Jaffe B M, Condon S
Ann Surg. 1976 Oct;184(4):516-24. doi: 10.1097/00000658-197610000-00015.
The role of prostaglandins in endocrine diarrheagenic syndromes was evaluated by measuring peripheral concentration of immunoreactive PGE and PGF in patients with non-endocrine diarrhea as well as those with the Zollinger-Ellison (Z-E) syndrome, MCT, carcinoid tumors and the WDHA syndrome. In 21 normals, PGE and PGF levels averaged 272 +/- 18 and 119 +/- 14 pg/ml, respectively. Twenty eight patients with diarrhea of non-endocrine origin (mainly inflammatory bowel disease) had levels indistinguishable from normal, i.e. 353 +/- 25 and 77 +/- 37 pg/ml, respectively. Among 29 patients with the Zollinger-Ellison syndrome (mean gastrin 6127 +/- 3267 pg/ml) only 2 had significantly elevated PGE levels; mean PGE levels, 382 +/- 32 pg/ml, were not significantly different from normal and did not correlate with either diarrhea or the serum gastrin concentration. In contrast, 18 of 22 patients with carcinoid tumors (mean blood serotonin concentration 1655 +/- 604 ng/ml; mean urinary excretion of 5 HIAA 66.8 +/- 16.7 mg/day) had elevated peripheral concentrations of PGE. The mean PGE level (1367 +/- 245 pg/ml) was significantly elevated (P less than 0.001). Nonetheless PGE levels did not correlate with diarrhea, blood concentrations of serotonin, or urinary indole excretion. MCT (mean serum calcitonin 24.5 +/- 6.3 ng/ml) was similarly associated with consistent (18/19) elevation in peripheral concentrations of PGE (mean 1922 +/- 541 pg/ml; P less than 0.001). Inthis syndrome, PGE levels were higher in patients with diarrhea and in those with markedly elevated serum thyrocalcitonin levels. Finally, 8 of 21 patients with the WDHA syndrome had increased levels of PGE. Although 13 of 17 patients had high levels of VIP (mean 8133 pg/ml), 2 patients had hyperprostaglandinemia in the face of normal peripheral concentrations of VIP. In one patient the serum PGE level was elevated prior to resection of the primary pancreatic neoplasm (9939 pg/ml) as well as the subsequent extirpation of a solitary hepatic metastasis (1063 pg/ml); following each procedure the diarrhea abated and the PGE level returned to normal. In none of these syndromes were mean PGF levels elevated. The study has documented hyperprostaglandinemia in some endocrine diarrheagenic syndromes and validated the usefullness of measurements of PGE in patients with unexplained diarrhea.
通过测量非内分泌性腹泻患者以及患有卓-艾（Z-E）综合征、多发性内分泌腺瘤（MCT）、类癌肿瘤和WDHA综合征患者外周血中免疫反应性前列腺素E（PGE）和前列腺素F（PGF）的浓度，评估前列腺素在内分泌性腹泻综合征中的作用。21名正常人的PGE和PGF水平分别平均为272±18和119±14 pg/ml。28名非内分泌源性腹泻患者（主要为炎症性肠病）的水平与正常无异，分别为353±25和77±37 pg/ml。在29名卓-艾综合征患者（平均胃泌素6127±3267 pg/ml）中，只有2名患者的PGE水平显著升高；平均PGE水平为382±32 pg/ml，与正常无显著差异，且与腹泻或血清胃泌素浓度均无相关性。相比之下，22名类癌肿瘤患者中有18名（平均血5-羟色胺浓度1655±604 ng/ml；平均5-羟吲哚乙酸尿排泄量66.8±16.7 mg/天）外周血PGE浓度升高。平均PGE水平（1367±245 pg/ml）显著升高（P＜0.001）。然而，PGE水平与腹泻、血5-羟色胺浓度或尿吲哚排泄均无相关性。MCT（平均血清降钙素24.5±6.3 ng/ml）同样与外周血PGE浓度持续升高（18/19）相关（平均1922±541 pg/ml；P＜0.001）。在该综合征中，腹泻患者和血清甲状腺降钙素水平显著升高的患者PGE水平更高。最后，21名WDHA综合征患者中有8名PGE水平升高。虽然17名患者中有13名血管活性肠肽水平较高（平均8133 pg/ml），但2名患者在周围血血管活性肠肽浓度正常的情况下出现高前列腺素血症。1例患者在原发性胰腺肿瘤切除前（9939 pg/ml）以及随后孤立性肝转移瘤切除后（1063 pg/ml）血清PGE水平均升高；每次手术后腹泻缓解，PGE水平恢复正常。在这些综合征中，平均PGF水平均未升高。该研究记录了某些内分泌性腹泻综合征中存在高前列腺素血症，并证实了对不明原因腹泻患者测定PGE的有用性。
