血瓜氨酸水平评价新生儿肠造口术后肠道吸收能力研究

Plasma citrulline concentration as a biomarker for bowel absorptive function in neonates with enterostomy

目的通过串联质谱检测新生儿肠造口术后血瓜氨酸水平来评估造口近端肠道营养吸收能力,指导临床是否需要静脉营养支持治疗。方法通过串联质谱检测2016年1月至2018年6月华中科技大学同济医学院附属武汉儿童医院新生儿期行肠造口患儿30例(包括小肠造口组17例,结肠造口组13例)及对照组婴幼儿20例的血氨基酸水平,比较18种氨基酸水平的差异,筛选出与患儿肠道营养吸收能力相关的氨基酸——瓜氨酸。采用Pearson相关性分析比较血瓜氨酸水平和患儿体质量增长的关系。结果小肠造口患儿体质量为(3.22±1.00) kg,明显低于结肠造口组[(5.63±0.66) kg]及对照组[(6.09±0.85) kg],差异有统计学意义(F=57.23,P<0.05)。小肠造口患儿血瓜氨酸水平为(10.65±5.82)μmol/L,明显低于结肠造口患儿[(16.57±4.33)μmol/L]及对照组[(16.52±4.20)μmol/L],差异有统计学意义(F=8.29,P<0.05)。造口患儿血瓜氨酸水平与每日体质量增长情况呈正相关(r=0.65,P<0.05)。以血清中瓜氨酸水平12 μmol/L为界限,患儿血瓜氨酸水平低于该值可导致低体质量,其敏感性为81.3%,特异性为71.4%。结论血瓜氨酸水平可反映肠造口患儿肠管的营养吸收能力及肠道的适应能力,若小肠造口患儿血瓜氨酸水平低于12 μmol/L可考虑肠外营养支持治疗。

Objective To investigate the clinical significance of serum citrulline levels in evaluating the remnant bowel absorptive function with enterostomy in the neonatal period by means of tandem mass spectrum so as to guide clinical treatment with parenteral nutrition(PN) or not. Methods The serum amino acid profiles of 30 enterostomy infants including small intestinal enterostomy 17 cases of enterostomy and 13 cases of colon enterostomy and 20 cases of control infants in Wuhan Children′s Hospital, Tongji Medical College University of Science & Technology from January 2016 to June 2018 were performed by using tandem mass spectrum, and the related amino acid with the bowel absorbing ability-citrulline was screened out.The Pearson correlation of the serum citrulline levels with the gain weight of the infants was studied. Results The weight of small intestinal enterostomy was significantly lower than colon enterostomy and control infants [(3.22±1.00) kg vs.(5.63±0.66) kg and (6.09±0.85) kg], and there was statistical significance (F=57.23, P<0.05). Serum citrulline levels were significantly lower in small intestinal enterostomy compared with colon enterostomy and controls[(10.65±5.82)μmol/L vs.(16.57±4.33)μmol/L and (16.52±4.20)μmol/L], and there was statistical significance (F=8.29, P<0.05). In enterostomy infants serum citrulline was positively correlated with gain weight everyday(r=0.65, P<0.05). Serum citrulline level <12 μmol/L had 81.3% sensitivity and 71.4% specificity for underweight. Conclusions Serum citrulline is a simple and accurate biomarker for evaluation of the absorptive function and adaptation of the enterostomy infants.Serum citrulline level <12 μmol/L is a strong predictor of PN-dependence in infants with temporary enterostomy.