Kent Dorothea Stark, Remer Thomas, Blumenthal Caron, Hunt Sharon, Simonds Sharon, Egert Sarah, Gaskin Kevin J
James Fairfax Institute of Paediatric Nutrition, University of Sydney, Sydney, Australia.
University of Bonn, IEL-Nutritional Epidemiology, DONALD Study, Dortmund, Germany.
J Pediatr Gastroenterol Nutr. 2018 May;66(5):811-815. doi: 10.1097/MPG.0000000000001905.
The 'gold standard' test for the indirect determination of pancreatic function status in infants with cystic fibrosis (CF), the 72-hour fecal fat excretion test, is likely to become obsolete in the near future. Alternative indirect pancreatic function tests with sufficient sensitivity and specificity to determine pancreatic phenotype need further evaluation in CF infants.
Evaluation of the clinical utility of both the noninvasive, nonradioactive C-mixed triglyceride (MTG) breath test and fecal elastase-1 (FE1) in comparison with the 72-hour fecal fat assessment in infants with CF.
C-MTG breath test and the monoclonal and polyclonal FE1 assessment in stool was compared with the 72-hour fecal fat assessment in 24 infants with CF. Oral pancreatic enzyme substitution (PERT; if already commenced) was stopped before the tests.
Sensitivity rates between 82% and 100% for CF patients with pancreatic insufficiency assessed by both the C-MTG breath test and the FE1 tests proved to be high and promising. The C-MTG breath test (31%-38%) as well as both FE1 tests assessed by the monoclonal (46%-54%) and the polyclonal (45%) ELISA kits, however, showed unacceptably low-sensitivity rates for the detection of pancreatic-sufficient CF patients in the present study.
The C-MTG breath test with nondispersive infrared spectroscopy (NDIRS) technique, as well as both FE1 tests, are not alternatives to the fecal fat balance test for the evaluation of pancreatic function in CF infants during the first year of life.
对于间接测定囊性纤维化（CF）婴儿胰腺功能状态的“金标准”测试——72小时粪便脂肪排泄试验，在不久的将来可能会过时。需要对具有足够敏感性和特异性以确定胰腺表型的替代性间接胰腺功能测试在CF婴儿中进行进一步评估。
与CF婴儿的72小时粪便脂肪评估相比，评估非侵入性、非放射性C混合甘油三酯（MTG）呼气试验和粪便弹性蛋白酶-1（FE1）的临床效用。
将24例CF婴儿的C-MTG呼气试验以及粪便中粪便弹性蛋白酶-1的单克隆和多克隆评估与72小时粪便脂肪评估进行比较。在测试前停止口服胰腺酶替代治疗（PERT；如果已经开始）。
通过C-MTG呼气试验和FE1试验评估的胰腺功能不全CF患者的敏感性率在82%至100%之间，证明是高且有前景的。然而，在本研究中，C-MTG呼气试验（31%-38%）以及通过单克隆（46%-54%）和多克隆（45%）ELISA试剂盒评估的两种FE1试验，在检测胰腺功能正常的CF患者时显示出不可接受的低敏感性率。
在生命的第一年，采用非分散红外光谱（NDIRS）技术的C-MTG呼气试验以及两种FE1试验，都不是评估CF婴儿胰腺功能的粪便脂肪平衡试验的替代方法。
