den Hartog G, van der Meer J W, Jansen J B, van Furth R, Lamers C B
Department of Gastroenterology-Hepatology, University Hospital, Leiden, The Netherlands.
N Engl J Med. 1988 Jun 16;318(24):1563-7. doi: 10.1056/NEJM198806163182402.
We undertook this study to determine whether patients with late-onset hypogammaglobulinemia, who are at very high risk for gastric cancer, have a reduced secretion of gastrin after stimulation with food or bombesin, a potent gastrin-releasing stimulus. We compared the plasma gastrin responses to bombesin and to a standard test meal in 18 patients with late-onset hypogammaglobulinemia with those in patients with X-linked agammaglobulinemia, early-onset hypogammaglobulinemia, or hypogammaglobulinemia due to lymphoproliferative cancer, and in 30 normal control subjects. Thirteen of 18 patients with late-onset hypogammaglobulinemia (72 percent) had an abnormally low gastrin response to bombesin, as compared with none of 21 patients with other forms of hypogammaglobulinemia (P less than 0.05). After a test meal, abnormally low gastrin secretion was found in 6 of 14 patients with late-onset hypogammaglobulinemia (43 percent) and in 1 of 18 patients with other forms of the disease (6 percent) (P not significant). The plasma gastrin responses to stimulation with bombesin or food distinguished late-onset hypogammaglobulinemia from other forms, with sensitivities of 72 and 43 percent and specificities of 100 and 94 percent, respectively. Stimulated gastrin response can therefore be used as a marker for this type of immunodeficiency. The test responses also showed heterogeneity among patients with late-onset hypogammaglobulinemia and may help to identify patients with an increased risk for gastric cancer.
我们开展这项研究，以确定胃癌风险极高的迟发性低丙种球蛋白血症患者在受到食物或蛙皮素（一种有效的促胃泌素释放刺激物）刺激后，促胃泌素分泌是否减少。我们比较了18例迟发性低丙种球蛋白血症患者、X连锁无丙种球蛋白血症患者、早发性低丙种球蛋白血症患者或淋巴增殖性癌症所致低丙种球蛋白血症患者以及30名正常对照者对蛙皮素和标准试验餐的血浆促胃泌素反应。18例迟发性低丙种球蛋白血症患者中有13例（72%）对蛙皮素的促胃泌素反应异常低，相比之下，21例其他形式低丙种球蛋白血症患者中无一例如此（P<0.05）。试验餐后，14例迟发性低丙种球蛋白血症患者中有6例（43%）促胃泌素分泌异常低，而18例其他形式疾病患者中有1例（6%）出现这种情况（P无显著性差异）。对蛙皮素或食物刺激的血浆促胃泌素反应可将迟发性低丙种球蛋白血症与其他形式区分开来，敏感性分别为72%和43%，特异性分别为100%和94%。因此，刺激后的促胃泌素反应可作为这种免疫缺陷类型的标志物。试验反应在迟发性低丙种球蛋白血症患者中也显示出异质性，可能有助于识别胃癌风险增加的患者。
