早期肠内营养对预测的重症急性胰腺炎炎症反应标志物影响的随机对照试验

Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis.

作者信息

Powell J J, Murchison J T, Fearon K C, Ross J A, Siriwardena A K

机构信息

University Department of Surgical and Clinical Sciences and Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.

出版信息

Br J Surg. 2000 Oct;87(10):1375-81. doi: 10.1046/j.1365-2168.2000.01558.x.

DOI:10.1046/j.1365-2168.2000.01558.x

PMID:11044164

Abstract

BACKGROUND

Recent evidence suggests that intestinal dysfunction has a role in sustaining the systemic inflammatory response in acute pancreatitis and may be ameliorated by the introduction of enteral nutrition. This study therefore assessed the effect of early enteral nutrition on the systemic inflammatory response in patients with prognostically severe acute pancreatitis.

METHODS

Patients with prognostically severe acute pancreatitis within 72 h of disease onset were randomized to receive either enteral nutrition or conventional therapy consisting of a nil-by-mouth regimen. Serum interleukin (IL) 6, soluble tumour necrosis factor receptor I (sTNFRI) and C-reactive protein (CRP) were used as markers of the inflammatory response. Intestinal function was assessed using a differential sugar permeability technique.

RESULTS

Of 27 patients, 13 received enteral nutrition. A median of 21 (range 0-100) per cent of calorific requirements was delivered over the first 4 days by enteral nutrition. There were no significant complications of enteral nutrition. The introduction of enteral nutrition did not affect the serum concentrations of IL-6 (P = 0.28), sTNFRI (P = 0.53) or CRP (P = 0.62) over the first 4 days of the study. Although there were no significant differences in intestinal permeability between the two patient groups at admission (chi2 = 2.33, d.f. = 1, P = 0.13), by day 4 abnormal intestinal permeability occurred more frequently in patients receiving enteral nutrition (chi2 = 4.94, d.f. = 1, P = 0.03)

CONCLUSION

Early enteral nutrition did not ameliorate the inflammatory response in patients with prognostically severe acute pancreatitis. Furthermore, it did not have a beneficial effect on intestinal permeability. Presented in part to the Pancreatic Society of Great Britain and Ireland in Leeds, UK, November 1998 and at Digestive Disease Week in Orlando, Florida, USA, May 1999

摘要

背景

最近有证据表明，肠道功能障碍在急性胰腺炎全身炎症反应的持续过程中起作用，肠内营养的引入可能会改善这种情况。因此，本研究评估了早期肠内营养对预后严重的急性胰腺炎患者全身炎症反应的影响。

方法

疾病发作72小时内预后严重的急性胰腺炎患者被随机分为接受肠内营养组或由禁食方案组成的传统治疗组。血清白细胞介素（IL）-6、可溶性肿瘤坏死因子受体I（sTNFRI）和C反应蛋白（CRP）用作炎症反应的标志物。使用差异糖通透性技术评估肠道功能。

结果

27例患者中，13例接受肠内营养。在最初4天内，肠内营养提供的热量需求中位数为21%（范围0-100%）。肠内营养无明显并发症。在研究的前4天，肠内营养的引入未影响IL-6（P = 0.28）、sTNFRI（P = 0.53）或CRP（P = 0.62）的血清浓度。虽然两组患者入院时肠道通透性无显著差异（χ2 = 2.33，自由度 = 1，P = 0.13），但到第4天，接受肠内营养的患者肠道通透性异常更频繁（χ2 = 4.94，自由度 = 1，P = 0.03）。