Wesdorp R I, Wang C A, Hirsch H, Fischer J E
Am J Surg. 1976 Jan;131(1):60-3. doi: 10.1016/0002-9610(76)90421-9.
Hyperparathyroidism has been associated with an increased incidence of duodenal ulcer, increased acid secretion, and increased plasma gastrin levels. A relationship between these changes, increased serum calcium levels, and the increased incidence of peptic ulceration has been suggested, especially since increased plasma gastrin levels, serum calcium levels, and gastric acid secretion decrease after parathyroidectomy. We have previously suggested that the decrease in plasma gastrin levels after parathyroidectomy may suggest an extragastric source of gastrin, whereas others using immunofluorescent studies have suggested that the parathyroid adenomas themselves might be the source of this gastrin. We prospectively studied in fifteen patients with primary hyperparathyroidism, plasma gastrin and serum calcium levels before and after parathyroidectomy, as well as the gastrin content of parathyroid tumor tissue. The mean basal plasma gastrin level before operation was significantly greater than that of a control group and decreased insignificantly after operation, in contrast to serum calcium levels. No positive correlation could be found between plasma gastrin and serum calcium levels before and after operation. Parathyroid tumor tissue was assayed for gastrin content by radioimmunoassay and no detectable amounts of gastrin could be recovered from any tumor. The results do not support the concept that the extragastric source of gastrin in patients with hyperparathyroidism is the parathyroid adenoma itself.
甲状旁腺功能亢进与十二指肠溃疡发病率增加、胃酸分泌增多以及血浆胃泌素水平升高有关。有人提出这些变化、血清钙水平升高与消化性溃疡发病率增加之间存在关联，尤其是甲状旁腺切除术后血浆胃泌素水平、血清钙水平和胃酸分泌均降低。我们之前曾提出甲状旁腺切除术后血浆胃泌素水平降低可能提示胃外存在胃泌素来源，而其他采用免疫荧光研究的人则认为甲状旁腺腺瘤本身可能是这种胃泌素的来源。我们对15例原发性甲状旁腺功能亢进患者进行了前瞻性研究，检测了甲状旁腺切除术前、后的血浆胃泌素和血清钙水平，以及甲状旁腺肿瘤组织中的胃泌素含量。与血清钙水平不同，术前基础血浆胃泌素水平显著高于对照组，术后虽有下降但不显著。术前、后血浆胃泌素水平与血清钙水平之间均未发现正相关。采用放射免疫分析法检测甲状旁腺肿瘤组织中的胃泌素含量，未从任何肿瘤中检测到可回收的胃泌素。这些结果不支持甲状旁腺功能亢进患者胃外胃泌素来源是甲状旁腺腺瘤本身这一观点。
