Penman I D, el-Omar E, Ardill J E, McGregor J R, Galloway D J, O'Dwyer P J, McColl K E
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, Scotland.
Gastroenterology. 1994 May;106(5):1263-70. doi: 10.1016/0016-5085(94)90018-3.
BACKGROUND/AIMS: Previous studies have found that colorectal cancer patients have hypergastrinemia, but most have been inadequately controlled. Preoperative fasting and meal-stimulated gastrin levels were measured in patients with colorectal tumors (n = 42) and in carefully matched controls (n = 34). Helicobacter pylori status was assessed because it causes significant hypergastrinemia.
Plasma gastrin levels were measured by radioimmunoassay. Helicobacter status was assessed using the [14C]urea breath test and serology (immunoglobulin G).
Preoperatively, fasting plasma gastrin levels were similar in patients with tumors (median, 55 ng/L; interquartile range, 45-82.5) and controls (77.5 ng/L; 53.7-137.5; P = 0.10). Similarly, peak gastrin levels were not significantly different in tumor patients (200 ng/L; 137.5-312.5) and controls (247.5 ng/L; 147.5-375; P = 0.21). The prevalence of H. pylori infection in patients with tumors (60%) and controls (53%) was similar in both groups. Five (20%) tumor patients who were H. pylori-positive preoperatively were negative postoperatively, and their median peak plasma gastrin level decreased from 200 ng/L to 140 ng/L. After these patients were excluded, fasting and peak plasma gastrin concentrations were similar preoperatively and postoperatively.
When confounding factors are controlled for, plasma gastrin levels are not increased in colorectal cancer and do not decrease after curative resection. Previously noted decreases in gastrin levels after tumor resection may be attributable to loss of H. pylori infection in some patients, as noted here.
背景/目的：既往研究发现，结直肠癌患者存在高胃泌素血症，但多数控制不佳。对42例结直肠肿瘤患者及34例精心匹配的对照者测定术前空腹及餐后刺激胃泌素水平。评估幽门螺杆菌状态，因为其可导致显著的高胃泌素血症。
采用放射免疫分析法测定血浆胃泌素水平。使用[14C]尿素呼气试验和血清学（免疫球蛋白G）评估幽门螺杆菌状态。
术前，肿瘤患者（中位数55 ng/L；四分位间距45 - 82.5）与对照者（77.5 ng/L；53.7 - 137.5；P = 0.10）的空腹血浆胃泌素水平相似。同样，肿瘤患者（200 ng/L；137.5 - 312.5）与对照者（247.5 ng/L；147.5 - 375；P = 0.21）的胃泌素峰值水平无显著差异。两组中肿瘤患者（60%）和对照者（53%）的幽门螺杆菌感染率相似。5例（20%）术前幽门螺杆菌阳性的肿瘤患者术后转为阴性，其血浆胃泌素峰值中位数从200 ng/L降至140 ng/L。排除这些患者后，术前和术后空腹及血浆胃泌素峰值浓度相似。
当控制混杂因素时，结直肠癌患者血浆胃泌素水平并未升高，根治性切除后也未降低。如本文所述，既往报道的肿瘤切除后胃泌素水平降低可能归因于部分患者幽门螺杆菌感染的消除。
