Mongin M, Harle J R, Weiller P J
Groupe Hospitalier de la Timone Adultes, Marseille.
Bull Acad Natl Med. 1992 May;176(5):693-700.
Achlorhydria that is due to antrum sparing atrophic gastritis is a characteristic finding in pernicious anemia. As a consequence of this achlorhydria serum gastrin level rise. Usually several signs are required for assessing a pernicious anemia: megaloblastic anemia, low serum cobalamin level, positivity of a Schilling test, low level of intrinsic factor in the gastric juice, existence of anti-intrinsic factor antibodies in plasma and/or in gastric juice. In this study the usefulness of the serum gastrin level is assessed. We report here the results in investigating sixteen patients with a pernicious anemia. All had: megaloblastic changes on bone marrow examination, serum cobalamin level lower than 150 pg/ml. For 14 patients the performed Schilling test was positive. For 2, no Schilling test was done, but anti-intrinsic factor antibodies were elevated. Serum gastrin levels were higher than 250 pg/ml (254 to 1770 pg/ml). In our patients with pernicious anemia, as a result of hypo or achlorhydria, serum gastrin increase was higher than in any other cause of hypochlohydria: anti-acid treatment, vagotomy... Measurement of serum gastrin is easy. High levels are simple to explain if found together with a sparing antrum atrophic gastritis and/or a low level of serum cobalamin. Serum gastrin measurement may be a cornerstone to rapid and reliable diagnosis of pernicious anemia.
由胃窦保留性萎缩性胃炎引起的胃酸缺乏是恶性贫血的一个特征性表现。由于这种胃酸缺乏，血清胃泌素水平会升高。通常评估恶性贫血需要几个体征：巨幼细胞贫血、血清钴胺素水平低、施林试验阳性、胃液中内因子水平低、血浆和/或胃液中存在抗内因子抗体。在本研究中，评估了血清胃泌素水平的作用。我们在此报告对16例恶性贫血患者进行调查的结果。所有患者均有：骨髓检查显示巨幼细胞改变，血清钴胺素水平低于150 pg/ml。14例患者施林试验阳性。2例未进行施林试验，但抗内因子抗体升高。血清胃泌素水平高于250 pg/ml（254至1770 pg/ml）。在我们的恶性贫血患者中，由于胃酸过少或缺乏，血清胃泌素的升高高于任何其他胃酸过少的原因：抗酸治疗、迷走神经切断术……血清胃泌素测量很容易。如果与胃窦保留性萎缩性胃炎和/或低血清钴胺素水平同时发现，高水平很容易解释。血清胃泌素测量可能是快速可靠诊断恶性贫血的基石。
