A Case of Diabetes Mellitus with Moderate Insulin Resistance, Macroamylasemia, Diffuse Interstitial Pneumonia, and Liver Cirrhosis

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  • びまん性問質性肺炎, 肝硬変症, マクロアミラセミア症を伴ったインスリン抵抗性糖尿病の1剖検例
  • ビマンセイ カンシツセイ ハイエン ハイ コウヘンショウ マクロアミラセミアシ

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A case of diabetes with moderate insulin resistance, marked hypergammaglobulinemia and macroamy. lasemia is reported here. A 45-years old male, who was a heavy alcoholic beverage drinker, was admitted with chief complaints of dyspnea and pain of lower extremities. Three years before admission, clinical symptoms of diabetes had appeared and he had been treated with oral hypoglycemic agents without much success. Physical examinations revealed crepitant rales in the lower lung fields, splenomegaly, clubbed fingers, vascular spider, palmar erythema, hyporeflexia and hypesthesia of the lower extremities. There was a moderate insulin resistance; a daily dose of 92 units (Conventional Lente, Ultralente, and Rapitard insulins) failed to control his blood sugar. By the use of Monocomponent Semilente insulin, however, diabetic control became better ; fasting blood sugar and urine sugar were decreased, and insulin dosage was also reduced. Serum total protein was 9.2 g/dl and marked polyclonal elevation of gamma globulins was detected with a marked increase in IgG. Serum amylase was always high, but urine amylase activity was subnormal. By gel filtration at pH 8.0 and 3.4, the serum amylase was found to be a macroamylase which dissociated at acid pH. Most of the amylase activity was associated with IgA, as revealed by affinity chromatography using anti-IgA coupled Sepharose. As much as 5.4 m-units insulin was extracted from 1 ml serum with acid ethanol, but extractable insulins decreased after Monocomponent Semilente insulin treatment. The insulin antibody was found to be IgG by use of the immunoprecipitation technic. Increases in serum gamma globulins, which were primarily caused by liver cirrhosis and diffuse interstitial pneumonia, might have been related to insulin resistance due to the presence of IgG-type insulin antibody, and with macroamylasemia due to a binding of the amylase to IgA.

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