Wisén O, Rössner S, Johansson C
Dig Dis Sci. 1987 Sep;32(9):968-72. doi: 10.1007/BF01297185.
Studies in animals and man suggest involvement of the vagal nerve in the pathophysiology of massive obesity. An abnormal vagal response pattern has been found in the obese rat, but corresponding functional studies in obese man are nonexistent. The gastric acid secretion was therefore examined in 13 nondiabetic grossly obese patients (average body weight 120 kg) and compared to 16 age-matched controls of normal body weight. The gastric acid response to modified sham feeding was significantly (P less than 0.05) reduced in obese patients, being on average 60% of the control output. The obese patients had a higher maximal gastric acid response to graded intravenous pentagastrin, 36.6 +/- 2.9 mmol/hr, compared to 27.1 +/- 2.4 mmol/hr in controls (P less than 0.05). In addition, the patients seemed to need less pentagastrin to reach a secretory plateau. Basal acid secretion rates were similar in obese and control groups. Plasma gastrin and blood glucose were not significantly different in obese patients and controls, but patients had significantly elevated plasma insulin levels. The change of plasma insulin during the sham-feeding procedure correlated with the magnitude of the secretory response in obese and control subjects. The reduced gastric acid response to vagal stimulation in the absence of impaired parietal cell function in obese patients is indicative of an association between massive obesity and altered vagal function in man.
对动物和人类的研究表明，迷走神经参与了重度肥胖的病理生理过程。在肥胖大鼠中发现了异常的迷走神经反应模式，但在肥胖人类中尚无相应的功能研究。因此，对13名非糖尿病的重度肥胖患者（平均体重120千克）的胃酸分泌进行了检测，并与16名年龄匹配的正常体重对照者进行了比较。肥胖患者对改良假饲的胃酸反应显著降低（P<0.05），平均为对照输出量的60%。肥胖患者对静脉注射递增剂量的五肽胃泌素的最大胃酸反应较高，为36.6±2.9毫摩尔/小时，而对照组为27.1±2.4毫摩尔/小时（P<0.05）。此外，患者似乎需要较少的五肽胃泌素就能达到分泌平台期。肥胖组和对照组的基础胃酸分泌率相似。肥胖患者和对照组的血浆胃泌素和血糖无显著差异，但患者的血浆胰岛素水平显著升高。假饲过程中血浆胰岛素的变化与肥胖和对照受试者的分泌反应幅度相关。肥胖患者在壁细胞功能未受损的情况下对迷走神经刺激的胃酸反应降低，表明重度肥胖与人类迷走神经功能改变之间存在关联。
