Pakarinen M P, Miettinen T A, Kuusanmäki P, Lauronen J, Vento P, Raivio P, Halttunen J
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Surgery. 1997 Nov;122(5):950-61. doi: 10.1016/s0039-6060(97)90337-8.
Transplantation of the small intestine impairs intestinal absorptive function, but the adaptive response of a segmental graft is unknown. The aim of this study was to investigate the effects of ileal autotransplantation on the adaptive absorption and metabolism of lipids in pigs that had undergone proximal gut resection.
Serum lipids, plasma vitamins A and E, absorption and excretion of cholesterol, bile acids and fat, plasma cholesterol precursor and plant sterol proportions to cholesterol (respective markers of cholesterol synthesis and absorption), enteric structure, and transit were determined 4, 8, and 14 weeks after 75% proximal resection with (n = 15) or without (n = 15) autotransplantation of the remaining ileum.
As compared with pigs that underwent proximal gut resection, the additional autotransplantation reduced the adaptive increase in total serum and high-density lipoprotein cholesterol, plasma plant sterol proportions and vitamin E concentrations, cholesterol and fat absorption efficiency, and villus height (p < 0.05 for all) during the 14 postoperative weeks and resulted in increases of up to 4.6, 2.7, 1.3, and 2.1 times the plasma cholesterol precursors (p < 0.005), fecal excretion of bile acids (p < 0.0005), neutral steroids (p < 0.005), and net elimination of cholesterol (p < 0.0005), respectively. Cholesterol and fat absorption and plasma plant sterols were significantly enhanced between 8 and 14 weeks after autotransplantation (p < 0.05, p < 0.005, and p < 0.05, respectively), whereas fecal elimination of cholesterol remained increased until the end of the follow-up.
Autotransplantation of the ileum in pigs that have undergone proximal small bowel resection disturbs the adaptive absorption of cholesterol, bile acids, fat, and fat-soluble vitamins, resulting, through increased fecal elimination of cholesterol, in decreased serum cholesterol despite a marked compensatory increase in cholesterol synthesis.
小肠移植会损害肠道吸收功能，但节段性移植物的适应性反应尚不清楚。本研究的目的是探讨回肠自体移植对近端肠道切除术后猪脂质适应性吸收和代谢的影响。
在75%近端切除术后4周、8周和14周，分别对15头接受（n = 15）或未接受（n = 15）剩余回肠自体移植的猪，测定血清脂质、血浆维生素A和E、胆固醇、胆汁酸和脂肪的吸收与排泄、血浆胆固醇前体以及植物甾醇与胆固醇的比例（分别为胆固醇合成和吸收的标志物）、肠道结构和转运情况。
与接受近端肠道切除的猪相比，额外的自体移植减少了术后14周内血清总胆固醇和高密度脂蛋白胆固醇、血浆植物甾醇比例和维生素E浓度、胆固醇和脂肪吸收效率以及绒毛高度的适应性增加（所有p < 0.05），并导致血浆胆固醇前体增加高达4.6倍、胆汁酸粪便排泄增加2.7倍、中性类固醇增加1.3倍以及胆固醇净清除增加2.1倍（分别为p < 0.005、p < 0.0005、p < 0.005和p < 0.0005）。自体移植后8至14周，胆固醇和脂肪吸收以及血浆植物甾醇显著增强（分别为p < 0.05、p < 0.005和p < 0.05），而胆固醇粪便清除在随访结束前一直增加。
近端小肠切除术后猪的回肠自体移植会干扰胆固醇、胆汁酸、脂肪和脂溶性维生素的适应性吸收，尽管胆固醇合成有明显的代偿性增加，但通过增加胆固醇粪便清除导致血清胆固醇降低。
