Arterial Stimulation and Venous Sampling for Glucagonomas of the Pancreas
Arterial Stimulation and Venous Sampling for Glucagonomas of the Pancreas
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DOI：
10.5754/hge11392
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Nagano, Hiroaki
中科院分区：
文献类型：
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作者：
Eguchi, Hidetoshi;Tanemura, Masahiro;Nagano, Hiroaki
背景/目的：动脉刺激和静脉采样（ASVS）是一种基于导管的诊断技术，用于确定胰岛素瘤或胃泌素瘤的定位。本研究的目的是阐明ASVS对胰高血糖素瘤的临床意义。方法：8例胰腺富血管肿瘤患者，外周血中血清胰高血糖素水平升高。进行胰腺血管造影术，并向合适的动脉注射团注剂量的钙艾德。然后获得肝静脉血液样品以测量胰高血糖素和胰岛素的浓度。所有患者均行手术切除，并对切除的标本进行免疫组化研究。结果：与胰岛素相比，4例患者的胰高血糖素水平在钙刺激后稳定，增加或减少1.2倍。在其余4名患者中，胰高血糖素水平增加了1.6至5.8倍。胰高血糖素的峰值出现在90 s或120 s，比胰岛素瘤患者的胰岛素峰值慢。ASVS期间胰高血糖素水平升高的患者在切除标本中胰高血糖素免疫染色呈阳性。结论：在胰高血糖素瘤患者中观察到钙刺激后胰高血糖素增加。胰高血糖素瘤的ASVS可能有助于确定最合适的外科手术。
Background/Aims: Arterial stimulation and venous sampling (ASVS) is a catheter-based diagnostic technique used to identify the localization of an insulinoma or gastrinoma. The aim of this study was to clarify the clinical significance of ASVS for glucagonomas. Methodology: Eight patients with pancreatic hypervascular tumors and elevated serum glucagon levels in the peripheral blood were enrolled. Pancreatic angiography was performed and a bolus dose of calcium was inject, ed into a suitable artery. Hepatic venous blood samples, were then obtained to measure concentrations of glucagon and insulin. All patients underwent surgical resection, and the resected specimens were investigated immunohistochemically. Results: Compared to insulin, the glucagon levels stabilized after calcium stimulation in four patients, with a 1.2-fold increase or decrease. In the remaining four patients, there was a 1.6- to 5.8-fold increase in glucagon levels. The peak value of glucagon was observed at 90s or 120s which was slower than the insulin peak observed in patients with insulinoma. The patients with elevated glucagon levels during ASVS exhibited positive immunostaining of glucagon in resected specimens. Conclusions: Increase in glucagon after calcium stimulation was observed in patients with glucagonomas. ASVS for glucagonomas may be useful in determining the most suitable surgical procedure.