Nomura T, Fukudo S, Muranaka M, Iwahashi S, Sasaki M, Satake M, Sasaki I, Shibata C, Matsuno S
Department of Psychosomatic Medicine, Tohoku University School of Medicine, Sendai, Japan.
Am J Gastroenterol. 1993 Sep;88(9):1432-5.
We report an impressive case with Zollinger-Ellison syndrome (ZES), in which stress-induced sympathetic discharge influenced serum gastrin. Our patient was a 35-yr-old female who complained of frequent and massive vomiting (more than 4000 ml of gastric juice) which was aggravated especially by psychosocial stress. Basal hypergastrinemia (1900 pg/ml) was found after the admission. The most striking finding was that laboratory stress dramatically increased serum gastrin (from 1900 to 5400 pg/ml) and plasma noradrenaline (from 180 to 1130 pg/ml). Mental arithmetic stress further enhanced hypergastrinemia (5800 pg/ml) with a concomitant increase in plasma noradrenaline (1240 pg/ml). Neostigmine (10 micrograms/kg im) also increased serum gastrin up to 6100 pg/ml but propranolol (40 micrograms/kg i.v.) reduced these elevations (noradrenaline: 990 pg/ml, gastrin: 5000 pg/ml). In this case, the effect of stress on serum gastrin mimicked the effect of catecholamine infusion in ZES. These findings suggest that psychological stress induces serum gastrin secretion via beta-adrenoceptor with exacerbation of symptoms in some cases with ZES.
我们报告了一例卓-艾综合征（ZES）的典型病例，其中应激诱导的交感神经放电影响血清胃泌素。我们的患者是一名35岁女性，主诉频繁大量呕吐（超过4000毫升胃液），心理社会应激会使其加重。入院后发现基础高胃泌素血症（1900 pg/ml）。最显著的发现是，实验室应激显著增加血清胃泌素（从1900 pg/ml升至5400 pg/ml）和血浆去甲肾上腺素（从180 pg/ml升至1130 pg/ml）。心算应激进一步加剧高胃泌素血症（5800 pg/ml），同时血浆去甲肾上腺素增加（1240 pg/ml）。新斯的明（10微克/千克，肌肉注射）也使血清胃泌素升高至6100 pg/ml，但普萘洛尔（40微克/千克，静脉注射）减轻了这些升高（去甲肾上腺素：990 pg/ml，胃泌素：5000 pg/ml）。在该病例中，应激对血清胃泌素的影响类似于在ZES中输注儿茶酚胺的影响。这些发现表明，心理应激通过β-肾上腺素能受体诱导血清胃泌素分泌，在某些ZES病例中会加重症状。
