Kaise M, Sumitomo H, Hashimoto K, Takahashi Y, Matsui J, Tanaka S, Kobayashi Y, Nishimura M
Department of Internal Medicine, Tachikawa Sougo Hospital, Tokyo, Japan.
Nihon Shokakibyo Gakkai Zasshi. 1992 Sep;89(9):1990-5.
Hypergastrinemia is a very important clinical condition for the reason that a growing body of evidence obtained from animal and human experiments has revealed gastric carcinoids induced by hypergastrinemia. We investigated 35 patients with Basedow's disease (BD) to elucidate the mechanism of hypergastrinemia associated with BD as well as the relationship between type A gastritis and BD. Fasting serum gastrin levels in BD (296.1 +/- 251.4 pg/ml; mean +/- S.D.) were significantly (p less than 0.001) higher than those in age-matched 27 healthy subjects (106.1 +/- 69.2), and in the BD group, significant positive correlation was detected between fasting serum gastrin levels and thyroid hormones (i.e. T3 and free T4). In the hyperchlorhydria group in BD with hypergastrinemia, the levels of fasting serum gastrin were normalized after euthyroidism was attained due to antithyroidal drugs. On the other hand, in the achlorhydria group in BD significant hypergastrinemia was persisted in spite of normalization of thyroid function. Twenty % of the BD patients had histologically proved type A gastritis with achlorhydria, and all patients with type A gastritis were older than 60 years old. Endoscopic examination revealed that one patient with type A gastritis had an early gastric cancer. However, no gastric carcinoids were demonstrated in this study. In conclusion, the results described as above suggested, 1) hypergastrinemia observed in patients with BD may be induced by gastrin hypersecretion due to hyperthyroidism as well as type A gastritis, 2) BD patients with type A gastritis were recommended to undertake regular endoscopic examination for detecting gastric cancers as well as gastric carcinoids.
高胃泌素血症是一种非常重要的临床病症，因为从动物和人体实验中获得的越来越多的证据表明高胃泌素血症可诱发胃类癌。我们调查了35例Graves病（BD）患者，以阐明与BD相关的高胃泌素血症的机制以及A型胃炎与BD之间的关系。BD患者的空腹血清胃泌素水平（296.1±251.4 pg/ml；平均值±标准差）显著高于（p<0.001）27名年龄匹配的健康受试者（106.1±69.2），并且在BD组中，空腹血清胃泌素水平与甲状腺激素（即T3和游离T4）之间存在显著正相关。在伴有高胃泌素血症的BD胃酸过多组中，由于使用抗甲状腺药物使甲状腺功能正常化后，空腹血清胃泌素水平恢复正常。另一方面，在BD胃酸缺乏组中，尽管甲状腺功能正常化，但仍持续存在显著的高胃泌素血症。20%的BD患者经组织学证实患有伴有胃酸缺乏的A型胃炎，所有A型胃炎患者年龄均超过60岁。内镜检查显示，1例A型胃炎患者患有早期胃癌。然而，本研究中未发现胃类癌。总之，上述结果表明，1）BD患者中观察到的高胃泌素血症可能是由于甲状腺功能亢进以及A型胃炎导致胃泌素分泌过多所致，2）建议患有A型胃炎的BD患者定期进行内镜检查，以检测胃癌和胃类癌。
