Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon
Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon
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DOI：
10.1053/gast.2001.22555
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发表时间：
2001-03-01
期刊：
影响因子：
29.4
通讯作者：
Mortensen, PB
中科院分区：
文献类型：
--
作者：
Jeppesen, PB;Hartmann, B;Mortensen, PB
背景与目的：胰升糖素样肽2(GLP-2)在啮齿类动物中具有肠道营养、抗分泌和转运调节作用，主要由食物摄入后的回肠末端和结肠的肠粘膜分泌。我们评估了GLP-2对没有末端回肠和结肠的功能性短弓综合征患者的胃肠功能的影响，这些患者患有严重的湿重(>；1.5公斤/天)和能量(>；2.3MJ/天)吸收不良，且餐后没有GLP-2分泌。方法：对8例患者(上次肠切除后4~17年，6例克罗恩病患者)进行GLP-2治疗前后的平衡测试，每天2次，共35天。4例患者接受家庭肠外营养(平均残留空肠83 cm)，4例未接受(平均回肠切除106 cm)。从空肠/回肠吻合口取活检标本，用放射性核素扫描测量通过时间，用双能X线吸收测量仪测量身体成分。结果：GLP-2可使肠道能量吸收3.5%+/-4.0%(平均+/-SD)由49.9%提高到53.4%(P=0.04)，湿重11%+/-12%从25%提高到36%(P=0.04)，氮吸收4.7%+/-5.4%从47.4%提高到52.1%(P=0.04)。体重增加1·2±-1·0 kg(P=0·01)，瘦体重增加2·9±-1·9 kg(P=0.004)，脂肪质量减少1·8±-1·3 kg(P=0.007)，24小时尿肌酐排泄量增加(P=0·02)。固体50%胃排空时间从89分钟增加到119分钟，延长30±16分钟(P<；0.05)。小肠通过时间没有改变。隐窝深度增加5例，绒毛高度增加6例。结论：GLP-2治疗改善了短肠患者的肠道吸收和营养状况，这些患者餐后GLP-2分泌受损，并已切除末端回肠和结肠。
Background & Aims: Glucagon-like peptide 2 (GLP-2) is intestinotrophic, antisecretory, and transit-modulating in rodents, and it is mainly secreted from the intestinal mucosa of the terminal ileum and colon after food ingestion. We assessed the effect of GLP-2 on the gastrointestinal function in patients without a terminal ileum and colon who have functional short-bower syndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2.3 MJ/day) and no postprandial secretion of GLP-2. Methods: Balance studies were performed before and after treatment with GLP-2, 400 mug subcutaneously twice a day for 35 days, in 8 patients (4-17 years from last bowel resection; 6 with Crohn's disease). Four patients received home parenteral nutrition (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 106 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry. Results: Treatment with GLP-2 improved the intestinal absorption of energy 3.5% +/- 4.0% (mean +/- SD) from 49.9% to 53.4% (P = 0.04), wet weight 11% +/- 12% from 25% to 36% (P = 0.04), and nitrogen 4.7% +/- 5.4% from 47.4% to 52.1% (P = 0.04). Body weight increased 1.2 +/- 1.0 kg (P = 0.01), lean body mass increased 2.9 +/- 1.9 kg (P = 0.004), fat mass decreased 1.8 +/- 1.3 kg (P 0.007), and 24-hour urine creatinine excretion increased (P = 0.02). The time to 50% gastric emptying of solids increased 30 +/- 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 and 6 patients, respectively. Conclusions: Treatment with GLP-2 improves intestinal absorption and nutritional status in short-bowel patients with impaired postprandial GLP-2 secretion in whom the terminal ileum and the colon have been resected.