胃肠激素在肝硬变胃粘膜病变发病机制中的作用

Significance of gut hormones in pathogenesis of gastric mucosal lesion in liver cirrhosis

目的探讨胃肠激素（ＧＩＨ）在肝硬变胃粘膜病变发病机制中的意义．方法用ＲＩＡ法测定临床诊断为肝硬变伴胃粘膜病变（ＣＧＭＬ）１７例，肝硬变（ＬＣ）３２例，胃溃疡（ＧＵ）１０例，轻度浅表性胃炎（ＣＳＧ）２３例及正常对照者３６例的空腹血浆生长抑素（ＳＳ），血管活性肠肽（ＶＩＰ），胃动素（ＭＴＬ）及促胃液素（Ｇａｓ）的变化，并结合各疾病组的内镜特点，分析ＣＧＭＬ与某些ＧＩＨ的关系．结果血浆ＳＳ水平（ｎｇ／Ｌ）在ＣＧＭＬ及ＧＵ组分别为４１２±２１２及３７６±１４３，与正常对照组（６１２±１７０）、ＬＣ组（６６２±３０９），ＣＳＧ组（６４８±３９１）比较，Ｐ均＜００１；ＶＩＰ浓度（ｎｇ／Ｌ）则在ＣＧＭＬ组（６３４±３５８）、ＧＵ组（１１０９±４２４）、ＬＣ组（７７８±４２６）及ＣＳＧ组（６３４±３４７）均高于正常对照组（３２７±１４４），Ｐ均＜００１．ＣＧＭＬ，ＧＵ及ＣＳＧ具不同的内镜特点；ＣＧＭＬ的发病与食管静脉曲张（ＥＶ）关系密切，随ＥＶ程度的加重，发病率有增高的趋势．结论ＣＧＭＬ发病与门脉高压关系密切，激素代谢紊乱可能通过影响内脏血流及粘膜抗损害能力而参与其形成．

IM To investigate the significance of gastrointestinal hormones (GIH) in the pathogenesis of gastric mucosal lesion in liver cirrhosis.METHODS Abstract:Plasma levels of somatostatin (SS), vasoactive intestinal peptide (VIP), motilin (MTL) and gastrin (Gas) in 17 patients with liver cirrhosis gastric mucosal lesion (CGML), 32 liver cirrhosis (LC), 10 gastric ulcer (GU), 23 chronic superficial gastritis (CSG) and 36 healthy controls were measured by radioimmunoassay. The relationship between CGML and GIH, the gastroscopic characterestics of each group was analyzed.RESULTS Plasma levels of SS (ng/L) in patients with CGML and GU were 412±212 and 376±143 respectively, significantly lower than those in normal control group (612±170, P<001) and CSG group (648±391, P<001). VIP levels (ng/L) in each desease group were higher than those in normal control group, and the highest level was in GU group (1109±424) being significantly different from any other groups (P<001). There were different gastroscopic characteristics in CGML, GU and CSG groups. A close relationship between the pathogenesis of CGML and esophageal varices (EV) was found. The more the degree of EV was, the higher morbidity rate of CGML.CONCLUSION The pathogenesis of CGML is closely related to portal hypertension, metabolic disfunction of GIH influencing the blood flow of internal organs and the anti-injury ability of mucosa.