Walsh J H
J Clin Gastroenterol. 1981;3(Suppl 2):73-8.
Measurements of basal and stimulated gastric acid secretion, serum gastrin, and serum pepsinogen I cannot replace direct radiologic and endoscopic examination of the gastroduodenal mucosa for diagnosis of peptic ulcer disease, or histological examination for classification of gastritis and duodenitis. These tests, however, can provide information about the functional status of the gastric mucosa and sometimes indicate the etiology of gastric acid hypersecretion. The most diagnostic combination of tests comprises markedly increased fasting serum gastrin, positive serum gastrin response to secretin challenge, and increased levels of basal acid secretion and serum pepsinogen I found in patients with gastrinoma. The same combination of results, except for negative response to secretin and marked stimulation of gastrin by food, is found in patients with antral gastrin cell hyperfunction. Increased serum gastrin concentrations often are found in patients with hyposecretion of gastric acid, including those with atrophic gastritis, and in patients with renal failure, or previous vagotomy. Patients with atrophic gastritis have a low serum pepsinogen I level, while an increased level is found with renal failure and a normal level is found after vagotomy. Thus, the concurrent measurement of serum pepsinogen I and creatinine provides a useful initial step in the evaluation of hypergastrinemia.
基础胃酸分泌量、刺激胃酸分泌量、血清胃泌素及血清胃蛋白酶原I的测定，无法替代对胃十二指肠黏膜进行的直接放射学和内镜检查以诊断消化性溃疡病，也不能替代用于胃炎和十二指肠炎分类的组织学检查。然而，这些检查可提供有关胃黏膜功能状态的信息，有时还能提示胃酸分泌过多的病因。最具诊断价值的检查组合包括：空腹血清胃泌素显著升高、对促胰液素激发试验血清胃泌素反应阳性、胃泌素瘤患者基础胃酸分泌量和血清胃蛋白酶原I水平升高。在胃窦胃泌素细胞功能亢进患者中也可发现相同的检查结果组合，只是对促胰液素反应阴性且食物对胃泌素的刺激明显。胃酸分泌减少的患者，包括萎缩性胃炎患者、肾衰竭患者或既往接受过迷走神经切断术的患者，血清胃泌素浓度常常升高。萎缩性胃炎患者血清胃蛋白酶原I水平较低，肾衰竭患者该水平升高，迷走神经切断术后则为正常水平。因此，同时测定血清胃蛋白酶原I和肌酐是评估高胃泌素血症的有用初始步骤。
