Nicholl Richard M, Deenmamode Jean M, Gamsu Harold R
Neonatal Unit, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
BMC Res Notes. 2008 Nov 17;1:115. doi: 10.1186/1756-0500-1-115.
Animal models and observations in human neonates suggest fetal exocrine pancreas vulnerability to reduced maternofetal blood flow. We investigated the relationship between superior mesenteric artery blood flow velocity (sma bfv) and exocrine pancreatic function, in a cohort of very low birth weight (VLBW) babies. Group 1: 9 babies < 3rd percentile for birth weight. Antenatally, all had absent or reversed diastolic flow on Doppler ultrasound of the umbilical artery (UA). Group 2: 18 babies > 10th percentile for birth weight.
All had Doppler ultrasound scan of the superior mesenteric artery (sma), by same operator (RMN), on day 1 of life before commencement of enteral feeding. Stool samples assayed for faecal chymotrypsin and weekly serum samples assayed for amylase and lipase (kinetic colorimetric assay) from days 1 to 14 of life.Growth restricted babies had significantly lower sma bfv values compared with appropriately grown preterm babies. Faecal chymotrypsin levels were also lower but this difference did not achieve statistical significance. Both groups had serum lipase levels detectable in adult concentrations. Serum amylase was undetectable in either group.
Babies with previous in-utero blood flow redistribution may exhibit altered gut ontogeny with re-setting of mesenteric blood flow velocities and altered exocrine pancreatic function.
动物模型和对人类新生儿的观察表明，胎儿外分泌胰腺易受母胎血流减少的影响。我们在一组极低出生体重（VLBW）婴儿中研究了肠系膜上动脉血流速度（sma bfv）与外分泌胰腺功能之间的关系。第1组：9名出生体重低于第3百分位数的婴儿。产前，所有婴儿脐动脉（UA）多普勒超声检查均显示舒张期血流缺失或反向。第2组：18名出生体重高于第10百分位数的婴儿。
所有婴儿在出生后第1天开始肠内喂养前，由同一名操作人员（RMN）进行肠系膜上动脉（sma）多普勒超声扫描。在出生后第1天至第14天，对粪便样本进行粪糜蛋白酶检测，对每周的血清样本进行淀粉酶和脂肪酶检测（动力学比色法）。生长受限的婴儿与生长正常的早产儿相比，sma bfv值显著更低。粪糜蛋白酶水平也较低，但这种差异未达到统计学意义。两组的血清脂肪酶水平均在成人浓度范围内可检测到。两组中血清淀粉酶均未检测到。
先前在子宫内有血流重新分布的婴儿可能表现出肠道发育异常，肠系膜血流速度重新设定，外分泌胰腺功能改变。
