肝疾患における胆汁酸検査の新しい視点 ： グルカゴン負荷の意義

Abstract

Temporal changes in serum total bile acid (TBA) level after glucagon loading were investigated in patients with liver diseases. According to the fluctuation pattern, these changes were divided into four types : with early drastic drop followed by low maintaining levels (Type Ⅰ), initial decrease followed by late increase often over preload levels (Type Ⅱ), initial increase followed by late decrease (Type Ⅲ) and no remarkable changes (Type Ⅳ). Patients at the florid stage of acute hepatitis showed Types Ⅲ and Ⅳ. Patients at the convalscent stage of acute hepatitis and patients with compensated liver cirrhosis showed Types Ⅰ and Ⅱ. Types Ⅰ, Ⅱ, Ⅲ and Ⅳ were observed in patients with decompensated liver cirrhosis. Patients with extrahepatic obstructive jaundice showed Type Ⅳ. Temporal changes in cholic acid (CA) and chenodeoxy cholic acid (CDCA) levels were similar to those of TBA. Decrease of CA/CDCA ratio and increase of G/T ratio were found in patients with Type Ⅰ. In patients with liver cirrhosis, percental changes in serum TBA level 15 minutes after an administration of glucagon (%G・TBA 15 min.) were significantly correlated with hepaplastin test, prothrombin time, ICG Rmax and cyclic AMP (cAMP) level 15 minutes after glucagon administration. Glucagon induced changes in serum TBA in patients with liver cirrhosis were reproduced by DBcAMP infusion. These observations indicate that these changes are mediated by a cAMP-dependent process. It is suggested that determination of serum TBA after glucagon loading is useful to estimate the severity of liver cirrhosis and evaluate the specific liver functions concerned.