Kushak Rafail I, Buie Timothy M, Murray Katherine F, Newburg David S, Chen Ceng, Nestoridi Eirini, Winter Harland S
*Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston †Department of Biology, Boston College, Chestnut Hill, MA.
J Pediatr Gastroenterol Nutr. 2016 May;62(5):687-91. doi: 10.1097/MPG.0000000000001174.
Alterations in intestinal function, often characterized as a "leaky gut," have been attributed to children who are on the autism spectrum. Disaccharidase activity, intestinal inflammation, and permeability were analyzed in 61 children with autism and 50 nonautistic individuals with gastrointestinal symptoms.
All patients had duodenal biopsies assayed for lactase, sucrase, maltase, and palatinase activity. Intestinal permeability was evaluated by rhamnose/lactulose test and measured by high-performance liquid chromatography-mass spectrometry. Intestinal inflammation was evaluated by fecal calprotectin and lactoferrin levels using enzyme-linked immunosorbent assay and histology.
Some children with autism had mild levels of mucosal inflammation on intestinal biopsy. Disaccharidase activity was not different in autistic and nonautistic individuals. Fecal calprotectin and lactoferrin were similar in both groups. Differences between lactulose and rhamnose recovery and lactulose/rhamnose ratio in urine were not statistically different in patients with and without autism.
The present study supports the observation that children with autism who have symptoms of gastrointestinal disorders have objective findings similar to children without autism. Neither noninvasive testing nor endoscopic findings identify gastrointestinal pathology specific to autism, but may be of benefit in identifying children with autism who have atypical symptoms.
肠道功能改变，常表现为“肠漏”，已被认为与自闭症谱系儿童有关。对61名自闭症儿童和50名有胃肠道症状的非自闭症个体的双糖酶活性、肠道炎症和通透性进行了分析。
所有患者均进行十二指肠活检，检测乳糖酶、蔗糖酶、麦芽糖酶和帕拉金酶活性。通过鼠李糖/乳果糖试验评估肠道通透性，并采用高效液相色谱-质谱法进行测定。通过酶联免疫吸附测定法和组织学评估粪便钙卫蛋白和乳铁蛋白水平来评估肠道炎症。
一些自闭症儿童在肠道活检时有轻度黏膜炎症。自闭症和非自闭症个体的双糖酶活性没有差异。两组的粪便钙卫蛋白和乳铁蛋白相似。自闭症患者和非自闭症患者尿液中乳果糖和鼠李糖回收率及乳果糖/鼠李糖比值的差异无统计学意义。
本研究支持以下观察结果，即有胃肠道疾病症状的自闭症儿童的客观检查结果与非自闭症儿童相似。无论是无创检测还是内镜检查结果都不能识别自闭症特有的胃肠道病理，但可能有助于识别有非典型症状的自闭症儿童。
