Nustede R, Köhler H, Fölsch U R, Schafmayer A
Department of Surgery, Georg-August-University of Göttingen, F.R.G.
Pancreas. 1991 May;6(3):260-5. doi: 10.1097/00006676-199105000-00002.
The peptide hormones neurotensin (NT) and cholecystokinin (CCK) are commonly attributed with a physiological role in the stimulation of exocrine pancreatic secretion. However, on the other hand, little is known about the effect of diminished exocrine pancreatic function and of the resulting maldigestion on postprandial plasma levels of these two gastrointestinal peptides. We investigated, therefore, the effect of enzyme substitution therapy on the magnitude and time course of plasma concentrations of both hormones in patients suffering from severe chronic pancreatitis. Pancreatic insufficiency led to elevated NT-concentrations, in response to a standard meal, which could be reduced by enzyme replacement therapy. Prior to enzyme therapy, the mean integrated postprandial release of NT amounted to 2800 +/- 250 pg/ml after 60 min in patients with severe chronic pancreatitis. This amount was significantly reduced to 1250 +/- 150 pg/ml after 60 min after enzyme therapy, compared to 810 +/- 90 pg/ml after 60 min in healthy volunteers after the standard meal. The integrated postprandial CCK level in patients investigated was significantly lower (35 +/- 4.8 pmol/L after 60 min) without any substitution therapy, compared to the integrated peptide amount in healthy volunteers (145 +/- 13.5 pmol/L after 60 min). Enzyme therapy in patients suffering from chronic pancreatitis led to an increased postprandial CCK-level (80 +/- 9.6 pmol/L after 60 min). Elevated CCK-plasma concentrations have not been demonstrated in these patients with pancreatic insufficiency. We therefore suggest that CCK might not play a major role in feedback regulation in patients with chronic pancreatitis. However, in light of elevated NT plasma concentrations in patients with chronic pancreatitis, NT-mediated influence on the pancreas deserves further study.
肽类激素神经降压素（NT）和胆囊收缩素（CCK）通常被认为在刺激胰腺外分泌中具有生理作用。然而，另一方面，关于胰腺外分泌功能减退以及由此产生的消化不良对这两种胃肠肽餐后血浆水平的影响却知之甚少。因此，我们研究了酶替代疗法对重症慢性胰腺炎患者这两种激素血浆浓度的幅度和时间进程的影响。胰腺功能不全导致标准餐后NT浓度升高，而酶替代疗法可使其降低。在酶治疗前，重症慢性胰腺炎患者餐后60分钟NT的平均累积释放量为2800±250 pg/ml。酶治疗后60分钟，这一数值显著降至1250±150 pg/ml，而健康志愿者标准餐后60分钟为810±90 pg/ml。在未进行任何替代治疗的情况下，所研究患者餐后CCK的累积水平显著低于健康志愿者（60分钟后为35±4.8 pmol/L，而健康志愿者为145±13.5 pmol/L）。慢性胰腺炎患者的酶治疗导致餐后CCK水平升高（60分钟后为80±9.6 pmol/L）。这些胰腺功能不全的患者并未出现CCK血浆浓度升高的情况。因此，我们认为CCK在慢性胰腺炎患者的反馈调节中可能不起主要作用。然而，鉴于慢性胰腺炎患者NT血浆浓度升高，NT对胰腺的介导影响值得进一步研究。
