神经内分泌肿瘤患者的胆汁酸吸收不良。
Bile Acid Malabsorption in Patients with Neuroendocrine Tumors.
机构信息
Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55905, USA.
Division of Medical Oncology, Mayo Clinic, 200 First St. S.W., Rochester, MN, 55905, USA.
出版信息
Dig Dis Sci. 2022 Jun;67(6):2517-2525. doi: 10.1007/s10620-021-07189-7. Epub 2021 Aug 7.
BACKGROUND
Chronic diarrhea in patients with neuroendocrine tumors (NET) may be caused by bioactive products of NET, bile acid malabsorption (BAM), ileal resection (IR) or steatorrhea.
AIM
To quantitate BA and fat malabsorption in NET with diarrhea.
METHODS
Part of evaluation in medical oncology clinical practice, 67 patients [42F, 25 M; median age 64.0 y (17.0 IQR)] with well-differentiated NET and diarrhea underwent clinically indicated measurements of 48-h fecal BA [(FBA), fecal weight (normal < 400 g/48 h), fecal fat (normal < 7 g/day) in n = 52] and fasting serum 7αC4 (marker of hepatic BA synthesis, n = 30) between 01/2018 and 11/2020. IR had been performed in 45 patients. BAM diagnosis was based on FBA criteria: elevated total FBA (> 2337 µmol/48 h) or > 10% primary FBA or combination > 4% primary FBA plus > 1000 µmol total FBA/48 h. We also measured fecal elastase (for pancreatic insufficiency) in 13 patients.
RESULTS
BAM was present in 48/52 (92%) patients with NET. There were significant correlations between total FBA and 48-h fecal weight (R = 0.645, P < 0.001). Mean length of IR was 47 cm; in patients with IR < 25 cm, total FBA was elevated in 85% and primary FBA > 10% in 69%. In 22 patients with no IR, 13/15 tested (87%) had BAM. Among 6 patients with pancreatic NET and no IR, 80% had BAM. Fecal fat was ≥ 15 g/day in 18/42 (43%). In 4/17 (24%) with IR < 25 cm and 8/19 (42%) patients with IR > 25 cm fecal fat was 44.0 (40.5) and 38.0 (38.0)g/day, respectively.
CONCLUSION
A majority of patients with NET and diarrhea had BAM, even with < 25 cm or no IR.
背景
神经内分泌肿瘤（NET）患者的慢性腹泻可能是由 NET 的生物活性产物、胆汁酸吸收不良（BAM）、回肠切除术（IR）或脂肪泻引起的。
目的
定量检测 NET 伴腹泻患者的 BA 和脂肪吸收不良。
方法
这是医学肿瘤学临床实践评估的一部分，67 例[42 例女性，25 例男性；中位年龄 64.0 岁（17.0 IQR）]伴有分化良好的 NET 和腹泻的患者进行了临床指示的 48 小时粪便 BA[（FBA）、粪便重量（正常 < 400 g/48 h）、粪便脂肪（正常 < 7 g/天），n = 52]和空腹血清 7αC4（肝 BA 合成标志物，n = 30）测量，测量时间为 2018 年 1 月至 2020 年 11 月。45 例患者进行了 IR。BAM 的诊断基于 FBA 标准：总 FBA 升高（> 2337 μmol/48 h）或原发性 FBA>10%或两者联合>4%原发性 FBA+>1000 μmol 总 FBA/48 h。我们还在 13 例患者中测量了粪便弹性蛋白酶（用于胰腺功能不全）。
结果
NET 患者中有 48/52（92%）存在 BAM。总 FBA 与 48 小时粪便重量呈显著正相关（R = 0.645，P < 0.001）。IR 的平均长度为 47 cm；在 IR<25 cm 的患者中，85%的总 FBA 升高，69%的原发性 FBA>10%。在 22 例无 IR 的患者中，15 例中有 13 例（87%）存在 BAM。在 6 例无 IR 的胰腺 NET 患者中，80%存在 BAM。42 例中有 18 例（43%）粪便脂肪≥15 g/天。在 IR<25 cm 的 4/17（24%）和 IR>25 cm 的 19/19（42%）患者中，粪便脂肪分别为 44.0（40.5）和 38.0（38.0）g/天。
结论
即使 IR<25 cm 或无 IR，大多数 NET 伴腹泻的患者也存在 BAM。
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