Alonso Falcón F, Codoceo Alquinta R, Polanco Allué I, Aguado Gil A, Fontán Casariego G
Department of Pediatrics, La Paz University Hospital, Madrid, Spain.
Rev Esp Enferm Dig. 1999 Jan;91(1):47-60.
Gastric abnormalities are a common feature in patients with primary antibody deficiency. The most important problem is the high incidence of stomach cancer found in these patients. Chronic atrophic gastritis with pernicious anemia is also a common finding that predisposes to gastric adenocarcinoma. The aim of the present study was to identify factors predictive of high risk for developing gastric cancer in patients with primary antibody deficiency.
We studied gastric hormones (gastrin, somatostatin and gastrin-releasing peptide, GRP) in 47 patients (23 children and 24 adults) with primary antibody deficiency. In accordance with the World Health Organization (WHO) classification, patients were diagnosed as having X-linked agammaglobulinemia (Bruton disease) in 13 cases, common variable immunodeficiency in 28, and hypogammaglobulinemia with hyperIgM in 6. Gastric biopsy was performed in 22 patients (16 children and 6 adults). Hormone determinations were carried out by radioimmunoassay.
Baseline serum gastrin levels were normal or increased compared with controls, but the response to stimulation with a hyperproteic diet was delayed in 18 patients and lower than in controls in 7. In 4 adult patients, all with pernicious anemia, gastric biopsy revealed chronic atrophic gastritis involving the stomach corpus and antrum (type B gastritis). The absence of a normal response of gastrin secretion to stimulation with a hyperproteic diet may be explained by this finding. Serum somatostatin and GRP levels were higher than in controls. No correlations were found between these findings and patient age, type of immunodeficiency or duration of clinical manifestations.
胃部异常是原发性抗体缺陷患者的常见特征。最重要的问题是这些患者中胃癌的高发病率。伴有恶性贫血的慢性萎缩性胃炎也是易患胃腺癌的常见表现。本研究的目的是确定原发性抗体缺陷患者发生胃癌高风险的预测因素。
我们研究了47例原发性抗体缺陷患者（23例儿童和24例成人）的胃激素（胃泌素、生长抑素和胃泌素释放肽，GRP）。根据世界卫生组织（WHO）分类，13例患者被诊断为X连锁无丙种球蛋白血症（布鲁顿病），28例为常见变异型免疫缺陷，6例为低丙种球蛋白血症伴高IgM血症。22例患者（16例儿童和6例成人）进行了胃活检。通过放射免疫测定法进行激素测定。
与对照组相比，基线血清胃泌素水平正常或升高，但18例患者对高蛋白饮食刺激的反应延迟，7例低于对照组。在4例成年患者中，均患有恶性贫血，胃活检显示慢性萎缩性胃炎累及胃体和胃窦（B型胃炎）。这一发现可能解释了胃泌素分泌对高蛋白饮食刺激缺乏正常反应的原因。血清生长抑素和GRP水平高于对照组。这些发现与患者年龄、免疫缺陷类型或临床表现持续时间之间未发现相关性。
