血清ビリルビンの臨床的研究

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The author has performed investigations by means of Jendrassik's method on the quantitative relationship between the amounts of direct and indirect bilirubins as well as on the total bilirubin levels in 305 cases, including normal persons as well as both in and out-patients in Ishikawa's Clinic, since 1946. The research has been carried out with a view to contributing to the improvement in the method of diagnosis and prognosis in liver diseases. As a preliminaryto the clinical research on serum bilirubin levels, the author first conducted experiments on the changes in pH values brought about by various dilutions of the test solution and on the influence the temperature of the test solution had on the results of experiments; then the investigations were performed to demonstrate that the fractional determination of the direct and indirect bilirubins was possible and that various phases of Lepehne's direct reaction did not depend solely upon the amount of single bilirubin. The serum bilirubin level in normal adults was found at 0.4mg %.0 It was higher in normal persons who were within 6 months after conversion from tuberculin-negative to tuberculin-positive state than in those who were tuberculin-negative reactors. It has scarcely fluctuated for a long tine in congenital hemolytic jaundice except when pseudogallstones occurred. It was mainly the indirect bilirubin that was increased in amount in cardiac insufficiency liver cirrhosis. In primary liver cancer, the amount of indirect bilirubin was increased with resultant moderate symptoms of jaundice, while in metastatic liver cancer, the amount of direct bilirubin was increased. In the cases where disturbances of the, liver parenchyma were involved, the amounts of both direct and indirect bilirubins, mainly the former, were increased following the attack of the disease, but in convalescence the amount of direct bilirubin was greatly reduced at a certain time corresponding to the improvement in general conditions.In 25 cases of gallstones, manifest jaundice with an increase in the amount of direct bilirubin occurred in 11 cases (44 %). In those cases, the quotient of the amount of direct bilirubin divided by that of indirect bilirubin has rarely come down below 1.0 in spite of the fact that the total bilirubin has been reduced in amount. The, direct bilirubin was increased in amount and consequently the quotient of the amount of direct bilirubin divided by that of indirect bilirubin has never been lowered in malignant tumor occurring near the bile duct, but in some of these cases the amount of total bilirubin was reduced at the last stage of the disease. While in malaria and erythroleukemia the amounts of both total and indirect bilirubin were increased in spite of the anemic symptoms, ancylostomiasis was characterized by hypobilirubinemia. In 3 out of 5 cases of uremia, the amount of total bilirubin, especially that of direct bilirubin, was increased. There existed no difference in bilirubin levels between the exudative and absorption stages in tuberculous pleurisy. In pulmonary tuberculosis, slight increase was observed in minimal and moderately advanced cases, while hypobilirubinemia was observed in far advanced cases.
千葉大学の論文

血清ビリルビンの臨床的研究

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