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清醒小牛十二指肠前段氢离子、碳酸氢根离子和渗透压之间的相互作用对胃功能的调节

The interplay between hydrogen ions, bicarbonate ions and osmolality in the anterior duodenum modulating gastric function in the conscious calf.

作者信息

Bell F R, Nouri M, Webber D E

出版信息

J Physiol. 1981 May;314:331-41. doi: 10.1113/jphysiol.1981.sp013711.

Abstract
  1. Gastric emptying, gastric acid and pepsinogen secretion were assessed simultaneously in the conscious calf using the test meal and duodenal perfusion technique (Bell & Mostaghni, 1975).2. Duodenal infusion of NaCl at a constant osmolality of 300 m-osmole/kg, but with pH ranging from 2.0 to 12.0, did not alter the high level of gastric emptying and secretion already reported for isotonic NaCl or NaHCO(3) alone (Bell & Mostaghni, 1975; Bell & Webber, 1979). Gastric function, therefore, is either unaffected by gastric chyme at pH 2.0-12.0 entering the duodenum, or else isotonicity is dominant over pH in activating duodenal receptors which increase motor activity.3. When the pH of the isotonic NaCl was reduced by the addition of HCl to below pH 2.0, inhibition of gastric function occurred in direct proportion to the amount of titratable acid present in the infusate. The H(+) moiety of isotonic duodenal infusates of pH < 2.0 dominates activation of osmoreceptors and so inhibits motor activity.4. When the same amount of acid but at differing concentrations and infusion rates was introduced into the duodenum uniform inhibition of gastric function occurred. This result indicates that duodenal acid receptors respond to acid concentration and flow rate to produce an integrated response in proportion to the amount (concentration x volume) of acid present.5. Isotonic NaHCO(3) solutions adjusted to pH 8.1-12.0 by the addition of NaOH, like isotonic NaCl infusions, did not affect gastric function until pH 11.0-12.0, when significant inhibition occurred. This inhibitory effect of isotonic NaHCO(3) at high pH is probably due to CO(3) (2-), since Na(2)CO(3) and Li(2)CO(3), but not LiCl, produce a similar inhibitory effect on gastric function.6. The inhibitory effect of carbonate gives some support to the existence of a CO(2)-sensor as suggested by Hunt & Knox (1972), whereby increased P(CO2) produced by intracellular or intercellular neutralization of CO(3) (2-) by duodenal H(+) activates acid receptors. But other experiments reported here, where simultaneous perfusion of HCl and excess NaHCO(3) produced a rise in intraluminal P(CO2), did not inhibit gastric function, which is contrary to the idea of a direct intraluminal effect of CO(2) on duodenal receptors.7. The pH, P(O2), P(CO2), HCO(3) (-) and base excess of venous blood showed no detectable change during duodenal infusion of either acidic or alkaline solutions. Metabolic acidosis or alkalosis, therefore, cannot be considered to play any part in controlling gastric function. The results thus corroborate the notion that the receptors controlling gastric function are localized in the intestinal mucosa.8. Our results suggest that interplay between acid and osmolality of gastric chyme occurs in the rostral part of the duodenum to produce a graded inhibitory effect which by negative feedback modulates the gastric effectors that normally activate smooth muscle, parietal cells and zymogen cells.
摘要
  1. 采用试餐和十二指肠灌注技术(贝尔和莫斯塔尼,1975年),在清醒的小牛身上同时评估胃排空、胃酸和胃蛋白酶原分泌。

  2. 以300毫渗摩尔/千克的恒定渗透压十二指肠输注氯化钠,但pH值范围为2.0至12.0,并未改变已报道的单纯等渗氯化钠或碳酸氢钠时的高胃排空和分泌水平(贝尔和莫斯塔尼,1975年;贝尔和韦伯,1979年)。因此,胃功能要么不受pH值为2.0至12.0的胃内容物进入十二指肠的影响,要么等渗性在激活增加运动活性的十二指肠受体方面比pH值占主导地位。

  3. 当通过添加盐酸将等渗氯化钠的pH值降低至2.0以下时,胃功能的抑制与输注液中可滴定酸的量成正比。pH值<2.0的等渗十二指肠输注液中的H⁺部分主导渗透压感受器的激活,从而抑制运动活性。

  4. 当将相同量但不同浓度和输注速率的酸引入十二指肠时,出现了对胃功能的均匀抑制。该结果表明十二指肠酸受体对酸浓度和流速作出反应,以产生与存在的酸量(浓度×体积)成比例的综合反应。

  5. 通过添加氢氧化钠将等渗碳酸氢钠溶液调节至pH值8.1至12.0,与等渗氯化钠输注一样,直到pH值为11.0至12.0时才影响胃功能,此时出现显著抑制。高pH值下等渗碳酸氢钠的这种抑制作用可能归因于CO₃²⁻,因为碳酸钠和碳酸锂,但不是氯化锂,对胃功能产生类似的抑制作用。

  6. 碳酸盐的抑制作用为亨特和诺克斯(1972年)提出的存在CO₂感受器提供了一些支持,即十二指肠H⁺对CO₃²⁻进行细胞内或细胞间中和所产生的PCO₂升高激活酸受体。但此处报道的其他实验中,同时灌注盐酸和过量碳酸氢钠导致管腔内PCO₂升高,并未抑制胃功能,这与CO₂对十二指肠受体的直接管腔内作用的观点相反。

  7. 在十二指肠输注酸性或碱性溶液期间,静脉血的pH值、P(O₂)、P(CO₂)、HCO₃⁻和碱剩余均未显示可检测到的变化。因此,代谢性酸中毒或碱中毒不能被认为在控制胃功能中起任何作用。这些结果因此证实了控制胃功能的受体位于肠黏膜中的观点。

  8. 我们的结果表明,胃内容物的酸和渗透压之间的相互作用发生在十二指肠的头侧部分,以产生分级抑制作用,该作用通过负反馈调节通常激活平滑肌、壁细胞和酶原细胞的胃效应器。

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本文引用的文献

1
The pattern of emptying of the human stomach.人类胃部的排空模式。
J Physiol. 1951 Apr;113(2-3):157-68. doi: 10.1113/jphysiol.1951.sp004562.
5
Some properties of an alimentary osmoreceptor mechanism.一种消化性渗透感受器机制的某些特性。
J Physiol. 1956 May 28;132(2):267-88. doi: 10.1113/jphysiol.1956.sp005524.
8
The slowing of gastric emptying by nine acids.九种酸对胃排空的延缓作用。
J Physiol. 1969 Mar;201(1):161-79. doi: 10.1113/jphysiol.1969.sp008749.

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