胃泌素瘤的临床特点分析和诊断方法比较

Clinical Features and Comparison of Diagnostic Methods of Gastrinoma

背景:胃泌素瘤为一少见的神经内分泌肿瘤,临床诊断困难。目的:总结胃泌素瘤的临床特点,以提高其诊断水平。方法:回顾性分析北京协和医院1983年1月～2006年12月收治的23例胃泌素瘤患者的临床资料。结果:本组患者从出现症状到确诊平均需(5.5±0.9)年,确诊时合并肝转移者占60.9%。临床表现以腹痛(91.3%)、腹泻(78.3%)为主。胃泌素瘤腹泻多为水泻(88.9%),抑酸剂可缓解症状(94.4%)。胃液分析和空腹血清胃泌素测定的诊断敏感性分别为76.9%和45.5%。生长抑素受体显像对胃泌素瘤诊断率较高(90.0%)。胃泌素瘤可同时分泌其他肽类激素,本组胃泌素瘤80%分泌2种以上激素,50%分泌3种激素。结论:胃泌素瘤的腹泻发生率近80%,仅次于最常见的腹痛症状,临床上不容忽视,其特点为水泻,且抑酸剂治疗有效。生长抑素受体显像对胃泌素瘤诊断率较高。

Background： Gastrinoma is a rare neuroendocrine tumor, which is difficult to diagnose in clinical practice. Aims： To summarize the clinical features of gastrinoma, and to increase its diagnosis rate. Methods： Clinical data of 23 patients with gastrinoma admitted from Jan. 1983 to Dec. 2006 in PUMC Hospital were analyzed retrospectively. Results： It took a period of （5.5±0.9） years from initial presentation till confirmation of diagnosis in gastrinoma patients enrolled in this study, and 60.9% of patients had liver metastases when the diagnosis was confirmed. The predominant symptoms of gastrinoma were abdominal pain （91.3%） and diarrhea （78.3%）. 88.9% of patients with diarrhea were watery, which could be relieved by acid inhibitors （94.4%）. The sensitivities of gastric acid output and fasting serum gastrin measurements were 76.9% and 45.5%, respectively. Somatostatin receptor imaging （SR1） had a high diagnostic sensitivity （90.0%）. Other gastrointestinal peptide hormones could also be secreted by gastrinoma, 80% of the tumors secreted more than two kinds of hormone, and 50% of the tumors secreted three kinds of hermone. Conclusions： The occurrence rate of diarrhea in gastrinoma is nearly 80%, just less than the abdominal pain, which is the most common symptom. Diarrhea should be paid more attention in clinical practice. The feature of diarrhea is watery, and acid inhibitors is effective. SRI has a high diagnosis rate in gastrinoma.