種々の肝疾患時におけるAlzheimer ＩＩ型astrocyteの病理組織学的研究—ベストカルミン陽性核内封入体について

HISTOPATHOLOGICAL STUDIES ON ALZHEIMER CITA TYPE II IN VARIOUS LIVER DISEASES : A STUDY OF BEST'S CARMINE POSITIVE INTRANUCLEAR INCLUSION

Ⅰ．はじめに

　今日，種々の肝疾患時におけるastrocyteの変化としてAlzheimer　Ⅱ型異型glia （A—Ⅱ型glia）とともに，それらの核内のBest´s carmine （B-C）陽性物質の出現がよく知られている。一般肝疾患時におけるA—Ⅱ型gliaについては，Stadler^21），王丸^19），原田^4），Adams^1），渡辺^25），その他報告があるが，A—Ⅱ型glia核内封入体についてのまとまつた研究は比較的少なく，野村^15），小田^17）らのB-C染色による記載が見られるのみで未だ十分に検討され尽したとは言えない。著者は，種々の肝疾患の脳を検索し，A—Ⅱ型glia核内封入体の光学顕微鏡所見（H＆E染色，Nissl染色，B-C染色），電子顕微鏡所見，核内封入体とastrocyteの異型化（A—Ⅱ型glia化）との関連，肝病理所見および臨床事項との関連について統計的に対比検討を行なつたので報告する。

72 autopsy cases of liver disease except Wilson's disease were studied and 15 cases without liver disease were studied as a control.

Intranuclear inclusion of Alzheimer glia type II was recognizable with H & E and Nissl stains in 35 cases.

Most of these inclusions showed reddish to pink-ish color with Best's carmine (B-C) stain in 25 cases and 8 cases were unstained.

Raddish colored inclusions did not always disa-pear after saliva digestion or 1% α-amylase treating for 30 minutes to 24 hours.

On ultrastructural features of Alzheimer glia type II, the nuclear chromatin was clamped at thenuclear margine and distended nucleus contained the nuclear body, which were composed of the glycogen granules surrounded by microfilamentous capsule or the aggregate of glycogen granules without capsule.

B-C positive intranuclear inclusions were more frequent in the cases of liver disease, compared with control group.

There was a positive corelation between satdium of Alzheimer glia type II_ (Stadler) and frequency of B-C positive intranuclear inclusions.

In concern to frequency of B-C positive intranu-clear inclusions, no significant difference was statis-tically recognized among various liver diseases, and there was no relationship between the size of tumor and frequency of B-C positive intranuclear inclusions in hepatocellular carcinoma and metastatic tumor.

B-C positive intranuclear inclusions with both hepatocytes and astrocytes were found in 5 cases among the 52 cases (9.6%).

It was interested that 3 cases among the 5 cases were the special type of hepatocerebral disease.

There was a close relationship between B-C posi-tive intranuclear inclusions and consciousness dis-turbance. In the cases with prolonged or repeated consciousness disturbance, B-C positive inclusions were found more frequently than in the cases with acute and short term consciousness disturbance (p<0.01).

Concerning to frequency of B-C positive intra-nuclear inclusions, a significant difference was statistically seen between the cases with abnormally high level of serum ammonia and the cases with normal ammonia level.

There was no relationship between ICG or BSP and frequency of B-C positive inclusions.

There was no relationship between serum tran-saminase and frequency of B-C positive intranuclear inclusion, and between blood sugar and B-C positive inclusions, and BUN and B-C positive inclusions as well.