Nucci Anita M, Barksdale Edward M, Beserock Natalie, Yaworski Jane Anne, Iurlano Kathy, Kosmach-Park Beverly, Reyes Jorge
Clinical Nutrition Department, Department of Pediatric Surgery, Intestinal Care Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
J Pediatr Surg. 2002 Mar;37(3):460-3. doi: 10.1053/jpsu.2002.30863.
BACKGROUND/PURPOSE: The aim of this study was to describe the long-term nutritional status of a large population of children after intestinal transplantation and to identify factors associated with nutritional outcomes.
Longitudinal anthropometric data are maintained in a database registry for all patients referred to our Intestinal Care Center (ICC). Z-scores for weight and height were calculated biannually over a maximum of 2 years, and associations between baseline and follow-up laboratory measures and growth were evaluated for patients greater than 6 months post intestinal transplant.
Since the inception of the ICC in December 1996, 24 pediatric patients (18 boys, 18 white) received an isolated small bowel or small bowel/liver transplant (median age, 3.2 years). The majority of cases (75%) had been diagnosed with surgical short bowel syndrome and were dependent on total parenteral nutrition (TPN) at the time of transplant. Of the 23 patients who survived the initial postoperative period, 87% were weaned from TPN to an amino-acid or peptide-based enteral formula or solid food within 3 months. A positive trend in z-scores for weight and height/length was observed in only 30% and 26% of patients, respectively, during the follow-up period. Although mean albumin levels increased significantly from 2.8 to 3.1 mg/dl by 6 months posttransplant (P <.01) no difference in alkaline phosphatase was found over time. Steroid doses were weaned within 3 to 4 months after transplantation but not discontinued. The cumulative survival rate was 91% at 1 year and 86% at 2 years posttransplant, whereas those weaned from TPN achieved 100% and 94% survival, respectively.
Attainment of positive linear growth remains a challenge in the pediatric transplant population despite successful liberation from TPN, protein anabolism, and high survival rates. Further investigation into alternative methods of nutritional evaluation and manipulation as well as the use of growth factors to enhance the growth process need to be investigated.
背景/目的：本研究旨在描述大量儿童肠道移植后的长期营养状况，并确定与营养结局相关的因素。
为所有转诊至我们肠道护理中心（ICC）的患者建立了一个数据库登记系统，记录纵向人体测量数据。在最长2年的时间里，每半年计算一次体重和身高的Z评分，并对肠道移植术后6个月以上的患者评估基线和随访实验室指标与生长之间的关联。
自1996年12月ICC成立以来，24例儿科患者（18名男孩，18名白人）接受了孤立小肠或小肠/肝脏移植（中位年龄3.2岁）。大多数病例（75%）被诊断为外科短肠综合征，移植时依赖全胃肠外营养（TPN）。在术后初期存活的23例患者中，87%在3个月内从TPN断奶，改用基于氨基酸或肽的肠内配方奶粉或固体食物。在随访期间，分别只有30%和26%的患者体重和身高/身长的Z评分呈上升趋势。虽然移植后6个月时白蛋白平均水平从2.8显著升至3.1mg/dl（P<.01），但碱性磷酸酶随时间无差异。移植后3至4个月内逐渐减少类固醇剂量，但未停用。移植后1年的累积生存率为91%，2年为86%，而那些从TPN断奶的患者生存率分别达到100%和94%。
尽管成功摆脱TPN、实现蛋白质合成代谢并保持高生存率，但小儿移植人群实现正向线性生长仍然是一项挑战。需要进一步研究替代营养评估和调控方法以及使用生长因子来促进生长过程。
