摘要

胃酸分泌一直被认为随着年龄的增长而减少，但随着幽门螺杆菌感染的重要性逐渐显现，这种观点正在被重新评估。本研究旨在确定年龄、幽门螺杆菌和胃炎伴萎缩对健康无症状男性血清胃泌素浓度、胃分泌量和酸输出的影响。年轻男性(平均(SD)年龄22.9(0.6)岁;N = 22)与老年男性(72.9(1.2)岁;N = 28)对基础血清胃泌素和基础饲、假饲的胃泌素的最大分泌量和峰值分泌量有刺激作用。取胃窦、体部和基底活检标本进行组织学检查和幽门螺杆菌状态(组织学、培养和快速脲酶试验)。22名年轻男性中3名(13.6%)和28名老年男性中16名(57.1%)存在幽门螺杆菌相关性胃炎。11例老年受试者出现胃炎伴萎缩，其中10例为幽门螺杆菌阳性。这些受试者的平均血清胃泌素浓度(SD)高于无萎缩的老年受试者和年轻受试者(61.8 (9.2);40.0 (2.9); 36.8 (2.3) pmol/l respectively; p < 0.001). H pylori infected subjects had higher gastrin values than uninfected subjects, overall (55.3 (5.9); 36.0 (1.8) pmol/l; p < 0.001) and in subjects without atrophy (45.3 (4.2); 36.0 (1.8) pmol/l; p < 0.03). In subjects without H pylori infection, gastrin values did not differ with age (old 37.1 (1.7); young 35.4 (2.1) pmol/l). The maximal gastric secretory volume was lower in old subjects with atrophy. Acid output (mmol/h) in subjects with atrophy was lower than in subjects with no atrophy (basal: 3.0(1.1); 5.1(0.7); p=NS; sham led: 5.4 (1.4); 9.3 (0.8); p<0.02; maximal: 18.9 (4.0); 31.4(1.8); p<0.002; peak: 25.1(5.3); 43.4(2.7); p<0.003). However, acid secretion in old subjects without atrophy was not different to that in young subjects, irrespective of H pylori status. These results did not differ when acid output was expressed as mmol/h/kg lean body mass or mmol/h/kg fat free body weight. Using multiple linear regression analysis, gastritis with atrophy was the only factor that had an independent negative effect on acid secretion. In healthy men without atrophy, gastric acid secretion is preserved with ageing and is independent of H pylori status. Atrophy, which is closely related to H pylori infection, is associated with a decline in acid secretion. Increased basal serum gastrin is related to both atrophy and H pylori infection but not to ageing per se.