Nabukeera-Barungi Nicolette, Grenov Benedikte, Friis Henrik, Lanyero Betty, Namusoke Hanifa, Mupere Ezekiel, Michaelsen Kim F, Mølgaard Christian, Christensen Vibeke B, Rytter Maren Johanne
a Department of Nutrition, Exercise and Sports , University of Copenhagen , Copenhagen , Denmark.
b Department of Paediatrics and Child Health, College of Health Sciences , Makerere University , Kampala , Uganda.
Paediatr Int Child Health. 2019 May;39(2):95-103. doi: 10.1080/20469047.2018.1535871. Epub 2018 Nov 1.
: Children with severe acute malnutrition (SAM) are prone to infections due to immune dysfunction including severe thymus atrophy which recovers during nutritional rehabilitation. : To investigate predictors of thymus size recovery, including probiotics during nutritional rehabilitation of children admitted with complicated SAM. : In this prospective study nested in a randomized controlled trial, children 6-59 months admitted with SAM received standard care and either probiotics or placebo during hospitalization until 8 weeks post-discharge. Thymus size was measured using ultrasound at admission, discharge, 8 weeks post-discharge and among 27 community controls. Predictors of thymus size recovery were assessed using linear regression. : Among 388 children with SAM, mean (SD) thymus size was 1.06 cm2 (0.41), 1.24 cm2 (0.48), 2.85 cm2 (1.07) and 4.2 cm2 (0.93) at admission, discharge, follow-up and in the healthy controls respectively (p < 0.05).Probiotics did not affect thymus recovery. During both inpatient therapeutic care (ITC) and outpatient therapeutic care (OTC), thymus recovery correlated positively with anthropometry but negatively with caregiver-perceived illness severity and Haemoglobin <8 g/dl. Negative predictors of thymus recovery during ITC included grade 3 oedema (β -0.13, 95%CI -0.25; -0.01), dermatosis (β -0.21, 95%CI -0.41; -0.01), C-reactive protein (CRP) >15mg/L (β -0.13, 95%CI -0.25; -0.02) and neutrophils (β -0.01, 95%CI -0.02; -0.002). During OTC, HIV negatively predicted thymus recovery. : Children with SAM failed to regain thymus size at 8 weeks post-discharge. Probiotics did not predict thymus recovery during nutritional rehabilitation. More research is needed to find interventions which can accelerate immune recovery. : ART, Antiretroviral therapy; BB-12, subsp. Lactis; CRP, C-reactive protein; ITC, inpatient therapeutic care; LGG, ; MNU, Mwanamugimu Nutrition Unit; MUAC, mid-upper arm circumference; OTC, outpatient therapeutic care; PCR, Polymerised chain reaction; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition; VAS, visual analogue score; WHO, World Health Organization; WHZ, weight-for-height score.
患有重度急性营养不良（SAM）的儿童由于免疫功能障碍，包括严重的胸腺萎缩，容易发生感染，而胸腺萎缩在营养康复过程中会恢复。：为了研究胸腺大小恢复的预测因素，包括在患有复杂SAM的住院儿童营养康复期间使用益生菌。：在这项嵌套于随机对照试验的前瞻性研究中，6至59个月患有SAM的儿童在住院期间接受标准护理，并在出院后8周内接受益生菌或安慰剂治疗。在入院时、出院时、出院后8周以及27名社区对照者中，使用超声测量胸腺大小。使用线性回归评估胸腺大小恢复的预测因素。：在388名患有SAM的儿童中，入院时、出院时、随访时以及健康对照者的平均（标准差）胸腺大小分别为1.06平方厘米（0.41）、1.24平方厘米（0.48）、2.85平方厘米（1.07）和4.2平方厘米（0.93）（p<0.05）。益生菌对胸腺恢复没有影响。在住院治疗护理（ITC）和门诊治疗护理（OTC）期间，胸腺恢复与人体测量学呈正相关，但与照顾者感知的疾病严重程度以及血红蛋白<8 g/dl呈负相关。ITC期间胸腺恢复的负向预测因素包括3级水肿（β -0.13，95%CI -0.25；-0.01）、皮肤病（β -0.21，95%CI -0.41；-0.01）、C反应蛋白（CRP）>15mg/L（β -0.13，95%CI -0.25；-0.02）和中性粒细胞（β -0.01，95%CI -0.02；-0.002）。在OTC期间，HIV对胸腺恢复有负向预测作用。：患有SAM的儿童在出院后8周未能恢复胸腺大小。益生菌在营养康复期间对胸腺恢复没有预测作用。需要更多研究来寻找能够加速免疫恢复的干预措施。：抗逆转录病毒疗法（ART）；嗜热栖热放线菌亚种乳酸亚种BB - 12；C反应蛋白（CRP）；住院治疗护理（ITC）；鼠李糖乳杆菌GG；姆瓦纳穆吉姆营养单位（MNU）；上臂中部周长（MUAC）；门诊治疗护理（OTC）；聚合酶链反应（PCR）；即食治疗食品（RUTF）；重度急性营养不良（SAM）；视觉模拟评分（VAS）；世界卫生组织（WHO）；身高别体重评分（WHZ）
