From the Department of Global Health, University of Washington, Seattle, Seattle, WA.
The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
J Pediatr Gastroenterol Nutr. 2022 Dec 1;75(6):768-774. doi: 10.1097/MPG.0000000000003619. Epub 2022 Sep 20.
To determine whether gut permeability is associated with post-discharge growth and systemic inflammation among hospitalized children in low- and middle-income countries.
Children aged 2-23 months being discharged from Civil Hospital Karachi (Pakistan) and Migori County Referral Hospital (Kenya) underwent lactulose-rhamnose ratio (LRR) permeability testing and were compared to age-matched children from their home communities. Linear mixed effect models estimated the associations between LRR among discharged children with change in length-for-age (LAZ) and weight-for-age z score (WAZ) at 45, 90, and 180 days after discharge. Linear regression tested if relationships between LRR, systemic inflammation [C-reative protein (CRP), Cluster of Differentiation 14 (CD14), Tumour Necrosis Factor Alpha (TNFα), Interleukin-6 (IL-6)], and enterocyte damage [Intestinal Fatty-Acid Binding protein (I-FABP)] differed between the hospitalized and community groups.
One hundred thirty-seven hospitalized and 84 community participants were included. The hospitalized group had higher log-LRR [0.43, 95% confidence interval (CI): 0.15-0.71, P = 0.003] than the community children. Adjustment for weight-for-length z score at discharge attenuated this association (0.31, 95% CI: 0.00-0.62, P = 0.049). LRR was not associated with changes in WAZ or LAZ in the post-discharge period. Associations between LRR and CRP (interaction P = 0.036), TNFα ( P = 0.017), CD14 ( P = 0.078), and IL-6 ( P = 0.243) differed between community and hospitalized groups. LRR was associated with TNFα ( P = 0.004) and approached significance with CD14 ( P = 0.078) and IL-6 ( P = 0.062) in community children, but there was no evidence of these associations among hospitalized children.
Although increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children.
确定肠道通透性是否与中低收入国家住院儿童出院后的生长和全身炎症有关。
从卡拉奇市立医院（巴基斯坦）和米戈里县转诊医院（肯尼亚）出院的 2-23 月龄儿童进行乳果糖-鼠李糖比率（LRR）通透性检测，并与来自其社区的同龄儿童进行比较。线性混合效应模型估计出院儿童 LRR 与出院后 45、90 和 180 天时长度-年龄 Z 评分（LAZ）和体重-年龄 Z 评分（WAZ）变化之间的关系。线性回归测试 LRR 与全身炎症[C-反应蛋白（CRP）、分化群 14（CD14）、肿瘤坏死因子-α（TNFα）、白细胞介素-6（IL-6）]和肠上皮细胞损伤[肠脂肪酸结合蛋白（I-FABP）]之间的关系是否在住院组和社区组之间存在差异。
共纳入 137 名住院患儿和 84 名社区患儿。住院组的 log-LRR 较高[0.43，95%置信区间（CI）：0.15-0.71，P=0.003]，出院时的体重-身长 Z 评分校正后，这种关联减弱（0.31，95%CI：0.00-0.62，P=0.049）。LRR 与出院后 WAZ 或 LAZ 的变化无关。LRR 与 CRP（交互 P=0.036）、TNFα（P=0.017）、CD14（P=0.078）和 IL-6（P=0.243）之间的关系在社区组和住院组之间存在差异。LRR 与社区儿童的 TNFα（P=0.004）和 CD14（P=0.078）和 IL-6（P=0.062）呈正相关，但在住院儿童中没有证据表明存在这些关联。
虽然与社区儿童相比，从医院出院的儿童中更普遍存在肠道通透性增加，但它似乎不是住院儿童全身炎症或出院后生长的重要决定因素。
