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Nicotinic acid (NA) loading test was evaluated among patients with various liver diseases. Serum total bilirubin (TB) and indirect bilirubin (IDB) reached a peak 90min after an intravenous injection of 50 mg NA and they gradually declined among healthy subjects (HS). The patterns of elevations of serum TB and IBD were generally similar to those observed among patients with acute hepatitis or chronic hepatitis. However, among patients with liver cirrhosis (LC), elevations of serum TB and IDB were sustained up to 120 min after NA administration. Maximum increments of TB and IDB (IDBmax) were significantly larger among patients with LC as compared to those observed among patients with HS or CH. Among 7 patients with Gilbert's syndrome and 3 patients with posthepatitic hyperbilirubinemia, elevations of serum TB or IDB were sustained and IDBmax was significantly augmented as compared to those observed among HS. The patterns of elevations of serum TB and IDB, and IDBmax among 2 patients with Dubin-Johnson syndrome were similar to those in HS. IDBmax among patients with LC was significantly larger in those with splenomegaly as compared to those without it. Further, there existed a positive correlation between IDBmax and the size of the spleen calculated on scintigram. In a patient with idiopathic portal hypertension (IPH) and 2 patients with congenital spherocytosis, elevations of serum TB and IDB after the administration of NA significantly reduced after splenectomy. However, NA-induced elevations of serum TB and IDB among patients with spherocytosis persisted after splenectomy. In contrast elevations of serum TB and IDB after NA were not observed among 3 patients who had splenectomy because of abdominal trauma or gastric cancer. NA provocation test was performed in 3 patients with CS and 4 cases of IPH during splenectomy. IDB concentration was the highest in blood obtained by splenic puncture, followed by splenic vein and artery, respectively. Serum haptoglobin levels did not decrease among subjects who received the measurement. It was also ascertained that the existence of the expected concentration of NA in blood did not induce hemolysis in vitro. Results suggest that hyperbilirubinemia after NA loading shows different curves in various liver diseases. In addition, results indicate that the spleen plays important roles in hyperbilirubinernia after NA administration.

Nicotinic acid loading test. Its significance in diagnosis of liver diseases and mechanism of hyperbilirubinemia.