Surgical Anatomy Does Not Affect the Progression of Intestinal Failure-Associated Liver Disease in Neonatal Piglets
Surgical Anatomy Does Not Affect the Progression of Intestinal Failure-Associated Liver Disease in Neonatal Piglets
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DOI：
10.1177/0148607117718478
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发表时间：
2018-01-01
影响因子：
3.4
通讯作者：
Turner, Justine M.
中科院分区：
文献类型：
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作者：
Lavallee, Celeste M.;Wizzard, Pamela R.;Turner, Justine M.
背景：肠衰竭相关肝病（IFALD）在依赖肠外营养（PN）的短肠综合征（SBS）新生儿中引起显著的发病率。回肠切除伴回盲瓣（ICV）丢失是SBS中最常见的解剖结构，但其对IFALD的影响尚未得到充分研究。方法：将新生仔猪随机分为75%空肠结肠吻合切除组（JC, n = 12）、75%空肠回肠吻合完整ICV切除组（JI, n = 13）、pn饲喂假手术组（sham, n = 14）和母猪饲喂对照组（SF, n = 8）。手术仔猪和假手术仔猪接受100% PN治疗14天后，测量胆汁流量，评估血液化学、肝脏病理、空肠通透性和细菌易位。结果：与SF相比，pn喂养的胆汁流量较低（P = 0.002），但pn喂养组之间无差异。pn组总胆红素（P = 0.03）和肝脏病理（P < 0.001）高于SF组，但pn组间差异无统计学意义。假手术组血清胆汁酸升高（P = 0.01）， SBS组间差异无统计学意义。pn喂养的脓毒症仔猪胆汁流量降低（P = 0.001），胆红素升高（P = 0.04）。JC组、JI组和sham组的空肠通透性和细菌易位均无差异。结论：与我们的假设相反，残余的解剖结构似乎不会恶化IFALD的进展。然而，脓毒症在IFALD中的作用，除了PN因子、宿主免疫反应、肠道细菌生态失调等其他机制外，还有待进一步探讨。
Background: Intestinal failure-associated liver disease (IFALD) causes significant morbidity in neonates with short bowel syndrome (SBS) dependent on parenteral nutrition (PN). Resected ileum, with loss of the ileocecal valve (ICV), is the most common anatomy in SBS, yet its impact on IFALD has not been adequately studied. Methods: Neonatal piglets were randomized to 75% intestinal resection with jejunocolic anastomosis (JC, n = 12), 75% resection with jejunoileal anastomosis and intact ICV (JI, n = 13), PN-fed sham (sham, n = 14), or sow-fed control (SF, n = 8). Surgical and sham piglets received 100% PN for 14 days before bile flow was measured and blood chemistry, liver pathology, jejunal permeability, and bacterial translocation were assessed. Results: Bile flow was lower for PN-fed compared with SF (P = .002) but not different between the PN-fed groups. Total bilirubin (P = .03) and liver pathology (P < .001) were greater in PN-fed than SF groups but not different between PN-fed groups. Serum bile acids were increased in sham (P = .01) but not different between SBS groups. PN-fed piglets with sepsis had lower bile flow (P = .001) and increased bilirubin (P = .04). Neither jejunal permeability nor bacterial translocation were different between JC, JI, or sham groups. Conclusion: Contrary to our hypothesis, the remnant anatomy does not appear to worsen the progression of IFALD. However, the role of sepsis in IFALD should be further explored, in addition to other mechanisms, including PN factors, host immune responses, and intestinal bacterial dysbiosis.