慢性心力衰竭患者肠道功能改变

Altered intestinal function in patients with chronic heart failure.

作者信息

Sandek Anja, Bauditz Juergen, Swidsinski Alexander, Buhner Sabine, Weber-Eibel Jutta, von Haehling Stephan, Schroedl Wieland, Karhausen Tim, Doehner Wolfram, Rauchhaus Mathias, Poole-Wilson Philip, Volk Hans-Dieter, Lochs Herbert, Anker Stefan D

机构信息

Department of Gastroenterology, Charite, Campus Mitte, Berlin, Germany.

出版信息

J Am Coll Cardiol. 2007 Oct 16;50(16):1561-9. doi: 10.1016/j.jacc.2007.07.016. Epub 2007 Oct 1.

DOI:10.1016/j.jacc.2007.07.016

PMID:17936155

Abstract

OBJECTIVES

We evaluated morphology and function of the gut in patients with chronic heart failure (CHF).

BACKGROUND

Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal.

METHODS

We studied 22 patients with CHF (age 67 +/- 2 years, left ventricular ejection fraction [LVEF] 31 +/- 1%, New York Heart Association functional class 2.3 +/- 0.1, peak VO2 15.0 +/- 1.0 ml/kg/min) and 22 control subjects (62 +/- 1 years, LVEF 68 +/- 2%, peak VO2 24.7 +/- 1.3 ml/kg/min). Bowel wall thickness was assessed by transcutaneous sonography, small intestinal permeability by the lactulose-mannitol test, passive carrier-mediated transport by D-xylose test, large intestinal permeability by sucralose test (5- and 26-h urine collection, high-performance liquid chromatography), and mucosal bacterial biofilm by fluorescence in situ hybridization in biopsies taken during sigmoidoscopy.

RESULTS

Chronic heart failure patients, compared with control patients, showed increased bowel wall thickness in the terminal ileum (1.48 +/- 0.16 mm vs. 1.04 +/- 0.08 mm), ascending colon (2.32 +/- 0.18 mm vs. 1.31 +/- 0.14 mm), transverse colon (2.19 +/- 0.20 vs. 1.27 +/- 0.08 mm), descending colon (2.59 +/- 0.18 mm vs. 1.43 +/- 0.13 mm), and sigmoid (2.97 +/- 0.27 mm vs. 1.64 +/- 0.14 mm) (all p < 0.01). Chronic heart failure patients had a 35% increase of small intestinal permeability (lactulose/mannitol ratio: 0.023 +/- 0.001 vs. 0.017 +/- 0.001, p = 0.006), a 210% increase of large intestinal permeability (sucralose excretion: 0.62 +/- 0.17% vs. 0.20 +/- 0.06%, p = 0.03), and a 29% decrease of D-xylose absorption, indicating bowel ischemia (26.7 +/- 3.0% vs. 37.4 +/- 1.4%, p = 0.003). Higher concentrations of adherent bacteria were found within mucus of CHF patients compared with control subjects (p = 0.007).

CONCLUSIONS

Chronic heart failure is a multisystem disorder in which intestinal morphology, permeability, and absorption are modified. Increased intestinal permeability and an augmented bacterial biofilm may contribute to the origin of both chronic inflammation and malnutrition.

摘要

目的

我们评估了慢性心力衰竭（CHF）患者肠道的形态和功能。

背景

细菌内毒素的肠道易位可能导致CHF患者出现炎症状态。肠道的形态和功能可能异常。

方法

我们研究了22例CHF患者（年龄67±2岁，左心室射血分数[LVEF] 31±1%，纽约心脏协会心功能分级2.3±0.1，峰值摄氧量15.0±1.0 ml/kg/min）和22例对照受试者（62±1岁，LVEF 68±2%，峰值摄氧量24.7±1.3 ml/kg/min）。通过经皮超声评估肠壁厚度，通过乳果糖-甘露醇试验评估小肠通透性，通过D-木糖试验评估被动载体介导转运，通过三氯蔗糖试验（收集5小时和26小时尿液，采用高效液相色谱法）评估大肠通透性，并通过乙状结肠镜检查时获取的活检组织进行荧光原位杂交评估黏膜细菌生物膜。

结果

与对照患者相比，CHF患者的回肠末端肠壁厚度增加（1.48±0.16 mm对1.04±0.08 mm），升结肠（2.32±0.18 mm对1.31±0.14 mm），横结肠（2.19±0.20对1.27±0.08 mm），降结肠（2.59±0.18 mm对1.43±0.13 mm）和乙状结肠（2.97±0.27 mm对1.64±0.14 mm）（均p<0.01）。CHF患者的小肠通透性增加35%（乳果糖/甘露醇比值：0.023±0.001对0.017±0.001，p = 0.006），大肠通透性增加210%（三氯蔗糖排泄：0.62±0.17%对0.20±0.06%，p = 0.03），D-木糖吸收减少29%，提示肠道缺血（26.7±3.0%对37.4±1.4%，p = 0.003）。与对照受试者相比，CHF患者黏液中黏附细菌的浓度更高（p = 0.007）。