短腸症治療的新契機：Teduglutide

TEDUGLUTIDE FOR THE TREATMENT OF SHORT BOWEL SYNDROME

羅惠珍(Hui-Chen Lo)

《秀傳醫學雜誌》 16卷2期 (2017/12) Pp. 105-109

https://doi.org/10.3966/156104972017121602006

摘要

短腸症是因腸道長度減少導致腸道功能損傷的疾病，可為先天腸道結構異常或後天因疾病如克隆氏症或手術切除大部分小腸所造成。短腸症患者症狀表現不一，包括腹瀉、腹痛、營養不良和脫水。症狀的嚴重度與殘存腸道的長度具相關性，短腸症患者需要多科專家進行跨團隊照護。過去，短腸症的治療主要以支持療法為主，治療藥物以症狀治療為主，減少患者腹瀉次數和抑制胃酸分泌，給予靜脈營養做為營養支持；但長期使用靜脈營養衍生問題如導管感染、靜脈栓塞、電解質失衡、腎臟及肝臟疾病等相關併發症影響了患者生活品質。增加腸道吸收能力和減少使用靜脈營養有助於提升患者生活品質並降低相關合併症發生。Teduglutide 為glucagon-like peptide 2 analog，作用為促進腸道適應能力和增加對營養及水分吸收，減少對靜脈營養和輸液依賴，經皮下注射給予，建議劑量為0.05 mg/kg/day，腎功能不全者需調降劑量。因為具有細胞增殖特性，所以不適用於胃腸道惡性腫瘤者；常見的藥物不良反應多來自胃腸道症狀，為短腸症治療帶來新契機。

關鍵字

短腸症 ； 靜脈營養 ； 腸道適應能力 ； 昇糖素類似胜肽-2 ； teduglutide

並列摘要

Short bowel syndrome (SBS) is a disease state with reduced functioning of the small bowel length that can be congenital, due to disease such as Crohns' disease or massive bowel resection. Patients present various symptoms, including diarrhea, abdominal pain, malnutrition, and dehydration. The severity of symptoms depends on the length of small bowel remaining .The care of SBS requires complex technologies and multidisciplinary expertise. In the past, management of SBS patients was predominantly supportive, using pharmacotherapeutic agents to minimize gastrointestinal fluid losses by controlling diarrhea or high stomal output and requiring parenteral nutrition. However, there are complications of parenteral nutrition such as catheter infections, venous thromboembolism, electrolyte disturbances, renal and liver disease and reduced quality of life. Increased intestinal absorption and reduced dependence on parenteral nutrition would improve the quality of life and complications related to parenteral nutrition. As one means of treatment, teduglutide is a human glucagon-like peptide 2(GLP-2) analog that has a role in intestinal adaptation and absorption as well as in reducing parenteral nutrition and fluid requirements and targeted treatment for SBS. Administered subcutaneously, the recommended dose of 0.05 mg/kg/day, renal dysfunction were required to reduce the dose. There is concern for teduglutide promoted cellular multiplication and growth, and therefore, it is not recommended in patients with active gastrointestinal malignancies. The most frequently reported adverse events are of gastrointestinal origin. As such, it is a promising treatment for short bowel syndrome.

並列關鍵字

Short bowel syndrome ； Parenteral nutrition ； Intestinal adaptation ； Glucagon-like peptide 2 ； Teduglutide