Katelaris P H, Seow F, Lin B P, Napoli J, Ngu M C, Jones D B
Gastroenterology Unit, Repatriation General Hospital, Concord, Sydney, NSW, Australia.
Gut. 1993 Aug;34(8):1032-7. doi: 10.1136/gut.34.8.1032.
Gastric acid secretion has been considered to decline with increasing age but this view is being re-evaluated as the importance of Helicobacter pylori infection emerges. This study aimed to determine the effect of age, H pylori, and gastritis with atrophy on the serum gastrin concentration, gastric secretory volumes, and acid output in healthy, asymptomatic men. Young men (mean (SD) age 22.9 (0.6) years; n = 22) were compared with old men (72.9 (1.2) years; n = 28) in respect of basal serum gastrin and basal, sham fed, pentagastrin stimulated maximal and peak acid secretion. Antral, corpus, and fundal biopsy specimens were taken for histology and H pylori status (histology, culture, and rapid urease test). H pylori associated gastritis was present in three of 22 young (13.6%) and 16 of 28 old (57.1%) men. Gastritis with atrophy was present in 11 old subjects, 10 of whom were H pylori positive. These subjects had higher mean (SD) serum gastrin concentrations than old subjects without atrophy and young subjects (61.8 (9.2); 40.0 (2.9); 36.8 (2.3) pmol/l respectively; p < 0.001). H pylori infected subjects had higher gastrin values than uninfected subjects, overall (55.3 (5.9); 36.0 (1.8) pmol/l; p < 0.001) and in subjects without atrophy (45.3 (4.2); 36.0 (1.8) pmol/l; p < 0.03). In subjects without H pylori infection, gastrin values did not differ with age (old 37.1 (1.7); young 35.4 (2.1) pmol/l). The maximal gastric secretory volume was lower in old subjects with atrophy. Acid output (mmol/h) in subjects with atrophy was lower than in subjects with no atrophy (basal: 3.0(1.1); 5.1(0.7); p=NS; sham led: 5.4 (1.4); 9.3 (0.8); p<0.02; maximal: 18.9 (4.0); 31.4(1.8); p<0.002; peak: 25.1(5.3); 43.4(2.7); p<0.003). However, acid secretion in old subjects without atrophy was not different to that in young subjects, irrespective of H pylori status. These results did not differ when acid output was expressed as mmol/h/kg lean body mass or mmol/h/kg fat free body weight. Using multiple linear regression analysis, gastritis with atrophy was the only factor that had an independent negative effect on acid secretion. In healthy men without atrophy, gastric acid secretion is preserved with ageing and is independent of H pylori status. Atrophy, which is closely related to H pylori infection, is associated with a decline in acid secretion. Increased basal serum gastrin is related to both atrophy and H pylori infection but not to ageing per se.
胃酸分泌曾被认为会随着年龄增长而下降，但随着幽门螺杆菌感染的重要性逐渐显现，这一观点正在重新评估。本研究旨在确定年龄、幽门螺杆菌以及萎缩性胃炎对健康无症状男性血清胃泌素浓度、胃分泌量和胃酸分泌的影响。将年轻男性（平均（标准差）年龄22.9（0.6）岁；n = 22）与老年男性（72.9（1.2）岁；n = 28）在基础血清胃泌素以及基础、假饲、五肽胃泌素刺激后的最大和峰值胃酸分泌方面进行比较。采集胃窦、胃体和胃底活检标本进行组织学检查及幽门螺杆菌检测（组织学、培养和快速尿素酶试验）。22名年轻男性中有3名（13.6%）、28名老年男性中有16名（57.1%）存在幽门螺杆菌相关性胃炎。11名老年受试者存在萎缩性胃炎，其中10名幽门螺杆菌阳性。这些受试者的平均（标准差）血清胃泌素浓度高于无萎缩的老年受试者和年轻受试者（分别为61.8（9.2）；40.0（2.9）；36.8（2.3）pmol/L；p < 0.001）。总体而言，幽门螺杆菌感染的受试者胃泌素值高于未感染的受试者（55.3（5.9）；36.0（1.8）pmol/L；p < 0.001），在无萎缩的受试者中也是如此（45.3（4.2）；36.0（1.8）pmol/L；p < 0.03）。在未感染幽门螺杆菌的受试者中，胃泌素值在年龄上无差异（老年37.1（1.7）；年轻35.4（2.1）pmol/L）。有萎缩的老年受试者最大胃分泌量较低。有萎缩的受试者胃酸分泌量（mmol/h）低于无萎缩的受试者（基础：3.0(1.1)；5.1(0.7)；p = 无显著差异；假饲：5.4（1.4）；9.3（0.8）；p < 0.02；最大：18.9（4.0）；31.4(1.8)；p < 0.002；峰值：25.1(5.3)；43.4(2.7)；p < 0.003）。然而，无萎缩的老年受试者的胃酸分泌与年轻受试者无差异，无论幽门螺杆菌感染状况如何。当胃酸分泌量以mmol/h/瘦体重或mmol/h/去脂体重表示时，这些结果并无不同。使用多元线性回归分析，萎缩性胃炎是唯一对胃酸分泌有独立负面影响的因素。在无萎缩的健康男性中，胃酸分泌随年龄增长得以保留，且与幽门螺杆菌感染状况无关。与幽门螺杆菌感染密切相关的萎缩与胃酸分泌减少有关。基础血清胃泌素升高与萎缩和幽门螺杆菌感染均有关，但与年龄本身无关。
