無痛性膵石症例の約7年8ヵ月の経過―とくにその糖代謝について

A Case of Painless Pancreatic Stones Followed up for about Seven Years and Eight Months: With special reference to glucose metabolism

症例

　患　者：47歳　男　蒔絵師

　主　訴：口渇，多尿および全身倦怠感

　家族歴：特記すべきものなし

　既往歴：20歳，左膝関節炎，37歳，右腎石のため腎摘出術を受けた．

　生活歴：日本酒2～3合/日，タバコ10本/日．

　現病歴：5年前より，便秘および下痢を繰り返していた．1970年6月末より，口渇，多尿，全身倦怠感および2週間に約5kgの体重減少を訴え，同年7月12日来院し，糖尿病を指摘され，同年8月11日入院した．

　A man aged 47, a heavy drinker of sake about 0.4 to 0.5 liter a day since the age of 20, had twice complained of symptoms due to diabetes mellitus during seven years and eight months since the end of June 1970. He was diagnosed to have the socalled“painless pancreatitis”. At the initial examination the red blood cell count was 372×10⁴. Five consecutive days, study of amylase was positive in 1/5 in the blood and 0/5 in the urine. Vagostigmine test negative ; Ellisworth Howard test normal. From the outset the PS test showed decreased excretion of the pancreatic juice and amylase. Concentration of maximal bicarbonate salt greatly decreased from 156 u to 39 u in the course of about seven years and six months. Plain X-ray film of the abdomen revealed a lot of small calculi in the site corresponding to the whole pancreas. Endoscopic retrograde pancreatography showed dilatation with tortuosity of the main pancreatic duct and its branches along with mural irregularity and rigidity. Stones were seen within the ducts. They did not change in size and shape during the course of follow-up.

　The oral GTT was as follows:

　　　　　　　　　　　　　fasting　60m.　120m.　180m.

July 24, 1970 100g O-GTT　　230　　470　　560　　570

　(mg/dl)

Dec. 26, 1972 100g O-GTT　　137　　290　　320　　285

　(mg/dl)

IRI (μU/ml)　　　　　　　 20.5　　24.5　29.5 　24.0

　The IRI level was always low in the 100 g O-GTT conducted five times during the follow-up. In tolbutamide test the time needed for reaching the lowest blood sugar level was delayed as compared with healthy individuals. In arginine test as well, the time for reaching the highest level of IRI was delayed. It was the same with IRG. Its level was lower than that of healthy persons. These results seem to suggest hypofunction of α and β cells of the pancreas. Since August 10, 1970, he was given one tablet of acetohexamide daily. After Oct. 8, 1972, when he stopped taking it of his own will, the fasting blood sugar level rose to 403 mg/dl. After he was again given two tablets of acetohexamide daily it was well controlled between 93 mg/dl to 180 mg/dl. On the contrary, IRI in fasting blood after Dec. 26, 1972, became lower from 20.5 μu/ml to 2.6 μu/ml. The insulinogenic index (the rate of fluctuation of IRI as against the amount of blood sugar level 30 minutes after 100 g O-GTT) became increasingly lower from 0.074 to 0.014. These results were suggestive of progressive impairment not only of the exocrine but also of endocrine functions of the pancreas.