急性胰腺炎患者住院早期胃肠功能与病情进展的相关性研究
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摘要
背景肠道作为吸收营养、参与免疫调节的重要器官,其在急性胰腺炎患者的病情进展中起着重要作用,但目前关于住院早期胃肠功能在急性胰腺炎患者病情进展中的作用鲜见报道。目的探讨轻度急性胰腺炎患者住院早期的胃肠功能与其病情进展之间的关系。方法选取2017年12月—2018年5月在南京医科大学第一附属医院胰腺中心接受治疗的轻度急性胰腺炎患者为研究对象。参照2013年急性胰腺炎患者诊治指南,根据出院诊断中病情严重程度,将患者分为轻度急性胰腺炎组(n=58)、中度急性胰腺炎组(n=28)、重度急性胰腺炎组(n=14)。比较3组患者入院后首次大便时间、入院第1、2、3天修订版胃瘫主要症状指数(GCSI-R)量表评分,并探讨患者的病情严重程度与以上指标的相关性。结果 3组急性胰腺炎患者性别、年龄、体质指数(BMI)、吸烟情况、饮酒情况、入院24 h液体入量比较,差异无统计学意义(P>0.05)。3组患者首次大便时间及GCSI-R量表总分、早饱维度评分、腹胀维度评分比较,差异有统计学意义(P<0.05);3组患者恶心/呕吐维度评分比较,差异无统计学意义(P>0.05)。急性胰腺炎患者的病情严重程度与其首次大便时间及入院第1、2、3天的GCSI-R量表总分、早饱维度及腹胀维度评分呈正相关(P<0.05),与入院第1、2、3天恶心/呕吐维度评分无相关性(P>0.05)。结论轻度急性胰腺炎患者入院早期的胃肠功能与其病情进展密切相关,反映了急性胰腺炎患者的病情严重程度,可作为预后评估指标之一。
Background Intestinal tract acts an important organ for nutrition absorption and immune regulation.In addition,it plays a vital role in the progression of acute pancreatits(AP).However,there are few reports about the role of gastrointestinal functions in assessing the severity of AP at early hospitalization.Objective To explore the relationship of gastrointestinal function with the progression of mild AP at early hospitalization.Methods Using convenient sampling,AP patients receiving inpatient treatment from Pancreas Center,the First Affiliated Hospital with Nanjing Medical University between December 2017 and May 2018 were selected.They were divided into mild AP group(n=58),moderate AP group(n=28),and severe AP group(n=14)according to the discharge diagnosis by Chinese Guidelines for the Management of Acute Pancreatitis(2013,Shanghai).The time of first stool after admission,scores of the Chinese version of Gastroparesis Cardinal Symptom Index-Revised(GCSI-R) assessed on the 1 st,2 nd,and 3 rd days of admission were collected,and their correlations with the severity of AP were analyzed.Results Analysis of variance showed that there were no significant differences in the general clinical data such as the distribution of gender,average age,average BMI,prevalence of smoking,prevalence of drinking,average total volume of intravenous fluids administered within 24 h after admission between the three groups(P>0.05).All groups showed significant differences in the time of first stool after admission,the average scores of the GCSI-R and its two dimensions(early satiety and bloating) assessed on the 1 st,2 nd,and 3 rd days of admission(P<0.05),but had no obvious difference in the average score of nausea/vomiting dimension during the three days(P>0.05).Correlation analysis showed that the severity of AP was positively related to the time of first stool after admission,the total score of GCSI-R and scores of early satiety and bloating on the 1 st,2 nd and 3 rd days of admission(P<0.05),but had no relation with the score of nausea/vomiting dimension on the 1 st,2 nd,and 3 rd day of admission(P>0.05). Conclusion The gastrointestinal function in patients with mild AP is closely related to the progression of the disease at early hospitalization. It reflects the severity of AP,and can be used as one of the indicators of prognosis evaluation.
Background Intestinal tract acts an important organ for nutrition absorption and immune regulation.In addition,it plays a vital role in the progression of acute pancreatits(AP).However,there are few reports about the role of gastrointestinal functions in assessing the severity of AP at early hospitalization.Objective To explore the relationship of gastrointestinal function with the progression of mild AP at early hospitalization.Methods Using convenient sampling,AP patients receiving inpatient treatment from Pancreas Center,the First Affiliated Hospital with Nanjing Medical University between December 2017 and May 2018 were selected.They were divided into mild AP group(n=58),moderate AP group(n=28),and severe AP group(n=14)according to the discharge diagnosis by Chinese Guidelines for the Management of Acute Pancreatitis(2013,Shanghai).The time of first stool after admission,scores of the Chinese version of Gastroparesis Cardinal Symptom Index-Revised(GCSI-R) assessed on the 1 st,2 nd,and 3 rd days of admission were collected,and their correlations with the severity of AP were analyzed.Results Analysis of variance showed that there were no significant differences in the general clinical data such as the distribution of gender,average age,average BMI,prevalence of smoking,prevalence of drinking,average total volume of intravenous fluids administered within 24 h after admission between the three groups(P>0.05).All groups showed significant differences in the time of first stool after admission,the average scores of the GCSI-R and its two dimensions(early satiety and bloating) assessed on the 1 st,2 nd,and 3 rd days of admission(P<0.05),but had no obvious difference in the average score of nausea/vomiting dimension during the three days(P>0.05).Correlation analysis showed that the severity of AP was positively related to the time of first stool after admission,the total score of GCSI-R and scores of early satiety and bloating on the 1 st,2 nd and 3 rd days of admission(P<0.05),but had no relation with the score of nausea/vomiting dimension on the 1 st,2 nd,and 3 rd day of admission(P>0.05). Conclusion The gastrointestinal function in patients with mild AP is closely related to the progression of the disease at early hospitalization. It reflects the severity of AP,and can be used as one of the indicators of prognosis evaluation.
引文
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[7]MA J,PENDHARKAR S A,O'GRADY G,et al.Effect of nasogastric tube feeding vs Nil per Os on dysmotility in acute pancreatitis[J].Nutr Clin Pract,2016,31(1):99.DOI:10.1177/0884533615603967.
[8]DI M Y,LIU H,YANG Z Y,et al.Prediction models of mortality in acute pancreatitis in adults:a systematic review[J].Ann Intern Med,2016,165(7):482.DOI:10.7326/M16-0650.
[9]WANG X,GONG Z,WU K,et al.Gastrointestinal dysmotility in patients with acute pancreatitis[J].J Gastroenterol Hepatol,2003,18(1):57-62.
[10]JIN Z,XU L,WANG X,et al.Risk factors for worsening of acute pancreatitis in patients admitted with mild acute pancreatitis[J].Med Sci Monit,2017,23:1026.
[11]LIU H,LI W,WANG X,et al.Early gut mucosal dysfunction in patients with acute pancreatitis[J].Pancreas,2008,36(2):192.DOI:10.1097/MPA.0b013e31815a399f.
[12]TAN C,LING Z,HUANG Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.DOI:10.1097/MPA.
[13]金伟,钟娟,李情洁,等.中药治疗急性胰腺炎并发急性胃肠损伤的系统评价[J].世界科学技术:中医药现代化,2016,18(4):699-708.DOI:10.11842/wst.2016.04.024.JIN W,ZHONG J,LI Q J,et al.Systematic evaluation of traditional Chinese medicine in the treatment of acute pancreatitis complicated with acute gastrointestinal injury[J].World Science and Technology:Modernization of Traditional Chinese Medicine,2016,18(4):699-708.DOI:10.11842/wst.2016.04.024.
[14]SLAWINSKI C,O'REILLY D A.Management of acute pancreatitis:a practical guide[J].Br J Hosp Med(Lond),2017,78(11):C171.DOI:10.12968/hmed.2017.78.11.C171.
[15]DI M Y,LIU H,YANG Z Y,et al.Prediction models of mortality in acute pancreatitis in adults:a systematic review[J].Ann Intern Med,2016,165(7):482.DOI:10.7326/M16-0650.
[2]TENNER S,BAILLIE J,DEWITT J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1416.DOI:10.1038/ajg.2013.218.
[3]杨军,顾元龙,姜东林,等.重症急性胰腺炎患者早期肠屏障失功能与炎症反应[J].肝胆胰外科杂志,2014,26(3):177-180.DOI:10.13709/j.cnki.1007-1954.2014.03.001.YANG J,GU Y L,JIANG D L,et al.Study on the correlation between gut mucosal barrier dysfunction and inflammatory response in patients with early severe acute pancreatitis[J].Journal of Hepatopancreatobiliary Surgery,2014,26(3):177-180.DOI:10.13709/j.cnki.1007-1954.2014.03.001.
[4]POROPAT G,GILJACA V,HAUSER G,et al.Enteral nutrition formulations for acute pancreatitis[J].Cochrane Database Syst Rev,2015,3(3):CD010605.DOI:10.1002/14651858.
[5]MARTA K,FARKAS N,SZABO I,et al.Meta-analysis of early nutrition:the benefits of enteral feeding compared to a Nil per Os diet not only in severe,but also in mild and moderate acute pancreatitis[J].Int J Mol Sc,2016,17(10):1691.DOI:10.3390/ijms17101691.
[6]REVICKI D A,RENTZ A M,DUBOIS D,et al.Gastroparesis cardinal symptom index(GCSI):development and validation of a patient reported assessment of severity of gastroparesis symptoms[J].Qual Life Res,2004,13:833-844.DOI:10.1023/B:QURE.0000021689.86296.e4.
[7]MA J,PENDHARKAR S A,O'GRADY G,et al.Effect of nasogastric tube feeding vs Nil per Os on dysmotility in acute pancreatitis[J].Nutr Clin Pract,2016,31(1):99.DOI:10.1177/0884533615603967.
[8]DI M Y,LIU H,YANG Z Y,et al.Prediction models of mortality in acute pancreatitis in adults:a systematic review[J].Ann Intern Med,2016,165(7):482.DOI:10.7326/M16-0650.
[9]WANG X,GONG Z,WU K,et al.Gastrointestinal dysmotility in patients with acute pancreatitis[J].J Gastroenterol Hepatol,2003,18(1):57-62.
[10]JIN Z,XU L,WANG X,et al.Risk factors for worsening of acute pancreatitis in patients admitted with mild acute pancreatitis[J].Med Sci Monit,2017,23:1026.
[11]LIU H,LI W,WANG X,et al.Early gut mucosal dysfunction in patients with acute pancreatitis[J].Pancreas,2008,36(2):192.DOI:10.1097/MPA.0b013e31815a399f.
[12]TAN C,LING Z,HUANG Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.DOI:10.1097/MPA.
[13]金伟,钟娟,李情洁,等.中药治疗急性胰腺炎并发急性胃肠损伤的系统评价[J].世界科学技术:中医药现代化,2016,18(4):699-708.DOI:10.11842/wst.2016.04.024.JIN W,ZHONG J,LI Q J,et al.Systematic evaluation of traditional Chinese medicine in the treatment of acute pancreatitis complicated with acute gastrointestinal injury[J].World Science and Technology:Modernization of Traditional Chinese Medicine,2016,18(4):699-708.DOI:10.11842/wst.2016.04.024.
[14]SLAWINSKI C,O'REILLY D A.Management of acute pancreatitis:a practical guide[J].Br J Hosp Med(Lond),2017,78(11):C171.DOI:10.12968/hmed.2017.78.11.C171.
[15]DI M Y,LIU H,YANG Z Y,et al.Prediction models of mortality in acute pancreatitis in adults:a systematic review[J].Ann Intern Med,2016,165(7):482.DOI:10.7326/M16-0650.
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