Nutrition and Clinical Services Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh.
Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Sci Rep. 2023 Jan 25;13(1):1416. doi: 10.1038/s41598-023-28114-0.
Two emerging biomarkers of environmental enteric dysfunction (EED) include plasma citrulline (CIT), and the kynurenine (KYN): tryptophan (TRP)/ (KT) ratio. We sought to investigate the plasma concentration of CIT and KT ratio among the children having dehydrating diarrhea and examine associations between concentrations of CIT and KT ratio with concurrent factors. For this analysis, we used cross-sectional data from a total of 102, 6-36 months old male children who suffered from non-cholera acute watery diarrhea and had some dehydration admitted to an urban diarrheal hospital, in Bangladesh. CIT, TRP, and KYN concentrations were determined at enrollment from plasma samples using ELIZA. At enrollment, the mean plasma CIT concentration was 864.48 ± 388.55 µmol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (× 1000) were 6.93 ± 3.08 µmol/L, 33.44 ± 16.39 µmol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: - 0.26; 95%CI: - 0.49, - 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: - 0.01; 95% CI: - 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: - 0.6; 95% CI: - 1.18, - 0.02; p = 0.042) after adjusting for potential covariates. The CIT concentration was associated with blood neutrophils (coef.: 0.02; 95% CI: 0.01, 0.03; p < 0.001), lymphocytes (coef.: - 0.02; 95% CI: - 0.03, - 0.02; p < 0.001) and monocyte (coef.: 0.06; 95% CI: 0.01, 0.11; p = 0.021); KYN concentration was negatively associated with basophil (coef.: - 0.62; 95% CI: - 1.23, - 0.01; p = 0.048) after adjusting for age. In addition, total stool output (gm) increased (coef.: 793.84; 95% CI: 187.16, 1400.52; p = 0.011) and also increased duration of hospital stay (hour) (coef.: 22.89; 95% CI: 10.24, 35.54; p = 0.001) with increasing CIT concentration. The morphological changes associated with EED may increase the risk of enteric infection and diarrheal disease among children. Further research is critically needed to better understand the complex mechanisms by which EED biomarkers may impact susceptibility to dehydrating diarrhea in children.
两种新兴的环境肠道功能障碍（EED）生物标志物包括血浆瓜氨酸（CIT）和犬尿氨酸（KYN）：色氨酸（TRP）/（KT）比值。我们试图研究患有脱水性腹泻的儿童的血浆 CIT 浓度和 KT 比值，并检查 CIT 和 KT 比值浓度与同期因素之间的关联。为此分析，我们使用了来自孟加拉国一个城市腹泻医院的总共 102 名 6-36 个月大的患有非霍乱急性水样腹泻和部分脱水的男性儿童的横断面数据。使用 ELISA 从血浆样本中测定 CIT、TRP 和 KYN 浓度。在入组时，平均血浆 CIT 浓度为 864.48 ± 388.55µmol/L。平均血浆犬尿氨酸、色氨酸浓度和 KT 比值（×1000）分别为 6.93 ± 3.08µmol/L、33.44 ± 16.39µmol/L 和 12.12 ± 18.10。随着儿童年龄的增长，KYN 浓度降低（系数：-0.26；95%CI：-0.49，-0.04；p=0.021）；随着淋巴细胞计数的增加，CIT 浓度降低（系数：-0.01；95%CI：-0.02，0.001，p=0.004）；消瘦儿童的 KT 比值降低（系数：-0.6；95%CI：-1.18，-0.02；p=0.042），调整了潜在的混杂因素后。CIT 浓度与血液中性粒细胞（系数：0.02；95%CI：0.01，0.03；p<0.001）、淋巴细胞（系数：-0.02；95%CI：-0.03，-0.02；p<0.001）和单核细胞（系数：0.06；95%CI：0.01，0.11；p=0.021）呈正相关；KYN 浓度与嗜碱性粒细胞呈负相关（系数：-0.62；95%CI：-1.23，-0.01；p=0.048），调整了年龄后。此外，随着 CIT 浓度的增加，总粪便排出量（gm）增加（系数：793.84；95%CI：187.16，1400.52；p=0.011），住院时间（小时）延长（系数：22.89；95%CI：10.24，35.54；p=0.001）。与 EED 相关的形态学变化可能会增加儿童肠道感染和腹泻病的风险。迫切需要进一步研究，以更好地了解 EED 生物标志物可能影响儿童脱水性腹泻易感性的复杂机制。
