Zamora S A, Amin H J, McMillan D D, Kubes P, Fick G H, Bützner J D, Parsons H G, Scott R B
Division of Gastroenterology, University of Calgary, Alberta, Canada.
J Pediatr. 1997 Aug;131(2):226-32. doi: 10.1016/s0022-3476(97)70158-6.
To determine whether L-arginine concentrations (the substrate for nitric oxide synthesis) are lower in premature infants in whom necrotizing enterocolitis (NEC) develops than in unaffected infants.
We measured arginine and nutritional intake, plasma arginine, glutamine, total amino acids, and ammonia concentrations in 53 premature infants (mean gestational age +/- SD: 27 +/- 1.7 weeks) at risk of NEC. Measurements were done on days 3, 7, 14 and 21 and just before treatment in infants with NEC.
Necrotizing enterocolitis developed in 11 infants between postnatal days 1 and 26. On day 3, plasma arginine concentrations were decreased compared with normal published values (mean +/- SE, 41 mumol/L +/- 4). Arginine concentrations increased with day of life of measurement (p < 0.001) and arginine intake (p < 0.001). Plasma arginine concentrations were significantly lower at the time of diagnosis in infants with NEC compared with control subjects, even after adjusting for arginine intake and day of life (p = 0.032). Plasma glutamine and total amino acid concentrations were not significantly different in infants with NEC compared with control subjects. Plasma ammonia concentrations were elevated on day 3 (mean +/- SE, 72 +/- 3.3 mumol/L) and decreased with postnatal age (p < 0.001) and increasing plasma arginine concentrations (p < 0.001).
Plasma arginine concentrations are decreased at the time of diagnosis in premature infants with NEC. The potential benefit of arginine supplementation in the prevention of the disease deserves evaluation.
确定发生坏死性小肠结肠炎（NEC）的早产儿体内L-精氨酸浓度（一氧化氮合成的底物）是否低于未患病的婴儿。
我们测量了53名有NEC风险的早产儿（平均胎龄±标准差：27±1.7周）的精氨酸和营养摄入量、血浆精氨酸、谷氨酰胺、总氨基酸及氨浓度。在第3、7、14和21天进行测量，对于患NEC的婴儿，在治疗前也进行测量。
11名婴儿在出生后第1天至第26天发生了坏死性小肠结肠炎。第3天时，血浆精氨酸浓度低于已发表的正常数值（平均±标准误，41μmol/L±4）。精氨酸浓度随测量时的日龄增加而升高（p<0.001），也随精氨酸摄入量增加而升高（p<0.001）。与对照组相比，即使在调整精氨酸摄入量和日龄后，患NEC婴儿在诊断时的血浆精氨酸浓度仍显著较低（p=0.032）。与对照组相比，患NEC婴儿的血浆谷氨酰胺和总氨基酸浓度无显著差异。第3天时血浆氨浓度升高（平均±标准误，72±3.3μmol/L），并随出生后年龄增加而降低（p<0.001），且随血浆精氨酸浓度升高而降低（p<0.001）。
患NEC的早产儿在诊断时血浆精氨酸浓度降低。补充精氨酸在预防该疾病方面的潜在益处值得评估。
