脳アンモニア代謝の臨床的研究
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概要
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Recently, as the genesis of hepatic coma, the blood ammonia concentration and its “up-take” in the brain, have been subjects of considerable debate. Using the Conway's microdiffusion method, the arterial blood ammonia concentrations (ANH3), the cerebral venous blood ammonia concentrations (CVNH3), and the cerebral arterio-venous blood ammonia differences (CA-VNH3) were measured respectively in 15 normal subjects, 34 cases of liver diseases, 36 cases of psychoneurological disorders, 15 cases of hypertension, 4 cases of diabetes mellitus, and 3 cases of Graves' disease. Additionally, the cerebral hemodynamics were studied in 15 patients with liver disease. 1) In the normal subjects, ANH3 was 0.20±0.28μg/cc, and CA-VNH3 was -0.01±0.09μg/cc. No significant difference between ANH3 and CVNH3 was recognized. 2) In 6 patients suffering from liver tumor, ANH3 was significantly increased, and in 10 patients with liver cirrhosis, increase of ANH3 and CA-VNH3 were significant. In 15 patients with hepatitis and 2 patients in congested liver, increase of ANH3 and CA-VNH3 were not distinct. 3) In 8 liver cirrhosis, decreased CBF, increased MABP, elevated CVR, and depressed CMRO2 were observed. In 2 cases of hepatic precoma, CBF was slightly decreased, while CVR and CMRO2 were slightly increased. In 2 patients with hepatic coma remarkable decrease of CBF, elevation of CVR and exceeding depression of CMRO2 were observed. There was a significant negative correlation between ANH3 and CMRO2. 4) In 3 cases of hypnotic coma and 15 of shizophrenics, no change in blood ammonia concentration were observed. But in 2 cases of 3 apoplectic coma, ANH3 and CA-VNH3 were elevated. 5) In the patients with insulin coma, blood ammonia level was not significantly changed. After the electric shock therapy was given, ANH3 and CA-VNH3 were significantly increased. At the same time, remarkable metabolic acidosis was observed. 6) In liver disease and after electric shock therapy was given, a significant correlation between ANH3 and CA-VNH3 was noted. The above mentioned facts lead to the conclusion that, in the hyperammoniemia and to be sure in the liver disease, “up-take” of the ammonia in the brain might usually observed.
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