Debru E, Martin G R, Sigalet D L
Department of Surgery, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
J Pediatr Surg. 2001 May;36(5):745-9. doi: 10.1053/jpsu.2001.22951.
The management of patients with short bowel syndrome is complicated by the paucity of methods to assess in vivo the absorptive capacity of the remaining bowel. The purpose of this experiment was to assess the feasibility of using urinary recovery of 3-0 methylglucose (3-0 MG) as a quantitative measure of carbohydrate absorptive capacity, comparing it with in vivo absorption and in vitro glucose transport studies.
Male Sprague Dawley rats underwent either a 90% proximal small bowel resection or sham resection (n = 8 in each group). Animals were pair fed, weighed, and followed up for 14 days. A 3-day balance study was done, measuring feed intake and fecal output for percentages of fat and energy absorption. Animals were gavaged with 3-0 MG/Mannitol solution, and 4-hour urinary recovery of sugars was assessed using high-performance liquid chromatography (HPLC). On different days these studies were repeated with increasing amounts of added normal glucose (1 mol/L, 1.25 mol/L, and 1.5 mol/L) in the gavage solution given to compete for 3-0 MG transport, and thus increase the "sensitivity" of the test. Animals were then killed, and sections of intestine taken for in vitro assessment of glucose transport using radiolabeled 3-0 MG in Ussing chambers.
Total energy, carbohydrate, and fat absorption all were reduced significantly in the resected animals, as was 3-0 MG urinary recovery (62.9 +/- 10.5%) in controls versus (35.8 +/- 17.5%) in resected animals (P <.05). 3-0 MG urinary recovery correlated well with dietary carbohydrate absorption (r = 0.74), and with Ussing chamber measures of glucose flux (r = 0.97). Adding exogenous glucose to the test solution to "compete" for 3-0 MG transport sites did not improve sensitivity.
These results show that 3-0 MG is useful in measuring nutrient absorption capacity in rats after massive small bowel resection. Further studies to validate these methods in human patients with short bowel syndrome are suggested.
短肠综合征患者的管理因缺乏评估剩余肠道体内吸收能力的方法而变得复杂。本实验的目的是评估使用3 - O - 甲基葡萄糖（3 - O - MG）的尿回收率作为碳水化合物吸收能力的定量指标的可行性，并将其与体内吸收和体外葡萄糖转运研究进行比较。
雄性Sprague Dawley大鼠接受90%近端小肠切除术或假手术切除（每组n = 8）。动物进行配对喂养、称重，并随访14天。进行为期3天的平衡研究，测量饲料摄入量和粪便输出量，以计算脂肪和能量吸收的百分比。给动物灌胃3 - O - MG/甘露醇溶液，使用高效液相色谱法（HPLC）评估4小时尿糖回收率。在不同日期，在灌胃溶液中添加递增剂量的正常葡萄糖（1 mol/L、1.25 mol/L和1.5 mol/L）以竞争3 - O - MG转运，从而提高测试的“敏感性”，重复这些研究。然后处死动物，取肠段在Ussing室中使用放射性标记的3 - O - MG进行体外葡萄糖转运评估。
切除组动物的总能量、碳水化合物和脂肪吸收均显著降低，对照组的3 - O - MG尿回收率为（62.9±10.5%），切除组为（35.8±17.5%）（P <.05）。3 - O - MG尿回收率与膳食碳水化合物吸收（r = 0.74）以及Ussing室葡萄糖通量测量值（r = 0.97）密切相关。向测试溶液中添加外源性葡萄糖以“竞争”3 - O - MG转运位点并未提高敏感性。
这些结果表明，3 - O - MG可用于测量大鼠大量小肠切除后的营养吸收能力。建议进一步开展研究以验证这些方法在短肠综合征人类患者中的有效性。
