Reynolds J V, O'Farrelly C, Feighery C, Murchan P, Leonard N, Fulton G, O'Morain C, Keane F B, Tanner W A
Department of Surgery, Meath and Adelaide Hospitals, Dublin, Ireland.
Br J Surg. 1996 Sep;83(9):1288-91.
The gastrointestinal tract is essential to host defence, acting as a barrier to absorption and translocation of gut antigens, including bacteria. In experimental models, protein malnutrition is permissive to gut barrier failure and endogenous infection. A clinical correlate has not been described. Intestinal morphology and barrier function to food protein antigens was studied in malnourished patients. Thirty-five individuals were evaluated, 20 malnourished patients and 15 well nourished hospital controls. Morphology was assessed from endoscopic biopsies of the second part of the duodenum, and serum immunoglobulin (Ig) G antibodies to gliadin and beta-lactoglobulin were measured. No antibody to food proteins was evident in the control group. In contrast, serum IgG antibodies to at least one antigen were present in 15 malnourished patients and to both antigens in ten (P < 0.0001 versus controls). Severely malnourished patients were more likely to have both antibodies present than those with mild or moderate malnutrition (P < 0.05). Antibody-positive malnourished patients had significantly better nutritional status than antibody-negative patients with malnutrition (P < 0.05). In no group of patients was there morphological evidence of abnormal mucosa or an immunological infiltrate. Gut barrier function is compromised in malnourished patients which suggests a mechanism that may facilitate gut-derived infection and sepsis.
胃肠道对于宿主防御至关重要，它作为肠道抗原（包括细菌）吸收和易位的屏障。在实验模型中，蛋白质营养不良会导致肠道屏障功能衰竭和内源性感染。尚未描述其临床相关性。对营养不良患者的肠道形态和对食物蛋白抗原的屏障功能进行了研究。共评估了35人，其中20名营养不良患者和15名营养良好的医院对照者。从十二指肠第二部的内镜活检评估形态，并测量血清免疫球蛋白（Ig）G对麦醇溶蛋白和β-乳球蛋白的抗体。对照组中未发现针对食物蛋白的抗体。相比之下，15名营养不良患者中存在针对至少一种抗原的血清IgG抗体，10名患者中存在针对两种抗原的血清IgG抗体（与对照组相比，P < 0.0001）。重度营养不良患者比轻度或中度营养不良患者更有可能同时存在两种抗体（P < 0.05）。抗体阳性的营养不良患者的营养状况明显优于抗体阴性的营养不良患者（P < 0.05）。在任何一组患者中，均未发现黏膜异常或免疫浸润的形态学证据。营养不良患者的肠道屏障功能受损，这提示了一种可能促进肠道源性感染和败血症的机制。
