Moore J G, Larsen K R, Barattini P, Dayton M T
Department of Medicine, Salt Lake Veterans Affairs Medical Center, Utah 84148.
Dig Dis Sci. 1994 Aug;39(8):1619-24. doi: 10.1007/BF02087766.
A model for gastric mucosal injury is proposed in which a key pathogenetic event is the disruption in the normal relationships among several circadian rhythms of gastric function. In the rat a circadian rhythm in acid secretion was found to be out of phase with a circadian rhythm in gastric pepsin secretion, another aggressive factor, and several mucosal defensive factors (mucus and bicarbonate efflux and tissue prostacyclin content). Gastric corpus mucosal blood flow circadian patterns paralleled the the rhythmicity in acid secretion and, therefore, was out of phase with the other measured mucosal defensive factors. Thus, gastric mucosal defense was maintained by different mechanisms over the 24-hr cycle. During the dark phase, when this species was active and when acid secretion was highest, enhanced damage by topical acidified aspirin was documented, despite increased mucosal blood flow. Natural asynchrony in circadian rhythms of gastric function can be protective of gastric mucosal integrity but disruption of this circadian interplay of gastric aggressive and defensive factors could theoretically lead to greater vulnerability to damage. In the human, a circadian rhythm in basal gastric acidity has been described but no information exists as to the possibility of similar rhythmic variation in other gastric factors (aggressive and defensive) and possible disruption of these rhythms in disease.
本文提出了一种胃黏膜损伤模型，其中一个关键的致病事件是胃功能的几种昼夜节律之间正常关系的破坏。在大鼠中，发现胃酸分泌的昼夜节律与胃蛋白酶分泌（另一种攻击因子）以及几种黏膜防御因子（黏液和碳酸氢盐外流以及组织前列环素含量）的昼夜节律不同步。胃体黏膜血流的昼夜模式与胃酸分泌的节律平行，因此与其他测量的黏膜防御因子不同步。因此，在24小时周期内，胃黏膜防御通过不同机制维持。在黑暗阶段，当该物种活跃且胃酸分泌最高时，尽管黏膜血流量增加，但局部酸化阿司匹林造成的损伤仍有所增强。胃功能昼夜节律的自然不同步可保护胃黏膜完整性，但胃攻击和防御因子这种昼夜相互作用的破坏理论上可能导致对损伤的更大易感性。在人类中，已经描述了基础胃酸度的昼夜节律，但对于其他胃因子（攻击和防御）是否存在类似的节律变化以及疾病中这些节律是否可能被破坏尚无相关信息。
