耳下腺唾液無機成分に関する研究

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The present paper deals with a study performed by the author in which Ca, Na and K contained in the saliva secreted by both the normal and morbid parotids have been examined and compared with those contained in the serum, and the relationship between the levels of these substances and the types of sialograms of the parotids has been investigated. The average levels of these substances contained in the saliva secreted with stimulation of 75 normal parotids by 1/4 mol tartaric acid (25 parotids each of persons under 19 years of age, between 20 and 39 and over 40) were (in mg/dl); Ca, 5.11±0.18; Na, 47.09±5.45; and K, 78.78±2.53. The average levels in the serum were: Ca, 10.05±0.33; Na, 319.68±4.12; and K, 18.86±2.58. When the stimulus applied to the normal parotids varied in intensity and nature, there occurred fluctuations in the levels of these substances in the saliva. For example, Ca, Na and K levels were higher when 1/4 mol tartaric acid was used as a stimulant than when 1/8 mol tartaric acid was used; stimulation with hypodermic injections of pilocarpin resulted in the marked increase of Ca and the decrease of Na and K. The Ca levels were higher in the period from November to April than from May to October, while Na and K levels manifested no appreciable changes ascribable to the difference in seasons. This would indicate that the autonomic nervous system controls the secretion of the saliva by the parotid and the changes in its excitability give rise to fluctuations in Ca levels in the saliva. Ca levels fell with the advance of age; Na reached the highest level in persons over 40 and the lowest level in persons between 20 and 39; and K levels showed little fluctuation. Na levels fluctuated in direct proportion to the amount of the saliva secreted, but there was no relation between Ca and K levels on the one hand and the amount of saliva secretion on the other. While the ratio Na/K of the digestive fluids other than the saliva secreted by the parotid was similar to that of the serum, the ratio Na/K of the saliva was similar to that of the intracellular fluid. Examinations of the levels of these substances in persons showing no subjective morbid symptoms in the parotid, whose sialograms fall under types 1-5 as classified by Kitamura in 1956, revealed that, as compared with the levels found in type I which was taken as a standard, Ca levels were higher in types 3, 4 and 5; that Na levels were lower in types 2, 3, 4 and 5; and that K levels were higher in types 2, 3, 4 and 5. It seemed that the sialograms of types 3, 4 and 5 represented functional disturbances of the parotids. In cases of acute parotitis (12 glands) and the so-called sialoangiectasis (15 glands), the marked rise of Na levels and the fall of Ca and K levels, which were considered to be the characteristic sighs of inflammation, were noticed. This tendency was observed in cases of tumor of the parotid (12 glands) as well, furnishing grounds for assumption that more or less inflammatory changes may have occurred in the area of the gland which was free from the development of tumor. In 13 cases where a parotid gland of one side had been removed, the rise of Ca and K levels and the fall of Na levels in the saliva secreted by the residual gland were observed. It would seem that this does not represent compensatory hyperfunction of the residual gland which has been believed to develop in such cases. It was noteworthy that, in persons who had had a parotid of one side removed, or who had developed either sialoangiectasis or tumor of the parotid, there was marked rise in serum Ca levels, indicating deficient secretion of parotin, a hormone of the salivary glands. In cases where inner and middle ears of one side had been radically operated on (12 cases), no marked changes in the levels of these substances in the saliva were found. The levels of these substances in the saliva secreted by persons afflicted with xerostomia manifested specific changes: The marked rise of Ca and K levels and the fall of Na levels; the ratio Na/K was more similar to that of the intracellular fluid as compared with normal persons. Of all the cases of xerostomia examined, those with objective symptoms showed more marked tendency to this change than those without them, and the sialograms of the majority of the former fell under types 3 and 4, indicating the presence of functional disturbances in the parotid. Cases of atrophic rhinitis seemed to show a tendency to raised Ca and Na levels and lowered K levels. No marked changes were found, however, so far as the present investigations were concerned. (The numbers of cases referred to are those that have been examined by the author in one year.)
千葉大学の論文

耳下腺唾液無機成分に関する研究

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