高血圧症(本態性・腎炎)を中心とした糖代謝の臨床的研究

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As an approach to the problem of the carbohydrate metabolism in essential hypertension, glomerulo-nephritis, arteriosclerosis, neurocirculatory asthenia and other diseases, the author studied the blood suger and related problems in these diseases.Method For the determination of the blood sugar Somogyi's method was used. With regard to the methodology two points appeared to have the crucial importance; one, sufficient caution must be paid to the temperature at which to preserve blood samples after they were withdrawn from the patient; two, a great care must be taken in the process of preparing and preserving the reagent to be used for deproteinizing the blood samples. In view of these existing imperfections of the method, the technique of the blood sugar determination may have to be re-studied and and refined in the future. A total of 230 patients were studied with the following two methods, (a) a load of glucose was injected intravenously in dose of 0.5 gram per kg body weight and in the form of a 20 % solution over a period of 40 minutes by the intravenous drip infusion, and (b) a load of glucose was administered orally in dose of 1.5 gram per kg body weight and in the form of a 50 % solution. After the administration of glucose the blood sugar was determined at different points of time over a period of 3 hours, and the observed patterns of blood sugar variations were examined for the possible correlation with various other clinical tests.Results With the oral administration, the blood sugar concentration returned to the initial level in a retarded manner in the majority of the patients as compared with the control subjects. However, there was a quicker return of the blood sugar concentration back to the initial level than in control subjects in certain cases of acute glomerulo-nephritis and neurocirculatory asthenia, and certain cases of hypertension. With the intravenous drip infusion, however, a greater proportion of the entire group showed normal responses than with the oral administration. Such difference like this, which exists between the oral test and intravenous test, must be something intrinsic to the method of glucose tolerance test itself, and suggests that the two tests must be interpreted differently. In evaluating the subject's ability to dispose of the glucose in a glucose tolerance test, the author depended on the angular coefficient of the ascending and descending limbs of the blood sugar curve. As the result of such a study the following characteristics of various diseases were revealed concerning the patients' glucose tolerance capacity : it was diminished in the essential hypertension both with the intravenous and with the oral test; it was diminished, but to a slighter extent, in the glomerulo-nephritis; it was diminished with the oral test but mostly normal with the intravenous test in the neurocirculatory asthenia.With regard to the relation between the arterial blood pressure and the blood sugar curve, there was an inverse correlation between the systolic blood pressure and the angular coefficient of the ascending limb of the blood sugar curve produced by the intravenous drip infusion. There was also an inverse correlation between the fasting blood sugar level and diastolic blood pressure.Discussion Clinical tests in various disease-groups revealed that functions were impaired in different degree in different diseases; functions relative to the liver, kidneys, endocrine, cardiovascular and autonomic nervous systems were impaired with the greatest severity in the arteriosclerosis, moderately in the essential hypertension, slightly in the glomerulo-nephritis and to the slightest extent, finally, in the neurocirculatory asthenia. It was in the same descending order of the severity that the patient's glucose tolerance capacity was impaired. In the next place, the author examined possible correlations between various clinical functional tests and the fasting blood sugar level or the angular coefficient of
社団法人日本循環器学会の論文
1960-11-20

高血圧症(本態性・腎炎)を中心とした糖代謝の臨床的研究

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