Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants
Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants
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DOI：
10.1097/mpg.0000000000001323
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Duggan, Christopher
中科院分区：
文献类型：
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作者：
Gosselin, Kerri B.;Aboud, Said;Duggan, Christopher
目的：腹泻病是世界范围内发病率和死亡率的主要原因，但腹泻的病因及其与资源有限环境中营养结果的关系尚不明确。我们试图确定坦桑尼亚婴儿社区获得性腹泻的病因，并评估与人体测量学和新的肠道生物标志物的关联。方法：在坦桑尼亚的锌和/或多种维生素补充剂的试验中选择了一个方便的婴儿样本。受试者在6周龄时入组，研究18个月。粪便样本取自急性腹泻儿童。一种新的，基于聚合酶链反应的TaqMan阵列被用来筛选粪便中的15种肠道病原体。受试者的一个子集有血清胃肠道生物标志物measurement.Results：一百二十三名腹泻受试者入组。粪便样本采集时的平均+/- SD年龄为12.4 +/- 3.9个月。在34例（27.6%）受试者中鉴定出35种肠道病原体：11种轮状病毒，9种隐孢子虫属，7种志贺氏菌属，3种空肠弯曲杆菌/大肠杆菌，3种热稳定肠致病性大肠埃希菌和2种肠致病性大肠埃希菌。在最终门诊访视时，与未确定病原体的受试者相比，具有任何确定的肠道病原体的受试者的体重-长度z评分显著较低（-0.55 +/- 1.10 vs 0.03 +/- 1.30，P = 0.03）。123名受试者中的50名（40.7%）进行了血清脂多糖（LPS）和鞭毛蛋白抗体分析。患有任何确定的肠道病原体的受试者对LPS的免疫球蛋白（伊加）抗体较低（0.75 +/- 0.27 vs 1.13 +/- 0.77，P = 0.01）和鞭毛蛋白（0.52 +/- 0.16 vs 0.73 +/- 0.47，P = 0.02）。结论：这种定量聚合酶链反应方法可以识别肠道病原体，使儿童处于较高的风险，次优生长。伊加抗LPS和鞭毛蛋白抗体有望成为新兴的肠道生物标志物。
Objective: Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relation to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants and to assess the association with anthropometrics and novel intestinal biomarkers.Methods: A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and studied for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, polymerase chain reaction-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured.Results: One hundred twenty-three subjects with diarrhea were enrolled. The mean +/- SD age at stool sample collection was 12.4 +/- 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni/coli, 3 heat stable-enterotoxigenic Escherichia coli, and 2 enteropathogenic E coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (-0.55 +/- 1.10 vs 0.03 +/- 1.30, P = 0.03) at the final clinic visit than those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to lipopolysaccharide (LPS) and flagellin. Subjects with any identified enteropathogen had lower immunoglobulin (IgA) antibodies to LPS (0.75 +/- 0.27 vs 1.13 +/- 0.77, P = 0.01) and flagellin (0.52 +/- 0.16 vs 0.73 +/- 0.47, P = 0.02) than those without an identified pathogen.Conclusions: This quantitative polymerase chain reaction method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers.