Widodo Ariani Dewi, Timan Ina S, Bardosono Saptawati, Winarta Widdy, Prasetyo Dwi, Firmansyah Agus
Gastrohepatology Division, Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta, Indonesia. Email:
Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Asia Pac J Clin Nutr. 2016 Dec;25(Suppl 1):S57-S61. doi: 10.6133/apjcn.122016.s3.
Persistent diarrhoea, a serious health problem, is closely related to malnutrition. Children with severe malnutrition have a 9-fold risk of death, and children with severe stunting have a 4-fold risk of death. Prolonged mucosal injury from diarrhoea causes reduced secretin and cholecystokinin secretion, which decreases stimulation to the pancreas, and is indicated by faecal elastase-1 levels. This further aggravates persistent diarrhoea and malnutrition because of the low levels of digestive enzyme production. This study evaluated the exocrine function of the pancreas in children with persistent diarrhoea and malnutrition.
This study used a cross-sectional design to compare exocrine pancreatic function among children with persistent diarrhoea, children with malnutrition, and apparently healthy children as reference Children aged 6-60 months were selected from the inpatient and outpatient units of various general hospitals in Jakarta. Faecal elastase- 1 levels were used to determine exocrine pancreatic function.
The median values of faecal elastase- 1 in children with persistent diarrhoea, children with malnutrition, and reference children were 743 (1-1503) mcg/g, 861 (17-2909) mcg/g, and 1210 (26-3000) mcg/g, respectively. A significant difference was observed in the faecal elastase-1 levels between reference children and those with persistent diarrhoea (p<0.001). However, no differences in the faecal elastase-1 levels were noted between malnourished and reference children (p>0.05). Children with both persistent diarrhoea and malnutrition showed mean FE-1 392.3±206.9 and median 419 (125- 593).
Exocrine pancreatic insufficiency is found in children with persistent diarrhoea. Children with combined persistent diarrhoea and malnutrition have the lowest FE-1, to which persistent diarrhea has the most significant contribution.
持续性腹泻是一个严重的健康问题，与营养不良密切相关。重度营养不良儿童的死亡风险是正常儿童的9倍，严重发育迟缓儿童的死亡风险是正常儿童的4倍。腹泻导致的长期黏膜损伤会使促胰液素和缩胆囊素分泌减少，从而降低对胰腺的刺激，这可通过粪便弹性蛋白酶-1水平来体现。由于消化酶分泌水平低，这会进一步加重持续性腹泻和营养不良。本研究评估了持续性腹泻伴营养不良儿童的胰腺外分泌功能。
本研究采用横断面设计，比较持续性腹泻儿童、营养不良儿童以及作为对照的健康儿童的胰腺外分泌功能。选取雅加达各综合医院住院部和门诊部6至60个月大的儿童。采用粪便弹性蛋白酶-1水平来测定胰腺外分泌功能。
持续性腹泻儿童、营养不良儿童和对照儿童的粪便弹性蛋白酶-1中位数分别为743（1 - 1503）μg/g、861（17 - 2909）μg/g和1210（26 - 3000）μg/g。对照儿童与持续性腹泻儿童的粪便弹性蛋白酶-1水平存在显著差异（p<0.001）。然而，营养不良儿童与对照儿童的粪便弹性蛋白酶-1水平无差异（p>0.05）。同时患有持续性腹泻和营养不良的儿童FE-1均值为392.3±206.9，中位数为419（125 - 593）。
持续性腹泻儿童存在胰腺外分泌功能不全。同时患有持续性腹泻和营养不良的儿童FE-1水平最低，其中持续性腹泻的影响最为显著。
