用胆酰肌氨酸进行胆汁酸替代疗法治疗短肠综合征。

Bile acid replacement therapy with cholylsarcosine for short-bowel syndrome.

作者信息

Heydorn S, Jeppesen P B, Mortensen P B

机构信息

Dept. of Medicine CA-2121, Rigshospitalet, University of Copenhagen, Denmark.

出版信息

Scand J Gastroenterol. 1999 Aug;34(8):818-23. doi: 10.1080/003655299750025769.

DOI:10.1080/003655299750025769

PMID:10499484

Abstract

BACKGROUND

Fat malabsorption in the short-bowel syndrome (SBS) may in part be caused by decreased bile secretion. Cholylsarcosine is a synthetic conjugated bile acid resistant to bacterial degradation with no cathartic activity.

METHODS

Metabolic balance studies were performed in four patients with SBS, two with a colon and two with a jejunostomy.

RESULTS

Treatment with cholylsarcosine, 6 and 12 g/day, increased fat absorption by 17 +/- 3 g/day (0.7 MJ/day; P <0.05) and 20+/-1 g/day (0.8 MJ/day; P <0.001; mean +/- standard error), respectively, to a total absorption of energy from fat of 2.0-2.2 MJ/day. Total absorption of energy increased from 11.0 MJ/day to 11.7 MJ/day (bomb calorimetry). Energy absorbed from carbohydrates (6.5 MJ/day) did not change. Faecal output increased in one of the patients with a colon and was unchanged in the other three patients. A higher percentage of the medium-chain and the unsaturated fatty acids were absorbed in comparison with the long-chain and the saturated fatty acids (100% of C8:0, 92% of C10:0, 74% of C12:0, 52% of C14:0, 30% of C16:0, 16% of C18:0, and 47% of unsaturated C18 fatty acids). Treatment with cholylsarcosine increased absorption of C14:0 by 23%-29%, of C16:0 by 59%-74%, of C18:0 by 125%-138%, and of unsaturated C18-fatty acids by 36%-45%. A fifth patient (without a colon) was enrolled in the study but had to be excluded because cholylsarcosine, 6 g/day, resulted in nausea and anorexia.

CONCLUSION

Cholylsarcosine increased fat absorption in SBS. The effect was relatively more pronounced on absorption of the low-absorbable, longer-chained, and saturated fatty acids. The overall gain in absorption of energy was small (6%) because energy absorption from carbohydrates was threefold higher than that from fat. Cholylsarcosine may have cathartic effects on some SBS patients with a colon. The maximal efficacy of cholylsarcosine was reached at a dose of 6 g/day, compared with 12 g/day in three of four patients.

摘要

背景

短肠综合征（SBS）中的脂肪吸收不良部分可能是由于胆汁分泌减少所致。胆酰肌氨酸是一种合成的结合胆汁酸，对细菌降解具有抗性且无导泻活性。

方法

对4例短肠综合征患者进行了代谢平衡研究，其中2例有结肠，2例为空肠造口术患者。

结果

分别给予胆酰肌氨酸6克/天和12克/天治疗，脂肪吸收量分别增加了17±3克/天（0.7兆焦/天；P<0.05）和20±1克/天（0.8兆焦/天；P<0.001；平均值±标准误），脂肪的总能量吸收达到2.0 - 2.2兆焦/天。总能量吸收从11.0兆焦/天增加到11.7兆焦/天（弹式量热法）。碳水化合物吸收的能量（6.5兆焦/天）未发生变化。1例有结肠的患者粪便量增加，其他3例患者粪便量未变。与长链和饱和脂肪酸相比，中链和不饱和脂肪酸的吸收百分比更高（C8:0为100%，C10:0为92%，C12:0为74%，C14:0为52%，C16:0为30%，C18:0为16%，不饱和C18脂肪酸为47%）。胆酰肌氨酸治疗使C14:0的吸收增加了23% - 29%，C16:0的吸收增加了59% - 74%，C18:0的吸收增加了125% - 138%，不饱和C18脂肪酸的吸收增加了36% - 45%。第5例患者（无结肠）纳入研究，但因给予6克/天胆酰肌氨酸导致恶心和厌食而不得不排除。