消化性溃疡患者的胃排空功能与胃肠激素变化

Changes of Gastric Emptying and Gut Hormones in Patients with Peptic Ulcer

目的：研究消化性溃疡患者治疗前后的胃排空功能与血浆基础胃肠激素水平变化。方法：以１５例健康志愿者为正常对照组，应用公认的“金标准”放射性核素法观察经内镜检查证实的１５例活动期十二指肠溃疡和１０例活动期胃溃疡患者治疗前后的胃排空功能，并深入分析其全胃、近端胃和远端胃排空情况；同时应用放射免疫法检测对照者和患者治疗前后的血浆基础胃泌素（ＧＡＳ）、胃动素（ＭＯＴ）、胰高血糖素（Ｇｌｕ）、血管活性肠肽（ＶＩＰ）和降钙素基因相关肽（ＣＧＲＰ）水平。结果：治疗前后，十二指肠溃疡和胃溃疡患者在进食４５ ｍｉｎ后均存在胃排空延迟（Ｐ＜０．０５），近端胃排空始终与正常对照者无显著差异，远端胃排空分别在进食３０ｍｉｎ和２０ ｍｉｎ后显著延迟（Ｐ＜０．０５）。消化性溃疡患者治疗前后的血浆ＧＡＳ、Ｇｌｕ和ＶＩＰ水平与正常对照者无显著差异；ＭＯＴ水平在治疗前显著增高（Ｐ＜０．０５），治疗后恢复正常；ＣＧＲＰ水平在治疗前后均显著减低（Ｐ＜０．０５）。结论：消化性溃疡患者存在远端胃排空障碍，可能参与了溃疡的发生机制，而与血浆ＧＡＳ、ＭＯＴ、Ｇｌｕ、ＶＩＰ和ＣＧＲＰ水平无关。治疗前ＭＯＴ水平增高可能系反馈性升高；ＣＧＲＰ水平减低可能是溃疡发?

Background/Aims: To study the changes of gastric emptying and the plasma levels of gut hormones in pa- tients with peptic ulcer before and after treatment. Methods: Radionuclide method as gold-standard for measur- ing gastric emptying was used in 15 endoscopy-proven active duodenal ulcer and 10 active gastric ulcer patients before and after treatment, and 15 healthy volunteers were taken as controls. The emptying of whole stomach, proximal and distal stomach were analyzed. The plasma levels of gastrin (GAS), motilin (MOT), glucagon (Glu), vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) were measured by radioim- munoassay. Results: Delayed gastric emptying was observed 45 mm after meal in both duodenal and gastric ul- cer patients before and after treatment (P<0.05), which was originating from dysfunction of distal stomach (P< 0.05) (in duodenal ulcer patients, the delayed gastric emptying occured 30 mm after meal and in gastric ulcer pa- tients, 20 mm after meal). No change was found in plasma levels of GAS, Glu and VIP in peptic ulcer patients with or without treatment. The MOT level increased significantly before treatment (P< 0.05) and returned to normal after treatment. However, the CGRP level decreased significantly before and after treatment (P< 0.05). Conclusions: Delayed emptying of distal stomach exists in peptic ulcer patients, which may play a role in its pathogenesis and it is not related with the plasma levels of GAS, MOT, Glu, VIP and CGRP. The increased MOT level before treatment may be due to a feedback mechanism, and the decreased CGRP level may be another pathogenic factor of peptic ulcer.