Prevalence of peptic ulcer in patients undergoing maintenance hemodialysis

Renal failure is said to be a risk factor for peptic ulceration, although most previous studies were small and utilized radiology rather than endoscopy for diagnosis. We endoscoped 114 of 126 patients with end-stage renal failure on maintenance hemodialysis and found peptic ulcer in two (2%);one other patient not endoscoped had previously undergone ulcer surgery. Erythema, petechial spots, or erosions were found in another 58 patients (51%). The ranges of gastric acid output and serum gastrin were wide and were inversely correlated. The prevalence of peptic ulcer among patients on hemodialysis therefore appeared to be no higher than that in the general population. Elevated serum gastrin levels may be a response to hypochlorhydria.     

血清神经元特异性烯醇酶和胃泌素用于肺癌的临床价值

检测３０例正常对照、２５例良性肺疾病、５５例非小细胞肺癌（ＮＳＣＬＣ）和１５例小细胞肺癌（ＳＣＬＣ）患者血清神经元特异性烯醇酶（ＮＳＥ）和胃泌素及其在治疗前后的动态变化，结果显示，血清ＮＳＥ和胃泌素在４组间差异有极显著性（Ｐ＜０００１），ＮＳＥ均值分别为８２２、１０８４、１４６４和３２００μｇ／Ｌ，胃泌素均值分别为５９４７、８２００、２２１５３和３５６８６ｎｇ／Ｌ。以２０３μｇ／Ｌ（ＮＳＥ）和８１４ｎｇ／Ｌ（胃泌素）为正常参考值上限，ＮＳＥ阳性率分别是８０％（ＳＣＬＣ）和１４５４％（ＮＳＣＬＣ），胃泌素分别是８０％（ＳＣＬＣ）和６３６３％（ＮＳＣＬＣ）。肺癌治疗后血清ＮＳＥ和胃泌素在ＳＣＬＣ组均显著下降（Ｐ＜０００１），而ＮＳＣＬＣ组仅有胃泌素降低（Ｐ＜０００１）。因此，ＮＳＥ主要用于ＳＣＬＣ的诊断、组织学分型及疗效监测，而胃泌素可以用于各型肺癌，两者联合可以提高临床应用价值。     

Inhibition of gastric acid secretion in humans by glucagon during euglycemia,hyperglycemia, and hypoglycemia

The effect of intravenous infusion of glucagon in a dose of 85 pmol/kg/hr on submaximal pentagastrin-stimulated gastric acid secretion was studied in eight healthy volunteers. The study was repeated four times in each subject. By a glucose-insulin clamp technique blood glucose levels were kept constant during the studies at 5.0 mmol/liter (euglycemic clamp), 2.5 mmol/liter (hypoglycemic clamp), or 7.0 mmol/liter (hyperglycemic clamp) on three different days. Glucose and insulin were not infused during one control day study. During glucagon infusion, plasma glucagon levels increased but the level reached was lower during the hyperglycemic condition when compared to euglycemic and hypoglycemic conditions. Glucagon infusion inhibited gastric acid secretion during hyper- and euglycemic conditions but not during hypoglycemic conditions. Hyperglycemia caused a modest but significant inhibition of acid secretion. Serum gastrin concentrations were unaltered during glucagon infusion regardless of the level of blood glucose. The present observations indicate that the inhibitory effect of glucagon is independent of the glucagon-induced hyperglycemia, but the effect is lost when blood glucose is below a certain limit, suggesting that blood glucose may have a modulating effect on gastric acid secretion.This study was supported by the Danish Hospital Foundation for Medical Research. Region of Copenhagen, The Faroe Islands and Greenland.     

Reciprocal changes in antral gastrin and somatostatin mRNA in pernicious anemia

Somatostatin is involved in the regulation of gastrin by intragastric pH in animal models. To investigate whether this is so in man, we measured gastrin and somatostatin mRNA in endoscopic biopsies from six patients with hypergastrinemia and achlorhydria due to pernicious anemia and 12 age- and sex-matched controls. The pernicious anemia patients had significantly higher fasting plasma gastrin concentrations with a median (range) of 640 (420–3500) pmol/liter compared with 5 (2–58) pmol/liter,P<0.001. The median gastrin mRNA/rRNA ratio was 10.4 (3.7–38.0) in the pernicious anemia patients compared with 1.7 (0.7–8.3) in the controls (P<0.02), and it correlated strongly with the plasma gastrin concentration,r=0.93,P<0.0001. In contrast, the median somatostatin mRNA/rRNA ratio was lower in the pernicious anemia patients 0.84 (0.58–2.32) versus 2.04 (0.05–6.47) in the controls,P<0.05. These findings suggest that in pernicious anemia gastric neutralization leads to hypergastrinemia through the modulation of antral gastrin synthesis by somatostatin.     

血清试餐胃泌素监测十二指肠溃疡患者幽门螺杆菌根除效果的研究

为探讨十二指肠溃疡（ＤＵ）患者血清试餐胃泌素（ＭＳＧ）对幽门螺杆菌（ＨＰ）感染的反应，评估抗ＨＰ治疗后ＭＳＧ的降低水平及其用于判定ＨＰ根除效果的可靠性，对５２例ＨＰ阳性ＤＵ患者治疗前后分别进行胃镜检查，取胃粘膜ＨＰ培养、病检及快速尿素酶试验，并测定其血清ＭＳＧ浓度。结果发现，ＤＵ患者血清ＭＳＧ浓度（１５４８±６３８ｐｇ／ｍｌ）较对照组（６０９±２５８ｐｇ／ｍｌ）明显升高（Ｐ＜０００１），但经治疗后，ＨＰ被根除者ＭＳＧ明显下降（５６５±１７７ｐｇ／ｍｌ），与治疗前比较差异有非常显著性（Ｐ＜０００１）。ＨＰ未根除者ＭＳＧ下降不明显（１２８２±２３５ｐｇ／ｍｌ），与治疗前比较差异无显著性（Ｐ＞００５）。如果以ＭＳＧ下降率≥３０％视为ＨＰ根除，与ＨＰ培养、病检及尿素酶方法比较，其敏感性为８７０％，特异性为８３３％，阳性预测值９７５％，阴性预测值４５５％，准确性８６５％。提示ＨＰ感染可引起ＤＵ患者血清ＭＳＧ升高，ＨＰ根除后则迅速下降，其一定范围的降低幅度可能对判定ＨＰ根除是一可靠的，无创伤性的较好指标     

急性脑血管病患者血清胃泌素的临床研究

目的：了解脑血管病患者血清胃泌素含量的动态变化及与临床的关系。方法：应用放射免疫法测量40例脑出血和60例脑梗死患者于发病后第3、7、14、21天血清胃泌素的含量，并与40例对照组比较。结果：急性脑血管病患者发病后血清胃泌素水平升高，随着病程延长逐步降低，峰值时间为第7天，第21天降至对照组范围。在各时间点疾病组间无明显差异。脑出血未破入脑室或无消化道出血者，血清胃泌素水平在第21天降至正常；而破入脑室或伴消化道出血者，在第21天时血清胃泌素仍高于正常对照组。血清胃泌素水平与出血量有关。结论：脑血管病患者于发病后血清胃泌素水平变化与临床有密切关系，这为应用抗酸剂治疗提供了理论依据。