Zhang Y, Lee B, Thompson M, Glass R, Cama R I, Figueroa D, Gilman R, Taylor D, Stephenson C
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Pediatr Gastroenterol Nutr. 2000 Jul;31(1):16-21. doi: 10.1097/00005176-200007000-00006.
The relationship between intestinal permeability and acute secretory diarrheal syndromes caused by rotavirus and Cryptosporidium parvum in infants less than 36 months of age was studied using the lactulose-mannitol excretion assay.
An oral solution containing 0.4 g/kg lactulose and 0.1 g/kg mannitol was administered to 15 infants with rotavirus, 7 with Cryptosporidium infection and a control group of 7 with secretory diarrhea admitted to the Oral Rehydration Unit of the National Children's Hospital in Lima, Peru. Urinary sugar excretion was measured using an enzymatic spectrophotometric method. The ratio of urinary excretion of lactulose to mannitol was used to measure intestinal mucosal permeability, with higher ratios indicative of increased intestinal permeability. Infants in all three groups were retested 20 days after the initial test.
The (mean +/- SE) lactulose:mannitol (L:M) excretion ratios during the acute phase (day 1) of diarrhea in infants with rotavirus or Cryptosporidium and control infants were 0.67 +/- 0.1, 0.76 +/- 0.16, and 0.26 +/- 0.04, respectively. In the convalescent phase (day 20) the ratios were 0.19 +/- 0.02, 0.28 +/- 0.05, and 0.29 +/- 0.07, respectively. Significant reductions in L:M ratios were noted in rotavirus patients between days 1 and 20 (paired t-test; P < 0.01), Cryptosporidium patients between days 1 and 20 (paired t-test; P < 0.05), and between control subjects on day 1 and rotavirus patients on day 1 and Cryptosporidium patients on day 1 (unpaired t-tests; P < 0.05 for both). There were no significant differences in control subjects between days 1 and 20, control subjects and rotavirus patients on day 20, or control subjects and Cryptosporidium patients on day 20.
The results indicate that increased intestinal permeability caused by rotavirus or cryptosporidium infections in Peruvian infants less than 36 months of age is a significant but reversible phenomenon. The temporal relationship observed in the current study and the contribution of such alterations in intestinal mucosal integrity to the burden of diarrheal disease and the development of malnutrition in developing countries is discussed.
采用乳果糖-甘露醇排泄试验，研究了36个月龄以下婴儿肠道通透性与轮状病毒和微小隐孢子虫引起的急性分泌性腹泻综合征之间的关系。
给秘鲁利马市国立儿童医院口服补液科收治的15例感染轮状病毒的婴儿、7例感染隐孢子虫的婴儿以及7例分泌性腹泻对照组婴儿服用含0.4g/kg乳果糖和0.1g/kg甘露醇的口服溶液。采用酶分光光度法测量尿糖排泄量。乳果糖与甘露醇的尿排泄率用于测量肠黏膜通透性，比率越高表明肠道通透性增加。所有三组婴儿在初次检测20天后再次接受检测。
轮状病毒感染婴儿、隐孢子虫感染婴儿及对照组婴儿腹泻急性期（第1天）的（平均±标准误）乳果糖：甘露醇（L:M）排泄率分别为0.67±0.1、0.76±0.16和0.26±0.04。恢复期（第20天）的比率分别为0.19±0.02、0.28±0.05和0.29±0.07。轮状病毒感染患者在第1天和第20天之间L:M比率显著降低（配对t检验；P<0.01），隐孢子虫感染患者在第1天和第20天之间L:M比率显著降低（配对t检验；P<0.05），第1天的对照组与第1天的轮状病毒感染患者以及第1天的隐孢子虫感染患者之间L:M比率也显著降低（非配对t检验；两者P均<0.05）。第1天和第20天的对照组之间、第20天的对照组与轮状病毒感染患者之间以及第20天的对照组与隐孢子虫感染患者之间均无显著差异。
结果表明，秘鲁36个月龄以下婴儿因轮状病毒或隐孢子虫感染导致的肠道通透性增加是一个显著但可逆的现象。讨论了本研究中观察到的时间关系以及肠道黏膜完整性的此类改变对发展中国家腹泻疾病负担和营养不良发展的影响。
