Quantitative study of digestive enzyme secretion and gastrointestinal lipolysis in chronic pancreatitis
Quantitative study of digestive enzyme secretion and gastrointestinal lipolysis in chronic pancreatitis
复制标题
DOI：
10.1016/s1542-3565(04)00601-9
复制
发表时间：
2005-01-01
影响因子：
12.6
通讯作者：
Laugier, R
中科院分区：
文献类型：
--
作者：
Carrière, F;Grandval, P;Laugier, R
背景与目的：人胃脂肪酶（HGL）在慢性胰腺炎（CP）的整体脂解过程中的作用，以及相关的胰酶水平，很少被提及。本研究旨在量化CP患者与健康志愿者的胰腺和胰腺外酶输出、活性和稳定性。方法：健康志愿者（n = 6）、轻度CP患者（n = 5）和重度CP患者（n = 7）在给药前分别用胃管和十二指肠管插管。通过测定胃和十二指肠样品中HGL、人胰脂肪酶（HPL）、胰凝乳蛋白酶和淀粉酶的活性来评估其浓度。根据脂肪分解产物的定量分析，估计Treitz角下的胃内和全身脂肪分解水平。对体外培养的十二指肠内容物进行了类似的分析，以研究酶的稳定性和脂肪分解的进化。结果：虽然HPL、胰凝乳酶和淀粉酶的输出量都极低，但严重CP患者的HGL输出量（46.8 +/- 31.0 mg）比健康对照组（13.3 +/- 13.8 mg）高3-4倍。然而，在严重CP患者中，胃内脂解并没有增加，这可能是因为胃酸分泌增多导致胃内容物pH值迅速下降。HGL在CP患者的酸性十二指肠内容物中保持活性和高度稳定，总体而言，在没有HPL的情况下，膳食甘油三酯可以实现显著的脂解（控制值的30%）。结论：虽然严重CP患者所有胰酶分泌同时减少，但胃脂肪酶可以部分补偿胰脂肪酶的损失，但不能使总体溶脂活性恢复正常。
Background & Aims: The contribution of human gastric lipase (HGL) to the overall lipolysis process in chronic pancreatitis (CP), as well as the relative pancreatic enzyme levels, rarely are addressed. This study was designed to quantify pancreatic and extrapancreatic enzyme output, activity, and stability in CP patients vs. healthy volunteers. Methods: Healthy volunteers (n = 6) mild CP patients (n = 5), and severe (n = 7) CP patients were intubated with gastric and duodenal tubes before the administration of a test meal. HGL, human pancreatic lipase (HPL), chymotrypsin, and amylase concentrations were assessed in gastric and duodenal samples by measuring the respective enzymatic activities. Intragastric and overall lipolysis levels at the angle of Treitz were estimated based on quantitative analysis of lipolysis products. Similar analyses were performed on duodenal contents incubated ex vivo for studying enzyme stability and evolution of lipolysis. Results: Although HPL, chymotrypsin, and amylase outputs all were extremely low, HGL outputs in patients with severe CP (46.8 +/- 31.0 mg) were 3-4-fold higher than in healthy controls (13.3 +/- 13.8 mg). Intragastric lipolysis did not increase, however, in patients with severe CP, probably because of the rapid decrease in the pH level of the gastric contents caused by a higher gastric acid secretion. HGL remains active and highly stable in the acidic duodenal contents of CP patients, and, overall, can achieve a significant lipolysis of the dietary triglycerides (30% of the control values) in the absence of HPL. Conclusions: Although all pancreatic enzyme secretions are simultaneously reduced in severe CP, gastric lipase can compensate partly for the loss of pancreatic lipase but not normalize overall lipolytic activity.