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非酒精性脂肪性肝病患儿的肠道通透性增加，且与肝脏疾病严重程度相关。

Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with liver disease severity.

作者信息

Giorgio Valentina, Miele Luca, Principessa Luigi, Ferretti Francesca, Villa Maria Pia, Negro Valentina, Grieco Antonio, Alisi Anna, Nobili Valerio

机构信息

Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.

Clinical Division of Internal Medicine, Gastroenterology and Liver Unit, Complesso Integrato Columbus Hospital, Catholic University of Rome, Italy; Institute of Internal Medicine, Catholic University of Rome, Italy.

出版信息

Dig Liver Dis. 2014 Jun;46(6):556-60. doi: 10.1016/j.dld.2014.02.010. Epub 2014 Mar 12.

DOI:10.1016/j.dld.2014.02.010

PMID:24631029

Abstract

BACKGROUND

Increased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.

AIM

To investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.

METHODS

We performed a case-control study examining intestinal permeability in children using the lactulose-mannitol bowel permeability test.

RESULTS

Overall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038±0.037 vs. 0.008±0.007, p<0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05±0.04 vs. 0.03 vs. 0.03, p<0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p=0.02), fibrosis (p=0.0002), and ballooning of hepatocytes (p=0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27±0.68 vs. 2.80±0.35, p<0.05).

CONCLUSIONS

Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.

摘要

背景

肠道通透性增加似乎在非酒精性肝病的发生和发展中起主要作用。

目的

调查非酒精性脂肪性肝病患儿肠道通透性改变的患病率，并研究其与肝病阶段的潜在关联。

方法

我们进行了一项病例对照研究，使用乳果糖-甘露醇肠通透性试验检测儿童的肠道通透性。

结果

总体而言，纳入了39例连续患者（30例男性，中位年龄12岁）和21例对照（14例男性，中位年龄11.8岁）。12/39例患者（31%）的乳果糖/甘露醇比值受损，而对照组无一例受损。非酒精性脂肪性肝病患儿的肠道通透性更高（乳果糖/甘露醇比值：0.038±0.037对0.008±0.007，p<0.05）。在非酒精性脂肪性肝病组中，与仅患有脂肪变性的儿童相比，脂肪性肝炎患儿的肠道通透性增加（0.05±0.04对0.03对0.03，p<0.05）。病理性乳果糖/甘露醇比值与门静脉炎症（p=0.02）、纤维化（p=0.0002）和肝细胞气球样变（p=0.003）相关。脂肪性肝炎患儿的血脂多糖水平更高（2.27±0.68对2.80±0.35，p<0.05）。