Thillainayagam A V, Hunt J B, Farthing M J
Digestive Diseases Research Centre, St. Bartholomew's, London, England.
Gastroenterology. 1998 Jan;114(1):197-210. doi: 10.1016/s0016-5085(98)70647-x.
Many empirical clinical trials have used complex carbohydrate as substrate in oral rehydration solutions (ORSs) instead of glucose and have shown a number of important clinical benefits. Foremost among these are reduced stool volumes, shorter duration of diarrheal illness, and lower ORS intake. The underlying mechanisms to explain this clinical advantage have not been fully established, but a number of possible factors have been proposed: (1) increased substrate availability, (2) a "kinetic advantage" for glucose absorption by glucose polymer, (3) differential handling of glucose monomer and polymer by the small intestine, (4) low osmolality, (5) a separate effect of peptides and amino acids on solute-linked sodium absorption, (6) an antisecretory moiety in rice, and (6) enhanced mucosal repair and regeneration by luminal nutrients. In this report, we assess the relative contribution of these factors using evidence from laboratory-based studies, mainly in disease-related intestinal perfusion systems in animals and humans, and the relevant clinical studies available to date. We advance the hypothesis that of all the possible mechanisms proposed to underlie the enhanced clinical efficacy of complex carbohydrate ORSs, their hypotonicity plays the dominant role. If confirmed, this concept could guide future development of glucose and complex carbohydrate-based ORSs.
许多实证临床试验在口服补液盐（ORS）中使用复合碳水化合物而非葡萄糖作为底物，并已显示出一些重要的临床益处。其中最主要的是减少粪便量、缩短腹泻病程以及降低ORS摄入量。解释这种临床优势的潜在机制尚未完全明确，但已提出了一些可能的因素：（1）底物可用性增加；（2）葡萄糖聚合物对葡萄糖吸收具有“动力学优势”；（3）小肠对葡萄糖单体和聚合物的处理方式不同；（4）低渗透压；（5）肽和氨基酸对溶质耦联钠吸收的单独作用；（6）大米中的抗分泌成分；以及（6）腔内营养物质增强黏膜修复和再生。在本报告中，我们利用基于实验室研究的证据评估这些因素的相对贡献，这些研究主要在动物和人类与疾病相关的肠道灌注系统中进行，以及迄今为止可用的相关临床研究。我们提出一个假说，即在所有为复合碳水化合物ORS增强临床疗效所提出的可能机制中，其低渗性起主导作用。如果得到证实，这一概念可指导未来基于葡萄糖和复合碳水化合物的ORS的开发。
