Chiba Masahiro, Sanada Yutaka, Toki Akira
Division of Pediatric Surgery, Department of Surgery, Showa University Hospital, Shinagawa, Tokyo, Japan.
Nutrition Support Team, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Pediatr Int. 2017 Aug;59(8):911-916. doi: 10.1111/ped.13315. Epub 2017 Jul 14.
The aim of this study was to ascertain if prospective determination of specific gut hormones and growth factors could predict bowel adaptation in children with short bowel syndrome (SBS).
We studied independence from parenteral nutrition (PN) as the short-term result and discontinuation of enteral nutrition (EN) as the long-term result from a retrospective chart review of seven patients with SBS, who were managed in the absence of growth retardation. The correlation between increased number of enteral feeds or enteral nutrients and fasting serum gastrin, glucagon-like peptide 2 (GLP-2), citrulline, and D-amino acid oxidase (DAO) activity was analyzed. Five patients were weaned from PN, and two from EN.
Fasting serum gastrin was significantly higher and serum GLP-2 lower in the PN-dependent patients than in the patients weaned from EN. The upper limit of fasting serum gastrin for PN independence and for EN independence was 300 and 200 pg/mL, respectively. The lower limit of fasting serum citrulline for PN independence was 15 μmol/L. The relationship between serum citrulline and DAO and the course of bowel adaptation, however, was poor.
Serum citrulline is a predictor of PN independence in children with SBS. Fasting serum gastrin and GLP-2 are indicators for adaptation of the residual intestine, but this was a small study and further larger prospective trials are required to confirm these results.
本研究的目的是确定前瞻性测定特定肠道激素和生长因子是否能够预测短肠综合征（SBS）患儿的肠道适应性。
我们通过对7例无生长发育迟缓的SBS患儿进行回顾性病历审查，将脱离肠外营养（PN）作为短期结果，停止肠内营养（EN）作为长期结果进行研究。分析了肠内喂养次数或肠内营养物质增加与空腹血清胃泌素、胰高血糖素样肽2（GLP - 2）、瓜氨酸和D - 氨基酸氧化酶（DAO）活性之间的相关性。5例患儿成功脱离PN，2例成功停止EN。
依赖PN的患儿空腹血清胃泌素显著高于已停止EN的患儿，而血清GLP - 2则较低。脱离PN和脱离EN的空腹血清胃泌素上限分别为300和200 pg/mL。脱离PN的空腹血清瓜氨酸下限为15 μmol/L。然而，血清瓜氨酸与DAO之间的关系以及肠道适应性过程较差。
血清瓜氨酸是SBS患儿脱离PN的预测指标。空腹血清胃泌素和GLP - 2是残余肠道适应性的指标，但本研究样本量较小，需要进一步开展更大规模的前瞻性试验来证实这些结果。
