ステロイド糖尿病に関する臨床的研究 第1編 臨床的観察

Of 180 cases with acute and chronic hepatitis and liver cirrhosis treated with glucocorticoids, 33 cases of steroid diabetets were selected for this study. Atmpts were done on the relation of a mode of occurrence and the clinical feature of steroid diabetes to pathologic changes of the liver. The results were as follows: 1) Steroid diabetes was found in seven cases of 39 acute hepatitis (17.9%), nine of 65 chronic hepatitis (13.0%) and 17 of 72 liver cirrhosis. 2) The incidence of steroid diabetes was slightly high in the obese cases and patients with serum hepatitis, and significantly high in patients with diabetic desposition. 3) There was no significant difference among Prednisolone, Dexamethasone and Paramethasone in the incidence of steroid diabetes. Although the cases treated with both Norandrostenolone phenylpropionate and Androstanolone showed no differece from those with glucocorticoid alone, the cases treated with the combination of Oxymetholone showed extremely high incidence of steroid diabetes. (eight of 17 cases; 47.1%) 4) Steroid diabetes could be classified into two types; early developed and lately developed type, according to the time of developmnt and the clinical feature The former showed clinical findings of diabetes. On the contrally, no diabetic findings were shown in the latter. 5) In liver cirrhosis, more early developed types of steroid diabetes were found and in acute and chronic hepatitis, no difference was seen in the incidence of the two types. 6) In the early developed type, a considerable number of cases showed heredity of diabetes, obesity, fatty degeneation of the liver cells and vacuole degeneration of nuclei at a punch biopsy, and abnormal glucose tolerance test (not diabetic) before the treatment of glucocorticoids. On the other hand, the lately developed type did not show those above mentioned. 7) Diabetic desposition or latent diabetes and abnormal glucose metabolism caused by a original disease were found in many of the early developed type, and few in the lately developed type. It is presumed that these differences played a important role in the time of the development and the clinical feature of steroid diabetes. 8) The incidence and the clinical feature of steroid diabetes, and the time of onset and disappearance of glycosuria were not always closely related to the degree of the disturbance of liverfunctions. However, they were closely related to the fatty degeneration of the liver cells and vacuole degeneration of the nuclei. 9) In many cases of steroid diabetes, the fatty degeneration of the liver cells and vacuole degeneration of the nuclei appeared or progressed after the glucocorticoids treatment. However, no tendency was seen in distribution of fat in acini of the liver.