Owyang C, Miller L J, DiMagno E P, Mitchell J C, Go V L
Gut. 1982 May;23(5):357-61. doi: 10.1136/gut.23.5.357.
Patients with chronic renal failure have an abnormal immunoreactive gastrointestinal hormone profile, which is characterised by raised fasting serum concentrations of hormones that have antagonistic effects on exocrine pancreatic function. In addition, in this present study we have found that in renal insufficiency cholecystokinin disappears slowly from the plasma after a constant intravenous infusion of the hormone (p = 0.05 compared with healthy subjects). To evaluate whether the stimulatory or inhibitory hormones have a predominant effect, pancreatic exocrine function under conditions of mannitol perfusion of the duodenum and continuous intravenous cholecystokinin stimulation was studied in eight patients who had severe chronic renal failure and eight age-matched and sex-matched control subjects. Compared with healthy subjects, patients with renal insufficiency had hypersecretion of trypsin in response both to mannitol perfusion of the duodenum and to cholecystokinin stimulation (p less than 0.05). No significant differences in lipase secretion were noted between the patients with renal insufficiency and control subjects. These findings are consistent with the hypothesis that, of the abnormally raised fasting serum concentrations of gastrointestinal hormones found in renal insufficiency, hormones that stimulate rather than inhibit pancreatic exocrine function predominate. Secondly, the dissociation between trypsin and lipase outputs in chronic renal failure may suggest a differential trophic influence of stimulatory hormones -- that is, hypercholecystokininaemia -- on pancreatic exocrine enzyme secretion.
慢性肾衰竭患者的免疫反应性胃肠激素谱异常，其特征是空腹血清中对胰腺外分泌功能有拮抗作用的激素浓度升高。此外，在本研究中我们发现，在肾功能不全患者中，持续静脉输注胆囊收缩素后，该激素在血浆中清除缓慢（与健康受试者相比，p = 0.05）。为了评估刺激激素或抑制激素是否起主要作用，我们对8例严重慢性肾衰竭患者和8例年龄及性别匹配的对照受试者进行了研究，观察在十二指肠灌注甘露醇和持续静脉注射胆囊收缩素刺激的条件下胰腺的外分泌功能。与健康受试者相比，肾功能不全患者对十二指肠灌注甘露醇和胆囊收缩素刺激均出现胰蛋白酶分泌过多（p < 0.05）。肾功能不全患者与对照受试者之间的脂肪酶分泌无显著差异。这些发现与以下假设一致：在肾功能不全患者空腹血清中异常升高的胃肠激素中，刺激而非抑制胰腺外分泌功能的激素占主导地位。其次，慢性肾衰竭患者胰蛋白酶和脂肪酶分泌的分离可能提示刺激激素（即高胆囊收缩素血症）对胰腺外分泌酶分泌有不同的营养影响。
