Fykse Vidar, Sandvik Arne Kristian, Waldum Helge Lyder
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, St. Olav University Hospital, NO-7006 Trondheim, Norway.
Scand J Gastroenterol. 2005 Nov;40(11):1269-74. doi: 10.1080/00365520510023684.
In a one-year study of 5 patients with chronic atrophic gastritis (CAG), pernicious anaemia (PA), hypergastrinaemia and enterochromaffin-like (ECL) cell tumours, the somatostatin analogue octreotide LAR (long-acting release) in a dose of 20 mg given intramuscularly at monthly intervals had an antiproliferative effect on the ECL cells. The aim of the present study was to follow neuroendocrine (NE) markers in the blood and macroscopic and histopathological changes in the stomach during a 12-month follow-up after discontinuation of octreotide LAR treatment.
Five patients underwent upper gastrointestinal endoscopy at 6 and 12 months' follow-up after octreotide LAR treatment. Biopsies from flat, oxyntic mucosa and from tumours were obtained. Sections were stained with haematoxylin-erythrosin and immunostained for the NE cell marker chromogranin A (CgA). Serum gastrin and CgA were measured every 3 months.
The number of visible tumours was unchanged (7) at 12 months' follow-up. One lesion showed carcinoid tumour and the others various degrees of linear and micronodular NE hyperplasia. At the same time-point, biopsies from flat, oxyntic mucosa showed a slightly (non-significant) elevated number of CgA immunoreactive (IR) cells. Serum gastrin increased from 186+/-50 pM (mean+/-SEM) to 603+/-109 pM (normal < 40 pM); p<0.05, and serum CgA increased non-significantly from 25+/-2 ng/ml (normal < 30 ng/ml) to 61+/-11 ng/ml.
During follow-up, slightly elevated levels of serum CgA and CgA IR cells in the oxyntic mucosa, without significant recurrence of ECL cell carcinoids, were observed.
在一项针对5例患有慢性萎缩性胃炎（CAG）、恶性贫血（PA）、高胃泌素血症和肠嗜铬样（ECL）细胞瘤患者的为期一年的研究中，每月肌肉注射一次剂量为20 mg的生长抑素类似物奥曲肽长效释放剂（LAR）对ECL细胞具有抗增殖作用。本研究的目的是在停用奥曲肽LAR治疗后的12个月随访期间，追踪血液中的神经内分泌（NE）标志物以及胃的宏观和组织病理学变化。
5例患者在接受奥曲肽LAR治疗后的6个月和12个月随访时接受了上消化道内镜检查。从平坦的泌酸黏膜和肿瘤处获取活检组织。切片用苏木精-伊红染色，并对NE细胞标志物嗜铬粒蛋白A（CgA）进行免疫染色。每3个月测量一次血清胃泌素和CgA。
在12个月的随访中，可见肿瘤数量未变（7个）。1个病变显示为类癌肿瘤，其他病变表现为不同程度的线性和微结节性NE增生。在同一时间点，来自平坦泌酸黏膜的活检显示CgA免疫反应性（IR）细胞数量略有（无统计学意义）增加。血清胃泌素从186±50 pM（平均值±标准误）增至603±109 pM（正常<40 pM）；p<0.05，血清CgA从25±2 ng/ml（正常<30 ng/ml）增至61±11 ng/ml，无统计学意义。
随访期间，观察到泌酸黏膜中血清CgA水平和CgA IR细胞略有升高，且ECL细胞类癌无明显复发。
