Vecino López R, Andrés Moreno A M, Ramos Boluda E, Martinez-Ojinaga Nodal E, Hernanz Macías A, Prieto Bozano G, Lopez Santamaria M, Tovar Larrucea J A
Servicio de Gastroenterología Infantil, Hospital Infantil La Paz, Madrid, España.
An Pediatr (Barc). 2013 Oct;79(4):218-23. doi: 10.1016/j.anpedi.2013.02.007. Epub 2013 Mar 23.
Citrulline is a non-essential amino acid produced solely in the enterocyte. The aim of this study was to analyse the role of serum citrulline as a biomarker of enterocyte load in children with intestinal failure due to short bowel syndrome (SBS) and its relationship to enteral adaptation.
Plasma citrulline concentration was determined by chromatography (normal value>15 μmol/L) in 57 patients (age 0.5-18 years) admitted to our Intestinal Rehabilitation Unit with intestinal failure. Those who were dehydrated, with renal insufficiency, or other conditions able to modify the results were excluded. Patients were divided into 4 groups: group i: SBS totally dependent on parenteral nutrition (PN); group ii: SBS under mixed enteral-parenteral nutrition; group iii: IF weaned from PN after a rehabilitation period; group iv: small bowel transplanted patients weaned from PN and taking a normal diet.
The mean ± SD plasma citrulline values were: group i (n=15): 7.1 ± 4.1; group ii (n=11): 15.8 ± 8.9; group iii (n=13): 20.6 ± 7.5; group iv (n=25): 28.8 ± 10.1. Values were significantly lower in group i in comparison with groups ii-iii-iv (P<.001), and in group ii in comparison with groups iii-iv (P<.001). A low citrulline was associated with remnant small bowel length (P<.001, r=0.85). In group iv citrulline levels decreased >50% in 3 patients who developed moderate-severe rejection, and in one patient who developed viral enteritis.
瓜氨酸是一种仅在肠细胞中产生的非必需氨基酸。本研究的目的是分析血清瓜氨酸作为短肠综合征（SBS）所致肠衰竭患儿肠细胞负荷生物标志物的作用及其与肠内适应的关系。
对我院肠道康复科收治的57例（年龄0.5 - 18岁）肠衰竭患者，采用色谱法测定血浆瓜氨酸浓度（正常值>15μmol/L）。排除脱水、肾功能不全或其他可能影响结果的情况。患者分为4组：i组：完全依赖肠外营养（PN）的SBS患者；ii组：接受肠内 - 肠外混合营养的SBS患者；iii组：康复期后停用PN的肠衰竭患者；iv组：停用PN并正常饮食的小肠移植患者。
血浆瓜氨酸均值±标准差分别为：i组（n = 15）：7.1±4.1；ii组（n = 11）：15.8±8.9；iii组（n = 13）：20.6±7.5；iv组（n = 25）：28.8±10.1。i组的值显著低于ii - iii - iv组（P<0.001），ii组的值显著低于iii - iv组（P<0.001）。低瓜氨酸与残余小肠长度相关（P<0.001，r = 0.85）。iv组中，3例发生中重度排斥反应的患者以及1例发生病毒性肠炎的患者瓜氨酸水平下降>50%。
