Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction
Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction
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DOI：
10.1016/j.clnu.2008.02.005
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发表时间：
2008-06-01
影响因子：
6.3
通讯作者：
Cynober, Luc
中科院分区：
文献类型：
--
作者：
Crenn, Pascal;Messing, Bernard;Cynober, Luc
背景和目的：在人类中，瓜氨酸（血浆浓度约40μmol/L）是一种参与中间代谢的氨基酸，并且不掺入蛋白质中。循环瓜氨酸主要由小肠肠细胞产生。因此，血浆或血清瓜氨酸浓度被提议作为残余小肠质量和功能的生物标志物。本文回顾了这一概念及其代谢基础。方法：在成人和儿童中测量了小肠肠上皮细胞质量和功能显着降低以及血浆或血清瓜氨酸的情况。这些研究包括患有短肠综合征、绒毛萎缩状态、克罗恩病的患者，监测化疗和放疗的消化毒性或小肠移植后患者的随访。结果：在所有这些情况下，超过 500 名研究患者的血浆瓜氨酸水平下降与肠上皮细胞质量减少相关，与营养和炎症状态无关。发现小肠残余长度与瓜氨酸血症之间存在密切相关性。此外，在肠上皮细胞质量明显减少的严重小肠疾病中，通过血浆瓜氨酸水平评估肠衰竭的诊断。讨论：绒毛萎缩疾病（10μmol/L）肠衰竭诊断的阈值低于短肠综合征（20μmol/L）。当将血浆瓜氨酸水平视为肠衰竭的标志时，肾功能受损是一个重要因素，因为这可能会增加循环瓜氨酸值。结论：血浆瓜氨酸水平降低是人类不同疾病状态下肠上皮细胞质量和功能显着降低的创新定量生物标志物。 (C) 2008 Elsevier Ltd 和欧洲临床营养与代谢学会。保留所有权利。
Background Et aims: In human, citrulline (plasma concentration about 40 mu mol/L) is an amino acid involved in intermediary metabolism and that is not incorporated in proteins. Circulating citrulline is mainly produced by enterocytes of the small bowel. For this reason plasma or serum citrulline concentration has been proposed as a biomarker of remnant small bowel mass and function. This article reviews this concept and its metabolic basis.Methods: Conditions in which there is a significantly reduced small bowel enterocyte mass and function and a plasma or serum citrulline were measured in adults and children. These studies included patients with a short bowel syndrome, villous atrophy states, Crohn's disease, during monitoring of digestive toxicity of chemotherapy and radiotherapy or follow-up of patients after small bowel transplantation.Results: In all these situations, with more than 500 studied patients a decreased level of plasma citrulline correlated with the reduced enterocyte mass independently of nutritional and inflammatory status. A close correlation between small bowel remnant Length and citrullinemia was found. In addition, diagnosis of intestinal failure was assessed through plasma citrulline levels in severe small bowel diseases in which there is a marked enterocyte mass reduction.Discussion: The threshold for establishing a diagnosis of intestinal failure is lower in villous atrophy disease (10 mu mol/L) than in short bowel syndrome (20 mu mol/L). Compromised renal function is an important factor when considering plasma citrulline levels as a marker of intestinal failure as this potentially can increase circulating citrulline values.Conclusions: Reduced plasma citrulline levels are an innovative quantitative biomarker of significantly reduced enterocyte mass and function in different disease states in humans. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Ail rights reserved.