胆汁酸負荷試験の臨床的意義に関する研究第I編 : 特に慢性非活動性肝炎患者に対する外因性胆汁酸経口負荷試験とその病態解析

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We evaluated normal and pathological bile acid responses to bile acid loads. We administered oral exogenous loads of 300mg ursodeoxycholid acid (UDCA) and 300mg chenodeoxycholic acid (CDCA), and endogenous loads of egg york and cerulein. Our subjects were normal or had chronic inactive hepatitis (CIH). A UDCA load in normal subjects produced 18.62 ± 2.47 μ mol / 1 total bile acid (TBA) and 12.09 ± 2.63μ mol / 1 free-UDCA at 60 min. A CDCA load produced TBA levels of 22.26 ± 3.83 μ mol / 1 and 19.56 ± 3.94 μ mol / 1 free-CDCA at 60 min. A UDCA load in CIH subjects produced 26.73 ± 6.76 μ mol / 1 TBA, 12.87 ± 3.37 μ mol / 1 free-UDCA, and 4.62 ± 1.54 μ mol / 1 glycochenodeoxycholic acid (GCDCA) at 60 min. A CDCA load produced 21.31 ± 3.82 μ mol / 1 TBA and 13.94 ± 3.48 μ mol /1 free-CDCA at 60 min. Three hours after the CDCA load, these CIH subjects had 16.62 ±4.01 μ mol/1 TBA, 5.35 ± 1.89 μ mol/1 GCDCA, and 2.32 ±O.95 μ mol/1 taurochenodeoxycholic acid (TCDCA). Egg york caused TBA to rise in normal subjects to 14.63 ± 2.27 μ mol/land GCD CA to 4.22 ± 1.03 μ mol/l at 60 min. Cerulein produced 11.78 ± 2.97 μ mol/ 1 TBA and little increase in free-CDCA or GCDCA at 60 min. CIH subjects contained 16.46 ± 2.21 μ mol / 1 of TBA 60 min after egg york, falling to 13.75 ± 3.18 μ mol/1 at 180 min. At 60 min they had 4.77 ±O.59 μ mol/1 GCDCA and at 180 min roughly as much. Cerulein at 60 min produced 22.9. ± 2.77 μ mol/1 TBA and 8.96 ± 1.23 μ mol/1 of GCDCA. TBA fell by 180 min. We conclude that CIH mainly damages CDCA metabolism in liver cells, and bile acid load is useful for a sensitive tool of pathological analysis in liver damage.
神戸大学の論文

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竹田文彦
神戸大学医学部内科学第二講座

胆汁酸負荷試験の臨床的意義に関する研究第I編 : 特に慢性非活動性肝炎患者に対する外因性胆汁酸経口負荷試験とその病態解析

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