Longshore S W, Wakeman D, McMellen M, Warner B W
Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
Minerva Pediatr. 2009 Jun;61(3):239-51.
Intestinal adaptation after massive short bowel resection (SBR) is characterized structurally by an increase in intestinal wet weight, protein, DNA content, villus height, crypt depth, and absorptive surface area. These structural characteristics are driven by a proliferative stimulus that increases crypt cell division and augments cellular progression along the crypt-villus axis. Functional characteristics of adaptation include an upregulation of NA+/Glucose cotransporters, Na+/H+ exchangers, and other enzymes involved in digestion and absorption. The combination of structural and functional adaptation are physiologic live-saving events that compensate for the sudden loss of digestive and absorptive capacity in the remnant intestine. If intestinal adaptation does not occur or is inadequate, a lifelong dependence on parenteral nutrition will ensue, which ultimately results in devastating cholestatic liver dysfunction. Several mediators are thought to play an influential role in postresection small bowel adaptation, including intraluminal nutrients, gastrointestinal secretions, hormones, growth factors, and other genetic/biochemical factors. A thorough understanding of the mechanisms that drive intestinal adaptation will be essential in the development of novel and innovative therapies that result in saving lives.
大量小肠切除术后的肠道适应性在结构上表现为肠湿重、蛋白质、DNA含量、绒毛高度、隐窝深度和吸收表面积增加。这些结构特征由增殖刺激驱动，该刺激增加隐窝细胞分裂并促进细胞沿隐窝 - 绒毛轴的进展。适应性的功能特征包括钠/葡萄糖共转运体、钠/氢交换体以及其他参与消化和吸收的酶的上调。结构和功能适应性的结合是生理上挽救生命的事件，可补偿残余肠道消化和吸收能力的突然丧失。如果肠道适应性未发生或不足，将导致终身依赖肠外营养，最终导致严重的胆汁淤积性肝功能障碍。几种介质被认为在切除术后小肠适应性中起重要作用，包括肠腔内营养物质、胃肠分泌物、激素、生长因子以及其他遗传/生化因素。深入了解驱动肠道适应性的机制对于开发能挽救生命的新型创新疗法至关重要。
