were studied in patients with cirrhosis, following oral administration of NH4Cl, without and with arginine pretreatment.<BR>i) Without arginine pretreatment:<BR>Peripheral blood ammonia level rose in 22 of 28 cirrhotic patients following NH4Cl ingestion. Elevations of the blood ammonia nearly paralleled the severity of liver function tests (esp. BSP value: γ=+0.696 and serum albumin concentration: γ=-0.511). Blood ammonia level rose higher in patients with vascular spiders than in patients without them. In one patient, the elevation of blood ammonia level was much higher after Eck's operation than that before the operation.<BR>In 6 of 17 cirrhotic patients, blood a-ketoglutarate level rose after NH4Cl administration. Its elevation was correlated with that of blood ammonia level.<BR>In 3 of 17 cirrhotic patients, blood pyruvate level was elevated after NH4Cl administration.<BR>One patient became lethargic after the administration, in whom the elevation of blood ammonia, a-ketoglutarate and pyruvate was the highest of them.<BR>ii) With arginine pretreatment:<BR>The elevations of blood ammonia and a-ketoglutarate level were prevented in 5 of 11 and in 2 of 4 patients respectively.<BR>(II) To obtain semi-quantitative data regarding the effect of portal-systemic shunt on blood ammonia level, extracorporeal portal-systemic (jugular) shunt was constructed in dogs. Blood flow bypassing liver by electromagnetic flowmeter or direct measurement using messcylinder and arterial, pheripheral venous, hepatic and portal blood ammonia lovel were simultaneously estimated.<BR>Arterial blood ammonia level in the “complete shunt” dogs, of which portal blood totally bypassed the liver, was higher than that in the “one half shunt” dogs, of which about one half portal blood bypassed the liver.<BR>The difference in arterial blood ammonia level between the two groups was considered to be due to the ammonia quantity bypassing the liver.

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