Brady C E, Utts S J, Hyatt J R, Dev J
Gastroenterology Service, Wilford Hall USAF Medical Center, San Antonio, Texas.
Am J Gastroenterol. 1988 Feb;83(2):130-5.
Our previous secretin provocation studies in normal volunteers and unoperated duodenal ulcer patients suggested that the gastrin rise in gastrinoma may be an exaggeration of the normal response rather than paradoxical. We report further studies in various clinical settings having normogastrinemia (normal, n = 17; unoperated duodenal ulcer, n = 13; primary hyperparathyroidism, n = 7) and hypergastrinemia (postvagotomy, n = 5; hypochlorhydria, n = 7; achlorhydria, n = 10; chronic renal failure, n = 10; gastrinoma, n = 5). Under all nongastrinoma conditions, there were similar gastrin rises of 9-19% between 2 and 5 min after bolus intravenous GIH secretin (2 CU/kg), which fell to baseline by 8 min, except for chronic renal failure. In chronic renal failure, gastrin remained elevated from 7 to 30 min and was significantly different (p less than 0.05) at 10-30 min compared to all other nongastrinoma conditions except hyperparathyroidism. Peak rises occurred within 5 min in all entities, but only three gastrinoma patients had positive secretin provocation tests by the predefined criterion of a gastrin rise greater than 200 pg/ml. The results of secretin provocation in various clinical entities with and without hypergastrinemia further support the hypothesis that the gastrin rise in gastrinoma is an exaggeration of the normal response. The prolonged gastrin rise seen in chronic renal failure may be due to altered renal clearance, inasmuch as other hypergastrinemic states had responses similar to normal and duodenal ulcer.
我们之前在正常志愿者和未经手术的十二指肠溃疡患者中进行的促胰液素激发试验表明，胃泌素瘤患者中胃泌素的升高可能是正常反应的过度表现，而非反常现象。我们报告了在各种临床情况下的进一步研究，这些情况包括胃泌素正常血症（正常，n = 17；未经手术的十二指肠溃疡，n = 13；原发性甲状旁腺功能亢进，n = 7）和高胃泌素血症（迷走神经切断术后，n = 5；胃酸过少，n = 7；无胃酸，n = 10；慢性肾衰竭，n = 10；胃泌素瘤，n = 5）。在所有非胃泌素瘤情况下，静脉推注生长抑素（2 CU/kg）后2至5分钟内，胃泌素的升高相似，为9%至19%，除慢性肾衰竭外，8分钟时降至基线水平。在慢性肾衰竭中，胃泌素在7至30分钟内持续升高，与除甲状旁腺功能亢进外的所有其他非胃泌素瘤情况相比，在10至30分钟时差异显著（p小于0.05）。所有组别的峰值升高均在5分钟内出现，但只有3例胃泌素瘤患者通过预先定义的胃泌素升高大于200 pg/ml的标准进行促胰液素激发试验呈阳性。在有和没有高胃泌素血症的各种临床实体中促胰液素激发试验的结果进一步支持了以下假设，即胃泌素瘤中胃泌素的升高是正常反应的过度表现。慢性肾衰竭中观察到的胃泌素升高持续时间延长可能是由于肾脏清除功能改变，因为其他高胃泌素血症状态的反应与正常人和十二指肠溃疡患者相似。
