Mayer Anton-Paul T, Durward Andrew, Turner Charles, Skellett Sophie, Dalton Neil, Tibby Shane M, Murdoch Ian A
Department of Paediatric Intensive Care, Guy's Hospital, Saint Thomas Street, London, SE1 9RT, UK.
Intensive Care Med. 2002 Mar;28(3):336-40. doi: 10.1007/s00134-002-1224-7. Epub 2002 Feb 8.
Amylin is a novel 37 amino acid that is secreted together with insulin from the pancreas in response to enteral nutrient intake. As a potent inhibitor of gastric motility it plays an important role in the control of carbohydrate absorption. In this study we aimed to determine the relationship between amylin levels and gastric emptying in critically ill children.
Prospective interventional study.
Tertiary paediatric intensive care unit.
Twenty-three patients were studied following admission to a paediatric intensive care unit. The median age (25th-75th centiles) was 5.8 years (1.5-11.6) and weight 20 kg (12.8-47.5).
Patients were defined as feed-intolerant on the basis of gastric residual volume greater than 125% 4 h after a feed challenge. Three objective measures of gastric emptying were then calculated from a 6 h paracetamol absorption test. Blood glucose, serum insulin and amylin levels were averaged across the paracetamol absorption test period.
Eight patients were classified as feed-intolerant (nTOL) and 15 as feed-tolerant (TOL) [median gastric residual volumes 321% (261-495) and 4% (0-6), respectively]. Gastric emptying was delayed in the feed-intolerant group as assessed by all paracetamol absorption test parameters ( p< or =0.01). The median serum amylin concentration was significantly higher in the feed-intolerant group [nTOL 47.0 (37.7-54.8) versus TOL 22.7 (13.6-26.7) pmol/l, p<0.0001]. A positive correlation between serum amylin and insulin was observed ( r=0.46, p=0.02) but not between amylin and glucose ( r=0.25, p=0.23).
The use of gastric residual volumes to define feed intolerance is justified in critically ill children. High serum amylin levels are associated with delayed gastric emptying in these patients. The correlation between serum amylin and insulin levels indicates a degree of preservation of pancreatic hormonal co-release.
胰淀素是一种含37个氨基酸的新型肽，在肠道营养摄入时与胰岛素一起从胰腺分泌。作为胃动力的强效抑制剂，它在碳水化合物吸收的控制中起重要作用。在本研究中，我们旨在确定危重症儿童胰淀素水平与胃排空之间的关系。
前瞻性干预研究。
三级儿科重症监护病房。
23例入住儿科重症监护病房的患者接受了研究。中位年龄（第25至75百分位数）为5.8岁（1.5至11.6岁），体重20 kg（12.8至47.5 kg）。
以喂养挑战后4小时胃残余量大于125%为依据，将患者定义为不耐受喂养。然后通过6小时对乙酰氨基酚吸收试验计算三项胃排空的客观指标。在对乙酰氨基酚吸收试验期间，对血糖、血清胰岛素和胰淀素水平进行平均。
8例患者被分类为不耐受喂养（nTOL），15例为耐受喂养（TOL）[中位胃残余量分别为321%（261至495）和4%（0至6）]。根据所有对乙酰氨基酚吸收试验参数评估，不耐受喂养组的胃排空延迟（p≤0.01）。不耐受喂养组的血清胰淀素浓度中位数显著更高[nTOL为47.0（37.7至54.8）pmol/l，而TOL为22.7（13.6至26.7）pmol/l，p<0.0001]。观察到血清胰淀素与胰岛素之间呈正相关（r = 0.46，p = 0.02），但胰淀素与葡萄糖之间无相关性（r = 0.25，p = 0.23）。
在危重症儿童中，使用胃残余量来定义喂养不耐受是合理的。这些患者血清胰淀素水平高与胃排空延迟有关。血清胰淀素与胰岛素水平之间的相关性表明胰腺激素共同释放有一定程度的保留。
