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Stomach and Intestine(Tokyo) Volume 9, Issue 11 （November 1974）

胃と腸 9巻11号（1974年11月発行）

Japanese English

今月の主題膵疾患の展望（1）―膵炎を中心に

主題

膵疾患の臨床生化学的検査 Clinical Chemistry for Pancreatic Diseases with Special Reference to Isoamylase 竹内正 ¹ , 神津忠彦 ¹ , 竹本忠良 ¹ , 竹内利行 ² , 杉村隆 ² T. Takeuchi ¹ , T. Kozu ¹ , T. Takemoto ¹ , T. Takeuchi ² , T. Sugimura ² ¹東京女子医科大学消化器内科 ²東京大学医科学研究所癌生物研究部 ¹Department of Internal Mediecine and Gastroenterology, Tokyo Women's Medical College ²Department of Molecular Oncology, Institute of Medical Science, University of Tokyo pp.1387-1393

発行日 1974年11月25日 Published Date 1974/11/25

DOI https://doi.org/10.11477/mf.1403112126

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Abstract 文献概要
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　膵は70～90gていどの小さな臓器であるにかかわらず，1日に約1,500ml，またはそれ以上の膵液を分泌している（Bodanskyら）．たんぱく量にすると，10～20gまたはそれ以上になると考えられ，大きなたんぱく合成能力をもっている，このたんぱくのほとんどが消化酵素である．

　Davenportの“Physiology of the Digestive Tract”によると，ネズミの膵組織は0.2gのたんぱく量であるが，1日に0.4gの膵酵素を合成し，分泌しているという．すなわち膵自体のもつたんぱくよりも多くのたんぱくを合成している．実験的にはラベルしたアミノ酸を注射すると，1分以内に膵外分泌細胞内のリボゾーム上にキモトリプシノーゲンとしてあらわれ，5分以内に膵酵素の前駆物質としてラベルされ，36分で分泌顆粒の中に酵素として存在し分泌状態となる．このことは臨床的には，⁷⁵Se-メチオニンによる膵のシンチグラフィーのときによく観察される．

　For clinico-biochemical examinations of pancreatic diseases we have described here particularly amylase assay by means of chromogenic method together with amylase isozyme that utilizes it. Approach to these disorders using isoamylase is not only an effective examination method for the analysis of hyperamylasemia but also of great interest seen from the aspect of pathophysiology.

　Blue starch-agar plate method makes it very easy to divide isoamylase into S-type (salivary type) and P-type (pancreatic type), and it can be shown quantitatively as well.

　Isoamylase pattern in the urine does not reflect that of the blood, and P-type is of higher level than in the blood. P-type isoamylase seems to have a structure that is easily filtered through the glomerulus of the kidney. In acute pancreatitis high amylase level returns to normal one within a relatively short time, while it is maintained for a longer period in the urine. Increase of P-type isoamylase, easily filtered through the renal glomerulus, probably accounts for this phenomenon.

　Serum amylase level in normal subjects does not show more than 30 percent increase in the level of post-pancreozymin-secretin test, but in the group in which pancreatitis is suspected it may show a higher figure.

　Investigation of the response of serum amylase seen from the aspect of amylase isozyme shows that rise in the amylase level after the test is due to the increase of P-type amylase. S-type amylase hardly shows any change in its level. From these facts we may assume that serum amylase response is due to release of a specific pancreatic amylase and this response should be regarded as a factor indicating some kind of pancreatic lesion.