Importance of colonic support for energy absorption as small-bowel failure proceeds
Importance of colonic support for energy absorption as small-bowel failure proceeds
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DOI：
10.1093/ajcn/64.2.222
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发表时间：
1996-08-01
影响因子：
7.1
通讯作者：
Mortensen, PB
中科院分区：
文献类型：
--
作者：
Nordgaard, I;Hansen, BS;Mortensen, PB
人类结肠的消化过程受到细菌发酵的影响，将吸收不良的碳水化合物和蛋白质转化为短链脂肪酸，这些脂肪酸被吸收并提供能量。通过评估粪便弹量热法，对148例小肠长度极不相同的患者进行能量吸收测定。结肠切除术使小肠长度在正常到150-200厘米之间的患者的粪便能量损失增加0.8MJ/d，碳水化合物排泄增加5倍。1 0 0~15 0 cm小肠组与无结肠组排泄量分别为1.3+/-0.3MJ/d和4.7+/-0.5MJ/d(P=0.002)，相差3.4MJ/d，两者差异显著(P=0.0 3)。在保留了结肠功能的患者中，碳水化合物的能量排出比脂肪少得多，这可能是因为发酵去除了碳水化合物作为吸收的短链脂肪酸，而在没有结肠功能的患者中，碳水化合物和脂肪损失了相当数量的能量。能量吸收不良与小肠长度的相关性较差(r=-0.41)，但将有结肠和无结肠患者的数据分开后，两者的相关性增加(r=-0.56和r=-0.58)。然而，小肠长度仍然不能准确地衡量肠道吸收营养能量的能力。总之，随着小肠衰竭的进展，结肠消化可以支持高达4.2MJ/d的能量供应，但对于小肠长度为200厘米或吸收不良&2.1MJ/d的患者来说，它是次要的。
Digestive processes in the human colon are affected by the bacterial fermentation of malabsorbed carbohydrates and protein to short-chain fatty acids, which are absorbed and supply energy. Energy absorption was measured by assessing fecal bomb calorimetry in 148 patients with extremely different small-bowel lengths. Colectomy increased fecal loss of energy by 0.8 MJ/d and carbohydrate excretion fivefold in patients with a small-bowel length between normal and 150-200 cm. Patients with 100-150 cm small bowel, with and without a colon, excreted 1.3 +/- 0.3 and 4.7 +/- 0.5 MJ/d, respectively (P = 0.002), a difference of 3.4 MJ/d. Patients with < 100 cm small bowel excreted 3.1 +/- 0.4 and 8.0 +/- 1.3 MJ/d, respectively (P = 0.03), a difference of 4.9 MJ/d. Similar and highly significant differences were calculated by linear-regression analysis. Considerably less energy was excreted as carbohydrate than as fat in patients with preserved colonic function, probably because fermentation removed carbohydrate as absorbed short-chain fatty acids, whereas a comparable amount of energy was lost as carbohydrate and fat in patients without colonic function. The correlation between malabsorbed energy and small-bowel length was poor (r = -0.41) but increased when data for patients with and without a colon were separated (r = -0.56 and r = -0.58, respectively). Small-bowel length, however, was still an inaccurate measure of intestinal failure to absorb nutrient energy. In conclusion, colonic digestion may support energy supply with up to approximate to 4.2 MJ/d as small-bowel failure proceeds, but it is of minor importance in patients with a small-bowel length > 200 cm or malabsorption < 2.1 MJ/d.