Pisegna J R, Norton J A, Slimak G G, Metz D C, Maton P N, Gardner J D, Jensen R T
Digestive Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Gastroenterology. 1992 Mar;102(3):767-78. doi: 10.1016/0016-5085(92)90157-t.
The chronic hypergastrinemia in diseases such as the Zollinger-Ellison syndrome has trophic effects on the gastric mucosa, causing increased parietal cell mass reflected by increased maximal acid output (MAO) and basal acid output (BAO). The time course for the development of these gastric changes in humans is unknown, and controversy exists regarding whether reversal of the hypergastrinemia results in rapid normalization of gastric secretory function. To address these uncertainties, gastric secretory function was prospectively evaluated in 20 patients with the Zollinger-Ellison syndrome undergoing successful curative resection of gastrinoma. Each patient had gastric acid measurements, imaging studies, fasting serum gastrin and secretin provocative testing preoperatively, postoperatively at 3-6 months, and yearly thereafter. Preoperative mean BAO was 39 mEq/h, MAO 56 mEq/h, BAO-MAO ratio 0.73, and fasting gastrin output 1020 pg/mL. All patients were evaluated at 6 months, 17 at 1 year, 15 at 2 years, 13 at 3 years, and 9 at 4 years. By 3-6 months, MAO decreased by 50% in men (mean, 30 mEq/h) and by 35% in women (mean, 29 mEq/h) and then remained relatively unchanged for up to 4 years. Before surgery, 14 of 20 patients (70%) had an elevated MAO, whereas 4 years after resection, none of 9 patients had elevated levels. By 3-6 months, BAO decreased by 75% and remained unchanged for up to 4 years. At 3-6 months, 56% of patients were mild hypersecretors and 67% remained hypersecretors up to 4 years. Preoperatively, the BAO-MAO ratio was elevated in 16 of 20 patients (80%); postoperatively, only 5 of 18 patients (28%) at 3-6 months, 2 of 15 (13%) at 1 year, and 2 of 10 (20%) at 4 years continued to have elevated ratios. Preoperatively, the mean ranitidine dose was 1597 mg/day, whereas after surgery the mean dose was 535 mg/day at 3-6 months and approximately 300 mg/day at 1-4 years with 8 patients requiring no antisecretory drug. These results show that the trophic effects of chronic hypergastrinemia are, in general, rapidly reversible with a 50% decrease in MAO within 3-6 months of cure. Similarly, BAO decreased by 75% within 3-6 months. Despite these decreases, careful monitoring of acid secretion is required after reversal of the chronic hypergastrinemia in diseases such as the Zollinger-Ellison syndrome, because 55% of patients at 3-6 months and up to 67% at 4 years continue to remain mild hypersecretors and require low doses of antisecretory drugs.
在诸如卓-艾综合征等疾病中，慢性高胃泌素血症对胃黏膜具有营养作用，导致壁细胞量增加，表现为最大胃酸分泌量（MAO）和基础胃酸分泌量（BAO）增加。人类这些胃部变化的发展时间进程尚不清楚，并且对于高胃泌素血症的逆转是否会导致胃分泌功能迅速恢复正常存在争议。为了解决这些不确定性，对20例接受胃泌素瘤根治性切除手术成功的卓-艾综合征患者的胃分泌功能进行了前瞻性评估。每位患者在术前、术后3 - 6个月以及此后每年均进行胃酸测量、影像学检查、空腹血清胃泌素和促胰液素激发试验。术前平均BAO为39 mEq/h，MAO为56 mEq/h，BAO - MAO比值为0.73，空腹胃泌素分泌量为1020 pg/mL。所有患者在6个月时接受评估，17例在1年时接受评估，15例在2年时接受评估，13例在3年时接受评估，9例在4年时接受评估。到3 - 6个月时，男性的MAO下降了50%（平均为30 mEq/h），女性下降了35%（平均为29 mEq/h），然后在长达4年的时间里保持相对稳定。手术前，20例患者中有14例（70%）MAO升高，而切除术后4年，9例患者中无MAO升高者。到3 - 6个月时，BAO下降了75%，并在长达4年的时间里保持不变。在3 - 6个月时，56%的患者为轻度胃酸分泌过多者，高达4年时67%的患者仍为胃酸分泌过多者。术前，20例患者中有16例（80%）的BAO - MAO比值升高；术后，3 - 6个月时18例患者中只有5例（28%）、1年时15例患者中有2例（13%）、4年时10例患者中有2例（20%）的比值持续升高。术前，雷尼替丁平均剂量为1597 mg/天，而术后3 - 6个月时平均剂量为53,5 mg/天，1 - 4年时约为300 mg/天，8例患者无需使用抗分泌药物。这些结果表明，慢性高胃泌素血症的营养作用通常在治愈后3 - 6个月内MAO下降50%的情况下迅速可逆。同样，BAO在3 - 6个月内下降了75%。尽管有这些下降，但在卓-艾综合征等疾病中慢性高胃泌素血症逆转后仍需要仔细监测胃酸分泌，因为3 - 6个月时55%的患者以及4年时高达67%的患者仍持续为轻度胃酸分泌过多者，需要低剂量的抗分泌药物。
