Malfertheiner P, Domínguez-Muñoz J E
Department of Internal Medicine, University of Bonn, FRG.
Digestion. 1993;54 Suppl 2:15-20. doi: 10.1159/000201098.
In clinical practice, exogenous pancreatic enzymes are administered for the treatment of pancreatogenic steatorrhea or with the intention to relieve pain due to chronic pancreatitis. Moreover, a large number of patients take pancreatin (i.e., exogenous pancreatic enzymes) for functional dyspepsia. The effect of exogenous pancreatic enzymes on the enteropancreatic axis is a complex issue. Intraduodenal but not intrajejunal protease activity appears to exert a dose-dependent negative feedback on exocrine pancreatic secretion. Only enzymes with a proteolytic activity but not amylase and lipase exert a control on pancreatic secretion. The mechanism responsible for this feedback regulation is debated, but the cholinergic system seems to play a major role. Intraduodenal pancreatic enzymes (pancreatin) lead to an increased release of pancreatic polypeptide but do not affect the release of insulin and glucagon. In addition, pancreatic enzymes have an influence on the release of some gastrointestinal hormones (i.e., cholecystokinin, motilin, gastric inhibitory polypeptide). Neither exogenous nor endogenous pancreatic enzymes seem to play a major role in the regulation of interdigestive gastrointestinal motility. However, an adequate rate of postprandial pancreatic output is required to control gastric emptying. Current knowledge on the effect of exogenous pancreatic enzymes on the enteropancreatic axis, gut peptide release and gastrointestinal motility are updated in the present article.
在临床实践中，外源性胰酶用于治疗胰源性脂肪泻或旨在缓解慢性胰腺炎引起的疼痛。此外，大量患者因功能性消化不良而服用胰酶（即外源性胰酶）。外源性胰酶对肠胰轴的影响是一个复杂的问题。十二指肠内而非空肠内的蛋白酶活性似乎对胰腺外分泌发挥剂量依赖性负反馈作用。只有具有蛋白水解活性的酶而非淀粉酶和脂肪酶对胰腺分泌有控制作用。负责这种反馈调节的机制存在争议，但胆碱能系统似乎起主要作用。十二指肠内的胰酶（胰酶制剂）会导致胰多肽释放增加，但不影响胰岛素和胰高血糖素的释放。此外，胰酶对一些胃肠激素（即胆囊收缩素、胃动素、胃抑制多肽）的释放有影响。外源性和内源性胰酶似乎在消化间期胃肠动力的调节中都不起主要作用。然而，需要足够的餐后胰腺分泌速率来控制胃排空。本文对外源性胰酶对肠胰轴、肠道肽释放和胃肠动力的影响的现有知识进行了更新。
