Journal of the Korean Pediatric Society 1972;15(7):638-674.
Published online July 31, 1972.
Studies of Urinary Hydroxyproline Excretion and Hydroxy pro line Index in the Korean Healthy Pediatric Age Group and Malnourished Group
Soon Keuk Hong
Dept, of Pediatrics, College of Medicine, Seoul National University
韓國小兒年齡別및 榮養失調症 患兒의 尿中 Hydroxyproline 排泄및 HOP lndex 의 趨移에 對하여
洪 淳克
서울大學校 홈科大學 小兒科學敎室
Abstract
Although protein malnutrition is probably the commonest deficiency disease in most parts of the world, it is difficult to advance beyond vague generalities until some method have been found of assessing the severity of protein depletion. Several workers have attempted to establish criteria for recognition of mild and early cases of kwashiorkor (So-called prekwashiorkor). These, however, are in the nature of associated phenomena and do not given any direct measure of the degree of protein depletion. In field studies the most useful single measurement is still that of body weight. Experience has shown that plasma protein concentration is not an early or sensitive index of protein depletion. A clear-cut reduction seems only to occur at a late stage, presumably because plasma proteins are maintained at the expense of tissue proteins. Jasin et al. (1962), Smiley and Ziff(1964) suggested that the excretion of hydroxyproline peptides in the urine might vary with the rate of growth, and Picou et al. (1965) found that hydroxyproline excretion in protein-depleted infants was below normal. Creatinine excretion also was reduced, but not to the same extent as the hydroxyproline. In children with malnutrion, failure to grow is one of the earliest signs. They therefore ought to have subnormal amounts of hydroxyproline peptides excretion in their urine. Because the collection of 24-hour specimens of urine was not practicable on a large scale and also, the ratio partially corrects for body size and for differences in renal function, the test has therefore been developed as the ratio between the amount of hydroxyproline and creatinine in random samples of urine (Hydroxyproline Index). It has become obvious that the detailed nature of the nutritional and infectious stresses on the chronically malnourished child varies from country to country and from environment to environment, and a standard value which is useful in one environment may be valueless in another. Accordingly in normal Korean children under 15 years of age, 24-hour urinary free-HOP value' total HOP value, percentage of the free-HOP to the total HOP, 24-hour urinary total creatinine value, total creatinine value per body weight (Kg), ratio between the amount of HOP and creatinine, and 24-hour urinary HOP Index were calculated according to the age. And also, 24-hour urinary excretion of HOP in malnourished cases admitted to the National Medical Center, selectively, was studied. A. Study in the Korean Healthy Pediatric Age Group. 1. The mean 24-hour urinary free-HOP value was 5. 2 mg in premature group, 3. 5 mg in newborn group, 4. 4 mg in the 1 month-1 year group, 1. 9 mg in the 1-5 years group, 3. 8 mg in the 5-10 years group, and 2. 7 mg in the 10-15 years group. There was no significant difference in 24-hour urinary free-HOP excretion between different age groups but highest in premature group, and thereafter tendency to fall slightly. In premature group, there was steady rise after birth; in 1 month-1 year group, tendency to fall in the late than early infant. 2. The mean 24-hour urinary total HOP value was 14.1 mg in premature group, 19. 3 mg in newborn group, 33. 7 mg in the 1 month-1 year group, 44. 9 mg in the 1~5 years group, 51. 9 mg in the 5-10 years group, and 120. 3 mg in the 10-15 years group. Steady rise according to age increase was noted and a sharp rise in the 10-15 years group was noted. 3. The mean percentage of the free-HOP to the total HOP was 32.1% in premature group, 18 in newborn group, 12. 5% in the 1 month-1 year group, 4. 2% in the 1-5 years group, and 2. 7% in the 10~15 year group. Steady fall according to age increase was noted and so, this percentage may be used as a simple method of assessing the maturation of catabolic enzymes in the neonatal period. 4. The mean 24-hour urinary total creatinine value was 22. 4 mg in premature group, 40. 2 mg in newborn group, 69.7 mg in the 1 month-1 year group, 190. 4 mg in the 1-5 years group, 401. 8 mg in the 5_10 year group, and 653mg in the 10~15 years group. Steady rise according to age increase was noted. And the mean 24-hour urinary total creatinine value per body weight(Kg) was 12. 4 mg/kg in premature group, 13. 6 mg/kg premature group, 13. 6 mg/kg in newborn group. 12. 5 mg/kg in the 1 month-1 year group, 13. 6 mg/kg in the 1-5 years group, 19. 3 mg/kg in the 5-10 years group and 19. 7 mg/kg in the 10-15 years group. Slight rising in the 5~15 years group was noted but almost constant value in the other groups. In. newborn group the total creatinine value per body weight (Kg) tended to fall after birth. 5. The mean ratio between the amount of HOP and creatinine was 0. 66 in premature group, 0. 60 in newborn group, 0. 55 in the 1 month-1 year group, 0. 24 in the 1-5 years group, 0. 14 in the 5~10 years group, and 0. 22 in the 10~15 years group. Steady fall according to age increase was noted and especially sharp fall after 1 year of age. But in the newborn group, there was steady rise after birth. 6. The mean HOP Index was 1. 05 in premature group, 1. 58 in newborn group, 2. 51 in the 1 month-1 year group, 2. 71 in the 1-5 years group, 2. 54 in the 5-10 years group, and 6. 33 in the 10~15 year group. There was steady rise according to aging and especially sharp rise in the 10~15 year group. B. Study in malnourished group. 1. The mean serum total protein was 5. 25 gm% and the mean albumin, 2. 5 gm%. In the electrophoretic pattern, rise in the alpha-1, alpha-2 globulin, slight fall in the beta globulin, and normal range in the gamma globulin were noted. 2. The mean serum amylase was 29 Somogy which showed marked fall compared to normal but alkaline phosphatase, average 11. 6 U which was within normal range. The mean SGOT was 53. 1 U and SGPT was 31. 1 U. The mean serum total cholesterol showed decreased value of 119. 7 mg% but thymol was within normal range of 3. 45 U. 3. The mean serum electrolyte values were Na 135 mEq, Cl 97. 4 mEq, K 3. 5 mEq, and HCOs 23. 1 mEq. 4. Almost normal curves in standard glucose tolerance test were noted except 2 cases which showed flattening in curve. 5. There was no different in 24-hour urinary free-HOP excretion of malnourished group compared to the previous normal healthy group but somewhat rise in malnourished cases of M 13 and M 15 was noted. Marked fall in 24-hour urinary total HOP excretion of malnourished group was noticed. Accordingly, marked rising in the percentage of the free-HOP to the total HOP was found in the malnourished group compared to the normal healthy group. 6. In the acute stage, there was marked fall in the 24-hour urinary creatinine excretion of malnourished cases (M 8, M 14 and M 15) compared to healthy group but tendency to rise after treatment. 7. The ratio between the amount of HOP and creatinine in the malnourished group was generally- lowered than normal healthy group of same age. 8. In the almost whole cases of malnourished group, there was fall in HOP Index compared to the normal healthy group. In the acute stage, slight fall in the HOP Index was noted but about 15 days later after treatment, the HOP Index tended to rise. 9. In the malnourished group, the change of the HOP Index wasn’t always paralleled to the change of the body weight.




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