Intrauterine growth restriction, visceral blood flow velocity and exocrine pancreatic function
Intrauterine growth restriction, visceral blood flow velocity and exocrine pancreatic function
复制标题
宫内生长受限、内脏血流速度和外分泌胰腺功能
作者：
R. Nicholl;J. Deenmamode;H. Gamsu
背景动物模型和人类新生儿的观察表明胎儿外分泌胰腺易受母胎血流量减少的影响。我们研究了一组极低出生体重儿（VLBW）的上级肠系膜动脉血流速度（sma bfv）与胰腺外分泌功能的关系。出生前，所有婴儿的脐动脉（UA）多普勒超声均显示舒张期血流缺失或反向。组2：18名婴儿出生体重>第10百分位数。结果所有婴儿均在出生后第1天开始肠内喂养前由同一操作员（RMN）对上级肠系膜动脉（sma）进行了多普勒超声扫描。从出生后第1天到第14天，对粪便样本进行胰凝乳蛋白酶检测，每周对血清样本进行淀粉酶和脂肪酶检测（动态比色法）。与正常生长的早产儿相比，生长受限的早产儿sma bfv值显著降低。粪便糜蛋白酶水平也较低，但该差异未达到统计学显著性。两组的血清脂肪酶水平在成人浓度中均可检出。血清淀粉酶是无法检测到在任何group.ConclusionBabies与以前在子宫内血流重新分配可能会表现出改变肠道个体发育与重新设置肠系膜血流速度和改变胰腺外分泌功能。
BackgroundAnimal models and observations in human neonates suggest fetal exocrine pancreas vulnerability to reduced maternofetal blood flow. We investigated the relationship between superior mesenteric artery blood flow velocity (sma bfv) and exocrine pancreatic function, in a cohort of very low birth weight (VLBW) babies.Group 1: 9 babies < 3rd percentile for birth weight. Antenatally, all had absent or reversed diastolic flow on Doppler ultrasound of the umbilical artery (UA).Group2: 18 babies > 10th percentile for birth weight.FindingsAll had Doppler ultrasound scan of the superior mesenteric artery (sma), by same operator (RMN), on day 1 of life before commencement of enteral feeding. Stool samples assayed for faecal chymotrypsin and weekly serum samples assayed for amylase and lipase (kinetic colorimetric assay) from days 1 to 14 of life.Growth restricted babies had significantly lower sma bfv values compared with appropriately grown preterm babies. Faecal chymotrypsin levels were also lower but this difference did not achieve statistical significance. Both groups had serum lipase levels detectable in adult concentrations. Serum amylase was undetectable in either group.ConclusionBabies with previous in-utero blood flow redistribution may exhibit altered gut ontogeny with re-setting of mesenteric blood flow velocities and altered exocrine pancreatic function.