人の心筋代謝にかんする知見補遺焦性ブドウ酸およびα-ケトグルタール酸の態度について
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Coronary sinus catheterization was performed in 101 human subjects, including 23 normal subjects, 43 patients with cardiac failure, 5 patients with hypertension, 11 patients with coronary sclerosis, 8 patients with anemia, 10 patients with hyperthyroidism, and one case with beri-beri. In these subjects myocardial pyruvate and α-ketoglutarate metabolism were investig ted in the resting state. And the effects of exercise and hypoxia (10% Oxygen) were tested. The results thus obtained were as follows.1. Pyruvate and α-ketoglutarate was extracted in the healthy heart. In the healthy individuals, the mean arterial pyruvate concentration was 1.23±0.19mg per dl and the coronary arterio-venous pyruvate difference was 0.58±0.13mg per dl. And linear correlation between arterial pyruvate concentration (Pa) and coronary arterio-venous pyruvate difference (ΔP) was demonstrated, giving the following formulaΔP=0.75Pa-0.34 (1)As for α-ketoglutarate, it tended to increased coronary A-V difference with arterial level, although any definite correlation could not be obtained.2. In the moderate and severe cadiac failure, myocardial pyruvate extraction and extraction coefficient ratio were reduced, but myocardial α-ketoglutarate extraction was increased.3. In patients with hypertension and coronary sclerosis, myocardial pyruvate and α-ketoglutarate extraction did not differ from normal, but myocardial pyruvate extraction c efficient ratio was reduced.4. Myocardial pyruvate extraction and extraction coefficient ratio were reduced in patients with anemia and hyperthyroidism.5. In general, myocardial pyruvate metabolism in pathologic hearts was disturbed.6. By exercise test, both arterial pyruvate level and coronary arterio-venous difference increased according to the formula (1), whereas in pathologic hearts, this correlation was disturbed.7. Myocardial pyruvate and α-ketoglutarate extractions decreased by 10% oxygen hypoxia test.8. Metabolic disturbances due to exercise test and hypoxia test were more sensitive in pyruvate than in lactate.9. Finally, in one beri-beri heart, it was demonstrated the disturbances of pyruvate and α-ketoglutarate metabolism, which were improved by the intravenous injection of thiamine.
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