Wirth H P, Eberle C, Gautschi K, Meyenberger C, Ammann R
Departement für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1995 Apr 15;125(15):735-9.
Pancreatic polypeptide (PP) can be used as a marker for endocrine active tumors originating from the pancreas. After intravenous administration of secretin, individually divergent increases in plasma PP concentration can be observed hampering interpretation of the stimulation test. Under certain circumstances elevated basal PP concentrations can be observed. Besides age, renal insufficiency and diabetes, hypoglycemia can cause high PP levels. We therefore inquired whether in patients with atypically high increase of PP after secretin this increase could be caused by hypoglycemia during the secretin stimulation test. In order to test this hypothesis we prospectively determined the plasma glucose and insulin concentrations in addition to the routinely measured gastro-intestinal hormones in 19 patients referred for secretin provocation test. In the 16 patients in whom the increase of PP was not due to an endocrine active tumor or renal insufficiency, PP rose to 170 +/- 57 pmol/l (+/- SEM) 2 minutes after secretin administration. In parallel, plasma insulin concentration increased to 365 +/- 51 pmol/l 2 minutes after secretin. The maximal insulin concentrations correlated significantly with the PP concentrations observed at the same time (R = 0.73, p < 0.01). The mean glucose concentration, however, remained constantly between 4.8 +/- 0.3 and 5.2 +/- 0.3 mmol/l and there was no correlation between the peak plasma PP concentrations after secretin and the plasma glucose concentrations (R = 0.07). The minimal glucose concentrations observed were 3.3 mmol/l in three patients (30 minutes after secretin in 2 patients and 45 minutes after secretin in one). The mean plasma glucagon concentration rose to 22.5 +/- 4.1 pmol/l 10 minutes after secretin.(ABSTRACT TRUNCATED AT 250 WORDS)
胰多肽（PP）可作为源自胰腺的内分泌活性肿瘤的标志物。静脉注射促胰液素后，血浆PP浓度会出现个体差异的升高，这妨碍了对刺激试验结果的解读。在某些情况下，可观察到基础PP浓度升高。除年龄、肾功能不全和糖尿病外，低血糖也可导致PP水平升高。因此，我们探究了在促胰液素刺激试验后PP异常大幅升高的患者中，这种升高是否由低血糖引起。为验证这一假设，我们前瞻性地测定了19例接受促胰液素激发试验患者的血浆葡萄糖和胰岛素浓度，同时还常规测定了胃肠激素。在16例PP升高并非由内分泌活性肿瘤或肾功能不全所致的患者中，促胰液素给药2分钟后，PP升至170±57 pmol/l（±标准误）。与此同时，促胰液素给药2分钟后，血浆胰岛素浓度升至365±51 pmol/l。最大胰岛素浓度与同一时间观察到的PP浓度显著相关（R = 0.73，p < 0.01）。然而，平均葡萄糖浓度始终保持在4.8±0.3至5.2±0.3 mmol/l之间，促胰液素刺激后血浆PP峰值浓度与血浆葡萄糖浓度之间无相关性（R = 0.07）。观察到的最低葡萄糖浓度在3例患者中为3.3 mmol/l（2例患者在促胰液素给药后30分钟，1例患者在促胰液素给药后45分钟）。促胰液素给药10分钟后，血浆胰高血糖素平均浓度升至22.5±4.1 pmol/l。（摘要截断于250字）
