Eguchi Hidetoshi, Tanemura Masahiro, Marubashi Shigeru, Kobayashi Shogo, Wada Hiroshi, Okita Kohei, Iwahashi Hiromi, Imagawa Akihisa, Shimomura Iichiro, Osuga Keigo, Umeshita Koji, Wakasa Kenichi, Mori Masaki, Doki Yuichiro, Nagano Hiroaki
Department of Surgery, Osaka University, Osaka, Japan.
Hepatogastroenterology. 2012 Jan-Feb;59(113):276-9. doi: 10.5754/hge11392.
BACKGROUND/AIMS: Arterial stimulation and venous sampling (ASVS) is a catheter-based diagnostic technique used to identify the localization of an insulinoma or gastrinoma. The aim of this study was to clarify the clinical significance of ASVS for glucagonomas.
Eight patients with pancreatic hypervascular tumors and elevated serum glucagon levels in the peripheral blood were enrolled. Pancreatic angiography was performed and a bolus dose of calcium was injected into a suitable artery. Hepatic venous blood samples were then obtained to measure concentrations of glucagon and insulin. All patients underwent surgical resection, and the resected specimens were investigated immunohistochemically.
Compared to insulin, the glucagon levels stabilized after calcium stimulation in four patients, with a 1.2-fold increase or decrease. In the remaining four patients, there was a 1.6- to 5.8-fold increase in glucagon levels. The peak value of glucagon was observed at 90s or 120s which was slower than the insulin peak observed in patients with insulinoma. The patients with elevated glucagon levels during ASVS exhibited positive immunostaining of glucagon in resected specimens.
Increase in glucagon after calcium stimulation was observed in patients with glucagonomas. ASVS for glucagonomas may be useful in determining the most suitable surgical procedure.
背景/目的：动脉刺激和静脉采血（ASVS）是一种基于导管的诊断技术，用于确定胰岛素瘤或胃泌素瘤的定位。本研究的目的是阐明ASVS对胰高血糖素瘤的临床意义。
纳入8例胰腺高血运肿瘤且外周血血清胰高血糖素水平升高的患者。进行胰腺血管造影，并向合适的动脉注射大剂量钙。然后采集肝静脉血样以测量胰高血糖素和胰岛素的浓度。所有患者均接受手术切除，并对切除标本进行免疫组织化学研究。
与胰岛素相比，4例患者在钙刺激后胰高血糖素水平稳定，升高或降低1.2倍。其余4例患者，胰高血糖素水平升高1.6至5.8倍。胰高血糖素峰值出现在90秒或120秒，比胰岛素瘤患者观察到的胰岛素峰值出现时间晚。在ASVS期间胰高血糖素水平升高的患者，其切除标本中胰高血糖素免疫染色呈阳性。
在胰高血糖素瘤患者中观察到钙刺激后胰高血糖素升高。ASVS对胰高血糖素瘤可能有助于确定最合适的手术方式。
