Lamberts R, Creutzfeldt W, Strüber H G, Brunner G, Solcia E
Department of Internal Medicine, University of Göttingen, Germany.
Gastroenterology. 1993 May;104(5):1356-70. doi: 10.1016/0016-5085(93)90344-c.
The effects of chronic drug-induced hypergastrinemia on the exocrine and endocrine stomach are still incompletely understood. Chronic hypergastrinemia in rats and humans is associated with gastric argyrophil cell hyperplasia.
Seventy-four patients with chronic ranitidine-resistant ulcerations were treated chronically with omeprazole (median observation period 48 [6-84] months).
Median fasting serum gastrin levels increased from a pretreatment value of 74-145 pg/mL after 3 months. No further increase was observed thereafter. The finding of atrophic gastritis increased from 1.8% to 20.8% after 5 years. A doubling of the mean argyrophil cell volume density (0.36% vs. 0.74% after 5 years; P < 0.01%) was paralleled by a decrease in the normal endocrine cell growth pattern from 64.3% to 33.3% and an increase in micronodular hyperplasia (8.9% vs. 16.7%). These changes correlated with the severity of corpus gastritis and seemed to be more disease- than drug-related. No statistically significant changes were observed in the antral G- and D-cell volume densities under therapy.
Long-term omeprazole therapy in humans results in moderate hypergastrinemia and a significant argyrophil cell hyperplasia, which are correlated to the grade of corpus gastritis. Because hypergastrinemia and gastritis are closely related, it is difficult to quantitatively assess their respective role in this process.
慢性药物诱导的高胃泌素血症对胃外分泌和内分泌功能的影响仍未完全明确。大鼠和人类的慢性高胃泌素血症与胃嗜银细胞增生有关。
74例慢性雷尼替丁抵抗性溃疡患者长期接受奥美拉唑治疗（中位观察期48[6 - 84]个月）。
3个月后，空腹血清胃泌素水平中位数从治疗前的74 - 145 pg/mL升高。此后未观察到进一步升高。5年后萎缩性胃炎的检出率从1.8%增至20.8%。平均嗜银细胞体积密度加倍（5年后从0.36%增至0.74%；P < 0.01%），同时正常内分泌细胞生长模式从64.3%降至33.3%，微结节增生增加（从8.9%增至16.7%）。这些变化与胃体胃炎的严重程度相关，似乎更多与疾病而非药物有关。治疗期间胃窦G细胞和D细胞体积密度未观察到统计学显著变化。
人类长期使用奥美拉唑治疗导致中度高胃泌素血症和显著的嗜银细胞增生，这与胃体胃炎的分级相关。由于高胃泌素血症和胃炎密切相关，难以定量评估它们在这一过程中的各自作用。
