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瓜氨酸作为因肠细胞数量减少导致肠衰竭的生物标志物。

Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction.

作者信息

Crenn Pascal, Messing Bernard, Cynober Luc

机构信息

Département de Médecine, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France.

出版信息

Clin Nutr. 2008 Jun;27(3):328-39. doi: 10.1016/j.clnu.2008.02.005. Epub 2008 Apr 28.

Abstract

BACKGROUND & AIMS: In human, citrulline (plasma concentration about 40 micromol/L) is an amino acid involved in intermediary metabolism and that is not incorporated in proteins. Circulating citrulline is mainly produced by enterocytes of the small bowel. For this reason plasma or serum citrulline concentration has been proposed as a biomarker of remnant small bowel mass and function. This article reviews this concept and its metabolic basis.

METHODS

Conditions in which there is a significantly reduced small bowel enterocyte mass and function and a plasma or serum citrulline were measured in adults and children. These studies included patients with a short bowel syndrome, villous atrophy states, Crohn's disease, during monitoring of digestive toxicity of chemotherapy and radiotherapy or follow-up of patients after small bowel transplantation.

RESULTS

In all these situations, with more than 500 studied patients a decreased level of plasma citrulline correlated with the reduced enterocyte mass independently of nutritional and inflammatory status. A close correlation between small bowel remnant length and citrullinemia was found. In addition, diagnosis of intestinal failure was assessed through plasma citrulline levels in severe small bowel diseases in which there is a marked enterocyte mass reduction.

DISCUSSION

The threshold for establishing a diagnosis of intestinal failure is lower in villous atrophy disease (10mumol/L) than in short bowel syndrome (20mumol/L). Compromised renal function is an important factor when considering plasma citrulline levels as a marker of intestinal failure as this potentially can increase circulating citrulline values.

CONCLUSIONS

Reduced plasma citrulline levels are an innovative quantitative biomarker of significantly reduced enterocyte mass and function in different disease states in humans.

摘要

背景与目的

在人类中,瓜氨酸(血浆浓度约为40微摩尔/升)是一种参与中间代谢且不参与蛋白质合成的氨基酸。循环中的瓜氨酸主要由小肠的肠上皮细胞产生。因此,血浆或血清瓜氨酸浓度已被提议作为残余小肠质量和功能的生物标志物。本文综述了这一概念及其代谢基础。

方法

在成人和儿童中测量小肠肠上皮细胞质量和功能显著降低且血浆或血清瓜氨酸水平的情况。这些研究包括短肠综合征、绒毛萎缩状态、克罗恩病患者,化疗和放疗消化毒性监测期间或小肠移植术后患者的随访。

结果

在所有这些情况下,超过500例研究患者中,血浆瓜氨酸水平降低与肠上皮细胞质量减少相关,且与营养和炎症状态无关。发现小肠残余长度与瓜氨酸血症之间存在密切相关性。此外,在严重小肠疾病导致肠上皮细胞质量明显减少的情况下,通过血浆瓜氨酸水平评估肠衰竭的诊断。

讨论

绒毛萎缩疾病(10微摩尔/升)中肠衰竭诊断的阈值低于短肠综合征(20微摩尔/升)。在将血浆瓜氨酸水平作为肠衰竭标志物时,肾功能受损是一个重要因素,因为这可能会增加循环瓜氨酸值。

结论

血浆瓜氨酸水平降低是人类不同疾病状态下肠上皮细胞质量和功能显著降低的一种创新性定量生物标志物。

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