Siddheshwar R K, Gray J C, Kelly S B
Department of Surgery, Regional School of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK.
Gut. 2001 Jan;48(1):47-52. doi: 10.1136/gut.48.1.47.
The relationship between plasma gastrin levels and colorectal cancer is controversial. When confounding factors which increase plasma gastrin levels are taken into account, it has been shown that gastrin levels are not elevated in patients with colorectal cancer. However, these studies only measured amidated gastrin. Total gastrin (which includes unprocessed, partially processed, and mature forms of gastrin) has been shown to be elevated in patients with colorectal cancer.
The aim of this study was to determine whether fasting plasma levels of progastrin, amidated gastrin, or glycine extended gastrin are elevated in patients with colorectal cancer or colorectal polyps compared with controls.
Progastrin, amidated gastrin, and glycine extended gastrin were estimated by radioimmunoassay using the following antibodies: L289, 109-21, and L2. Blood samples were analysed for Helicobacter pylori by an enzyme linked immunosorbent assay.
Median progastrin levels were significantly higher in the cancer group (27.5 pmol/l) than in the polyp (< or =15 pmol/l) or control (< or =15 pmol/l) group (p=0.0001 There was no difference in median levels of amidated gastrin between groups. Median levels of amidated gastrin were significantly higher in H pylori positive patients (19 pmol/l) than in H pylori negative patients (8 pmol/l) (p=0.0022). Median plasma progastrin levels were significantly higher for moderately dysplastic polyps (38 pmol/l) compared with mildly dysplastic (15 pmol/l) and severely dysplastic (15 pmol/l) polyps (p=0.05).
Plasma levels of progastrin, but not amidated gastrin or glycine extended gastrin, are significantly elevated in patients with colorectal cancer compared with those with colorectal polyps or controls, irrespective of their H pylori status. We conclude that measuring plasma progastrin levels in patients with colorectal cancer is warranted.
血浆胃泌素水平与结直肠癌之间的关系存在争议。当考虑到会增加血浆胃泌素水平的混杂因素时，已表明结直肠癌患者的胃泌素水平并未升高。然而，这些研究仅测量了酰胺化胃泌素。总胃泌素（包括未加工、部分加工和成熟形式的胃泌素）已被证明在结直肠癌患者中升高。
本研究的目的是确定与对照组相比，结直肠癌或结肠息肉患者的空腹血浆前胃泌素、酰胺化胃泌素或甘氨酸延伸胃泌素水平是否升高。
使用以下抗体通过放射免疫测定法估算前胃泌素、酰胺化胃泌素和甘氨酸延伸胃泌素：L289、109 - 21和L2。通过酶联免疫吸附测定法分析血样中的幽门螺杆菌。
癌症组的前胃泌素中位数水平（27.5 pmol/l）显著高于息肉组（≤15 pmol/l）或对照组（≤15 pmol/l）（p = 0.0001）。各组之间酰胺化胃泌素的中位数水平没有差异。幽门螺杆菌阳性患者的酰胺化胃泌素中位数水平（19 pmol/l）显著高于幽门螺杆菌阴性患者（8 pmol/l）（p = 0.0022）。与轻度发育异常（15 pmol/l）和重度发育异常（15 pmol/l）的息肉相比，中度发育异常息肉（38 pmol/l）的血浆前胃泌素中位数水平显著更高（p = 0.05）。
与结肠息肉患者或对照组相比，结直肠癌患者的血浆前胃泌素水平显著升高，而酰胺化胃泌素或甘氨酸延伸胃泌素水平则不然，无论其幽门螺杆菌状态如何。我们得出结论，对结直肠癌患者测量血浆前胃泌素水平是有必要的。
