van der Hulst R R, von Meyenfeldt M F, van Kreel B K, Thunnissen F B, Brummer R J, Arends J W, Soeters P B
Department of Surgery, University of Limburg, Maastricht, The Netherlands.
Nutrition. 1998 Jan;14(1):1-6. doi: 10.1016/s0899-9007(97)00385-7.
Nutritional depletion increases the risk for postoperative complications. The intestinal barrier may be important in the underlying pathophysiologic mechanism. In this study, 26 patients were evaluated to determine whether nutritional depletion was related to gut integrity and intestinal morphology. Nutritional depletion was estimated by calculating percentage ideal body weight (PIB) or percentage ideal fat free mass (PIFFM). To assess gut integrity, a lactulose/mannitol (L/M) test was performed. Duodenal biopsies were taken, and villous height, crypt depth, number of IgA-producing plasma cells, intraepithelial lymphocytes (IELs), and proliferating index were determined. The L/M ratio was increased, and villous height was decreased in depleted patients. Depletion was not associated with differences in the number of immune cells or proliferating index. The number of IgA-producing plasma cells was positively correlated with the L/M ratio. This study shows that nutritional depletion is associated with increased intestinal permeability and a decrease in villous height.
营养耗竭会增加术后并发症的风险。肠道屏障可能在潜在的病理生理机制中起重要作用。在本研究中，对26名患者进行了评估，以确定营养耗竭是否与肠道完整性和肠道形态有关。通过计算理想体重百分比（PIB）或理想去脂体重百分比（PIFFM）来评估营养耗竭情况。为评估肠道完整性，进行了乳果糖/甘露醇（L/M）试验。采集十二指肠活检组织，测定绒毛高度、隐窝深度、产生IgA的浆细胞数量、上皮内淋巴细胞（IELs）数量和增殖指数。营养耗竭患者的L/M比值升高，绒毛高度降低。营养耗竭与免疫细胞数量或增殖指数的差异无关。产生IgA的浆细胞数量与L/M比值呈正相关。本研究表明，营养耗竭与肠道通透性增加和绒毛高度降低有关。
