Carver J D, Barness L A
Department of Pediatrics, University of South Florida College of Medicine, Tampa, USA.
Clin Perinatol. 1996 Jun;23(2):265-85.
GI trophic factors that influence the coordinated pre- and postnatal growth and development of the GI tract have been identified. Studies in animals and humans demonstrate that GI trophic factors can initiate cellular growth and expression of differentiated function, and they are important in adaptation and repair following injury. Systemically as well as enterally administered growth factors can stimulate GI growth and maturation, suggesting that trophic factors in the serum of neonates may modulate GI growth via receptors on the serosal membranes of enterocytes. GI trophic factors may be synthesized endogenously or provided postnatally in milk. GI trophic factors in human milk play an important role in regulating the adaptive functional changes that accompany the transition to postnatal enteral feedings. Although human milk growth factors do not appear to be essential for infant survival, the elevated risk of gastrointestinal-related illnesses in formula-fed as compared with breast-fed infants (diarrhea, necrotizing enterocolitis, colitis, Crohn's disease) suggest that bioactive compounds in human milk contribute to the apparent protective effect of breast feeding. GI trophic factors have the potential to be used therapeutically to enhance GI maturation and repair following injury. These applications may be particularly useful in the premature or postsurgical infant. Several issues require further research, including (1) the mechanism of action, (2) the efficacy of oral versus systemic administration, (3) characterization of the complex interactions between the various growth factors, because some appear to act synergistically, (4) the effect of exogenously administered growth factors on endogenous production of that factor, its receptor, or other growth factors, (5) the effect of growth factors upon tissues not directly associated with the GI tract, and (6) the determination of safe and effective upper limits.
已发现影响胃肠道产前和产后协调生长发育的胃肠道营养因子。对动物和人类的研究表明，胃肠道营养因子可启动细胞生长并表达分化功能，且在损伤后的适应和修复过程中发挥重要作用。全身给药和肠内给药的生长因子均可刺激胃肠道生长和成熟，这表明新生儿血清中的营养因子可能通过肠上皮细胞浆膜上的受体调节胃肠道生长。胃肠道营养因子可内源性合成或在出生后由乳汁提供。人乳中的胃肠道营养因子在调节伴随出生后过渡到肠内喂养的适应性功能变化中起重要作用。虽然人乳生长因子似乎并非婴儿生存所必需，但与母乳喂养婴儿相比，配方奶喂养婴儿患胃肠道相关疾病（腹泻、坏死性小肠结肠炎、结肠炎、克罗恩病）的风险升高，这表明人乳中的生物活性化合物有助于母乳喂养的明显保护作用。胃肠道营养因子有潜力用于治疗，以促进损伤后胃肠道的成熟和修复。这些应用对早产儿或术后婴儿可能特别有用。有几个问题需要进一步研究，包括：（1）作用机制；（2）口服给药与全身给药的疗效；（3）各种生长因子之间复杂相互作用的特征，因为有些因子似乎具有协同作用；（4）外源性给予生长因子对该因子、其受体或其他生长因子内源性产生的影响；（5）生长因子对与胃肠道无直接关联的组织的影响；（6）确定安全有效的上限。
