Albumin Metabolism in Hypoproteinemia
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概要
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With an attempt to clarifying the mechanism of hypoproteinemic complication in protein- losing gastroenteropathy, the phenomenon of plasma protein exsudation into the alimemtary tract was investigated by the dynamic analysis of albumin metabolism using 131I-labelled albumin (RISA) and the 131I-labelled polyvinyl pyrrolidone (131I-PVP) test on 29 patients with hypoproteinemia due to various causes (protein-losing gastroenteropathy, congestive heart failure, liver cirrhosis, anorexia nervosa, miscellaneous group)In 8 cases of protein-losing gastroenteropathy, the total exchangeable albumin (TEA) was 152.5±32.6gm or 3.78±0.62gm/kg on the average, markedly lower than the control (260.0±52.3gm or 5.17±0.85gm/kg). Especially, the circulating albumin pool (CAP) was 50.0±15.0gm or 1.31±0.32gm/kg on the average, showing a greater tendency to decrease in comparison with the control (103.8±20.3gm or 2.09±0.28gm/kg).The half-life of albumin in blood (T1/2) was markedly shortened to 4.3±1.6 days on the average in all the cases examined as compared with the control (13.4±3.0 days). The albumin turn over rate was significantly increased to 17.00±5.40%/day on the average as compared with the control, 5.38±1.17%/day.In the metabolically homeostatic condition, the amount dissolved is equal to the amount synthesized. The albumin synthesized in this disease amounted to 0.669gm/kg per day on the average, being greatly increased as compared with the control (0.274gm/kg per day). In short, no disturbance of albumin synthesis was demonstrated in this disease.Consequently, it was suggested that complication of hypoproteinemia in this disease might be caused by a failure in establishment of the metabolic equilibrium probably due to the theoritical amount remarkably surpassing the synthesizing ability of the liver or due to the disturbed dissolution and reabsorption of the exsudated protein.The 131I-PVP test was 1.44% to 13.96% (less than 0.74% in the control), demonstrating the exsudation of plasma protein into the alimentary tract in all the cases.In congestive heart failure, liver cirrhosis and miscellaneous groups, none of the cases was positive in the 131I-PVP test. These disease groups showed a decrease in TEA and CAP, prolongation of T1/2, and a decline in the albumin turnover rate. The amount of albumin dissolved (=synthesized) was observed to decrease. The complication of hypoproteinemia in these disease groups was proved to have arisen from a disturbance of albumin synthesis through a mechanism quite different from that of protein-losing gastroenteropathy.In respect to the mechanism for exsudation of plasma protein into the alimentary tract, it was supposed that the mechanism might be evidently different between the cases where the primary changes were present in the alimentary tract and the cases of congestive heart failure. In the comparative study of constrictive pericarditis and congestive heart failure, it was difficult to attribute this phenomenon only to the extent or duration of venous pressure elevation, but it seemed reasonable to consider that the mechanism might be additionally participated by a stagnant lymph stream or by regeneration of a collateral against obstruction.
- 財団法人 日本消化器病学会の論文