Nathavitharana K A, Lloyd D R, Raafat F, Brown G A, McNeish A S
Institute of Child Health, University of Birmingham.
Arch Dis Child. 1988 Sep;63(9):1054-9. doi: 10.1136/adc.63.9.1054.
A dual sugar (mannitol, lactulose) absorption test was evaluated using an iso-osmolar oral dose in two groups of children: a study group of 43 children divided into five subgroups, based on severity of mucosal damage, and a control group of 53 children with histologically normal jejunal biopsy specimens. After an oral dose, the three hour urinary mannitol: lactulose ratios in the control group showed a highly significant positive correlation with body surface area. After correction for the body surface area relationship, a control lower limit was defined by the mean -2SD of the log10 transformed control mannitol: lactulose ratios. Specificity and sensitivity for severe villous atrophy was 98% and 95% respectively but the sensitivity declined rapidly with decreasing degrees of mucosal damage, and the test would not therefore be an adequate screening procedure for all enteropathies. In sequential studies in 18 children, the changes in the mannitol: lactulose ratio were consistent with the changes in mucosal structure induced by gluten challenge or gluten withdrawal. The test may therefore have a role in any sequential study of lesions of the mucosa of the small intestine.
在两组儿童中使用等渗口服剂量评估双糖（甘露醇、乳果糖）吸收试验：一组为43名儿童的研究组，根据黏膜损伤严重程度分为五个亚组；另一组为53名空肠活检组织学正常儿童的对照组。口服给药后，对照组三小时尿中甘露醇与乳果糖的比值与体表面积呈高度显著正相关。校正体表面积关系后，通过对对照组甘露醇与乳果糖比值进行log10转换后的均值减去2个标准差来确定对照下限。严重绒毛萎缩的特异性和敏感性分别为98%和95%，但随着黏膜损伤程度降低，敏感性迅速下降，因此该试验并非适用于所有肠道疾病的充分筛查方法。在对18名儿童进行的序贯研究中，甘露醇与乳果糖比值的变化与麸质激发或停用麸质引起的黏膜结构变化一致。因此，该试验可能在小肠黏膜病变的任何序贯研究中发挥作用。
