@article{oai:niigata-u.repo.nii.ac.jp:00022947,
 author = {清水, 武昭 and 大村, 康夫 and 佐藤, 攻 and 吉田, 奎介 and 武藤, 輝一},
 issue = {4},
 journal = {新潟医学会雑誌, 新潟医学会雑誌},
 month = {Apr},
 note = {We made the formula of the serum bilirubin fall for patients with obstructive jaundice after the biliary decompression. Since 1975, we have used this formula (y=ae^<bx>), called bilirubin decreasing rate b, as the liver function test for patients with obstructive jaundice. The cause to make this natural bilirubin clearance worse was mainly cholangitis and/or cancer infiltration into the intrahepatic bile duct. The ductal cell degeneration occurred and made the bilirubin clearance worse by the cholangitis. Severe obstructive cholangitis sometimes developed into multi-organ failures(MOF). However, the ductal cell degeneration was not found and the good bilirubin clearance was maintained in some patients with severe obstructive cholangitis. Therefore, it seems plausible considered that there were 2 types of cholangitis; worse bilirubin clearance type (hepatic injury type) and good bilirubin clearance type (renal injury type). We studied 21 MOF patients caused by obstructive cholangitis to clarify the pathophysiology of these 2 types of cholangitis. The b value was calculated within 10 days after percutaneous transhepatic biliary drainage. These 21 patients were classified into 2 groups according to the bilirubin decreasing rate b. Group 1 (good bilirubin fall group) consisted of 14 patients, Group 2 (worse bilirubin fall group) 7 patients. Statistical difference between Group 1 and Group 2 were as follows: 1) Onset time (initial symptom to serum creatinine over 2 mg/dl) was 2.8+1.7 days in Group 1 and 18.5+5.1 days in Group 2. 2) Urine volume was 252+239ml in Group 1 and 1540+413ml in Group 2. 3) Serum creatinine was 9.6+2.4mg/dl in Group 1 and 3.6+0.9mg/dl in Group 2. 4) BUN/Cr was 13.2+3.0 in Group 1 and 22.8+6.4 in Group 2. 5) Platelet count was 9.4+8.4/10 in Group 1 and 12.0+14.6/10 in Group 2. 6) Lymphocytes were 917+499 in Group 1 and 1655+548 in Group 2. 7) GOT, GPT and LDH were not different from each other. [Summery] 1) Cholangitis of good bilirubin clearance group suffered from strong toxic agents in bile because of a statistical decrease in the number of platelets and lymphocytes, but this duration was very short. 2) Hepatic and renal injury states were contrary. Therefore, we consider that these 2 types of cholangitis differ fundamentally from each other.},
 pages = {249--254},
 title = {2) 細菌性ショックとその対策(シンポジウム 各科におけるショックとその対策, 第440回新潟医学会)},
 volume = {103},
 year = {1989}
}