Alonso E M, Whitington P F, Whitington S H, Rivard W A, Given G
Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Illinois.
J Pediatr. 1991 Mar;118(3):425-30. doi: 10.1016/s0022-3476(05)82162-6.
To test the hypothesis that enhanced intestinal absorption of bilirubin may contribute to prolonged nonconjugated hyperbilirubinemia in human milk-fed infants, we studied a cross-section of 36 healthy infants and mothers. Milk from mothers and serum from infants were collected at 16.3 +/- 2.4 days. Milk was studied for its effect on the absorption of bilirubin labeled with carbon 14 in rats and compared with buffer and iron-fortified infant formula (Similac With Iron). The percentage of a 1 mg bilirubin dose absorbed by the rat was 25.29 +/- 4.0% when it was administered into the duodenum with buffer, 4.67 +/- 2.4% with Similac formula, and 7.7 +/- 2.9% with human milk. Linear regression analysis, using the infant's serum nonconjugated bilirubin level as the dependent variable and the percentage of (14C)bilirubin absorbed by the rat with the corresponding mother's milk as the independent variable, revealed a significant correlation (r = 0.40; p = 0.016). Inspection of the data suggested that absorptive permissiveness correlated closely with infant serum bilirubin values greater than 24 mumol/L (1.4 mg/dl) (r = 0.55; p = 0.007), whereas in those with bilirubin values less than or equal to 24 mumol/L, there was no apparent correlation. Milk was also analyzed for beta-glucuronidase, nonesterified fatty acids, and the ability to inhibit glucuronosyltransferase activity of rat liver microsomes in vitro, none of which correlated with the infant's serum bilirubin. These data support the theory that enhanced intestinal absorption of bilirubin contributes to the jaundice associated with breast-feeding.
为验证胆红素肠道吸收增强可能导致母乳喂养婴儿非结合胆红素血症持续时间延长这一假说，我们对36名健康婴儿及其母亲进行了横断面研究。在16.3±2.4日收集母亲的乳汁和婴儿的血清。研究了乳汁对大鼠中14C标记胆红素吸收的影响，并与缓冲液和铁强化婴儿配方奶粉（含铁的Similac）进行比较。当将1mg胆红素剂量与缓冲液一起注入大鼠十二指肠时，大鼠吸收的百分比为25.29±4.0%，与Similac配方奶粉一起时为4.67±2.4%，与人乳一起时为7.7±2.9%。以婴儿血清非结合胆红素水平作为因变量，以大鼠对相应母乳中（14C）胆红素的吸收百分比作为自变量进行线性回归分析，结果显示存在显著相关性（r = 0.40；p = 0.016）。对数据的检查表明，吸收允许性与婴儿血清胆红素值大于24μmol/L（1.4mg/dl）密切相关（r = 0.55；p = 0.007），而在胆红素值小于或等于24μmol/L的婴儿中，没有明显的相关性。还对乳汁进行了β-葡萄糖醛酸酶、非酯化脂肪酸以及体外抑制大鼠肝微粒体葡萄糖醛酸基转移酶活性能力的分析，这些均与婴儿血清胆红素无关。这些数据支持了胆红素肠道吸收增强导致母乳喂养相关黄疸的理论。
