背景:胆道梗阻是一种相对常见的疾病,每年约有5/1000的人受到影响。营养不良在胆道梗阻患者中非常常见,因为它与显著的发病率和死亡率相关。重要的是要确定参与其发展的因素和机制。
目的:探讨梗阻性黄疸对食欲控制激素及营养状况的影响。
方法:这是一项在萨格勒布三级中心进行的前瞻性病例对照研究,克罗地亚。纳入2012年9月至2013年8月接受胆道内引流术的胆道梗阻患者。排除出现手术相关并发症或随访失败的患者后,在最初的73名患者中,55名患者被纳入分析,其中良性34例,恶性21例。同时,还包括40名非黄疸对照。食欲,营养状况,和血清生长素释放肽,胆囊收缩素(CCK),白细胞介素6(IL-6),入院时测定肿瘤坏死因子α(TNF-α),胆道内引流术后48h和28d。分类变量采用卡方检验。通过Kolmogorov-Smirnov检验和相关的非参数分析连续变量的正态(Mann-Whitney,Kruskal-Wallis,和弗里德曼)或参数(t检验和方差分析)检验。
结果:与对照组相比,阻塞性黄疸患者明显营养不良,不管疾病的病因。阻塞性黄疸患者血浆ghrelin和CCK水平明显升高。血清胆红素浓度与ghrelin水平呈负相关,与TNF-α呈正相关,但与CCK浓度无关。胆道内引流后,虽然ghrelin的血清浓度显着改善了营养状况,即使在手术后28d,IL-6和TNF-α仍显着升高。术后28d无营养不良患者的CCK水平仍然升高,但是在营养不良的患者中,CCK水平降低至与对照组相当的水平。我们还没有确定食欲和血清ghrelin水平之间的任何相关性,CCK,胆道引流前后IL-6和TNF-α。
结论:在胆道梗阻患者的炎症反应过程中,ghrelin和CCK调节的可能异常可能与营养不良的发展有关。
BACKGROUND: Biliary obstruction is a relatively common condition that affects approximately 5 in 1000 people annually. Malnutrition is very common in patients with biliary obstruction and since it is associated with significant morbidity and mortality, it is important to identify factors and mechanisms involved in its development.
OBJECTIVE: To determine the influence of obstructive jaundice on the hormones controlling appetite and nutritive status.
METHODS: This was a prospective
case control study performed in a tertiary center in Zagreb, Croatia. Patients with biliary obstruction undergoing internal biliary drainage from September 2012 until August 2013 were enrolled. After excluding patients who developed procedure related complications or were lost in the follow-up, out of initial 73 patients, 55 patients were included in the analysis, including 34 with benign and 21 with malignant disease. Meanwhile, 40 non-jaundiced controls were also included. Appetite, nutritional status, and serum
ghrelin, cholecystokinin (CCK), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) were determined at admission, 48 h and 28 d after internal biliary drainage. Chi square test was used for categorical variables. Continuous variables were analysed for normality by Kolmogorov-Smirnov test and relevant non-parametric (Mann-Whitney, Kruskal-Wallis, and Friedman) or parametric (t-test and analysis of variance) tests were used.
RESULTS: Patients with obstructive jaundice were significantly malnourished compared to controls, regardless of disease etiology. Plasma
ghrelin and CCK levels were significantly higher in patients with obstructive jaundice. Serum bilirubin concentrations were negatively correlated with
ghrelin levels and positively correlated with TNF-α, but had no correlation with CCK concentrations. After internal biliary drainage, a significant improvement of nutritional status was observed although serum concentrations of ghrelin, IL-6, and TNF-α remained significantly elevated even 28 d after the procedure. CCK levels in patients without malnutrition remained elevated 28 d after the procedure, but in patients with malnutrition, CCK levels decreased to levels comparable with those in the control group. We have not established any correlation between appetite and serum levels of
ghrelin, CCK, IL-6, and TNF-α before and after biliary drainage.
CONCLUSIONS: Possible abnormalities in ghrelin and CCK regulation may be associated with the development of malnutrition during the inflammatory response in patients with biliary obstruction.