van Elburg R M, Uil J J, van Aalderen W M, Mulder C J, Heymans H S
Beatrix Children's Hospital, University Hospital Groningen, The Netherlands.
Pediatr Res. 1996 Jun;39(6):985-91. doi: 10.1203/00006450-199606000-00010.
Disturbances of the intestinal integrity, reflected by an increased intestinal permeability, are reported in cystic fibrosis (CF). Controversy exists whether the increased intestinal permeability is due to CF itself or a consequence of the concomitant exocrine pancreatic insufficiency (PI). We measured intestinal permeability by the sugar absorption test in 32 PI patients: 20 CF-PI, 12 nonCF-PI with chronic pancreatitis, and 50 controls. In the sugar absorption test, the lactulose/mannitol ratio is measured in 5-h urine samples after oral ingestion of a solution of lactulose and mannitol, hyperosmolar by the addition of sucrose. The lactulose/mannitol ratio was increased in both CF-PI and nonCF-PI versus controls (p < 0.0001). In CF, the L/M ratio and permeability for lactulose and mannitol did not change by increasing pancreatic enzyme supplementation by 30-50% for 2 wk (p = 0.74, p = 0.97, p = 0.74, respectively) nor by decreasing the osmolarity of the test solution by 75% (p = 0.24, p = 0.10, p = 0.39, respectively). We conclude that an increased intestinal permeability in CF is probably a consequence of PI and is not related to the dose of pancreatic enzyme supplementation nor the osmolarity of the test solution. The increase is due to an increased permeability for lactulose which might point toward a defect in the tight junctions of the villi and/or crypts. The cause of the increased intestinal permeability in the presence of PI is still unclear. An increased intestinal permeability points toward an impaired functional integrity of the small bowel, which may contribute to gastrointestinal dysfunction in CF.
据报道，囊性纤维化（CF）患者存在肠道完整性紊乱，表现为肠道通透性增加。目前尚存在争议的是，肠道通透性增加是CF本身所致，还是伴随的外分泌性胰腺功能不全（PI）的结果。我们通过糖吸收试验对32例PI患者的肠道通透性进行了测量：20例CF-PI患者、12例患有慢性胰腺炎的非CF-PI患者以及50名对照者。在糖吸收试验中，口服含有乳果糖和甘露醇的溶液（通过添加蔗糖使其具有高渗性）后，测量5小时尿液样本中的乳果糖/甘露醇比值。与对照组相比，CF-PI组和非CF-PI组的乳果糖/甘露醇比值均升高（p < 0.0001）。在CF患者中，将胰酶补充量增加30 - 50%持续2周（分别为p = 0.74、p = 0.97、p = 0.74），以及将试验溶液的渗透压降低75%（分别为p = 0.24、p = 0.10、p = 0.39），乳果糖/甘露醇比值以及乳果糖和甘露醇的通透性均未改变。我们得出结论，CF患者肠道通透性增加可能是PI的结果，与胰酶补充剂量和试验溶液渗透压无关。这种增加是由于乳果糖通透性增加所致，这可能表明绒毛和/或隐窝的紧密连接存在缺陷。PI情况下肠道通透性增加的原因仍不清楚。肠道通透性增加表明小肠功能完整性受损，这可能导致CF患者出现胃肠功能障碍。
