De Boeck K, Delbeke I, Eggermont E, Veereman-Wauters G, Ghoos Y
Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium.
J Pediatr Gastroenterol Nutr. 1998 Apr;26(4):408-11. doi: 10.1097/00005176-199804000-00009.
Fat maldigestion occurs in most patients with cystic fibrosis. Conventional pancreatic enzyme replacement therapy partially corrects this defect. In this study, the mixed-triglyceride breath test was used to evaluate whether high-lipase enzymes are equivalent to conventional enzymes in improving fat maldigestion in children with cystic fibrosis.
Fat digestion was studied in 11 patients with a mean age of 10.5 years. The mean intake of conventional enzyme capsules a day was 19. Four 13C mixed-triglyceride tests were performed on separate days and in random order. One test was taken without enzyme substitution, one with three capsules of 8,000 FIP units Creon (pancreatinum, Kali-chemie Pharma, Hannover, Germany) and one with one capsule of 25,000 FIP units. The fourth test was made with 13C octanoic acid to study gastric emptying time.
Without enzyme intake, the mean cumulative percentage of 13C dose exhaled after 6 hours was 7.2+/-3.7%. This increased to 14.4+/-4% with intake of conventional pancreatinum and to 14.3+/-5.1% with intake of high-lipase pancreatinum (p = 0.0008 for both; paired t-test). There was no difference between both treatments. Also, the time course of 13C exhalation measured by percentage of 13CO2 exhaled per hour did not differ between enzyme treatments.
The 13C mixed-triglyceride test is noninvasive and documents improved lipid digestion with pancreatic enzyme replacement therapy. If the lipase dose is kept constant, results obtained with high-lipase preparations are equivalent to those obtained with conventional preparations.
大多数囊性纤维化患者存在脂肪消化不良。传统的胰酶替代疗法可部分纠正这一缺陷。在本研究中，采用混合甘油三酯呼气试验来评估高活性脂肪酶的胰酶制剂在改善囊性纤维化患儿脂肪消化不良方面是否等同于传统胰酶制剂。
对11名平均年龄为10.5岁的患者进行脂肪消化研究。传统酶胶囊的日平均摄入量为19粒。在不同日期以随机顺序进行4次13C混合甘油三酯试验。一次试验不进行酶替代，一次试验服用3粒8000 FIP单位的慷彼申（胰酶，德国汉诺威卡利化学制药公司生产），一次试验服用1粒25000 FIP单位的胰酶。第四次试验采用13C辛酸来研究胃排空时间。
不摄入酶时，6小时后呼出的13C剂量的平均累积百分比为7.2±3.7%。摄入传统胰酶后该值增至14.4±4%，摄入高活性脂肪酶的胰酶后增至14.3±5.1%（两者p值均为0.0008；配对t检验）。两种治疗方法之间无差异。此外，两种酶治疗方法之间，以每小时呼出的13CO2百分比衡量的13C呼出时间进程也无差异。
13C混合甘油三酯试验是非侵入性的，可证明胰酶替代疗法能改善脂质消化。如果脂肪酶剂量保持恒定，高活性脂肪酶制剂所获得的结果与传统制剂相当。
