Padillo F J, Andicoberry B, Naranjo A, Miño G, Pera C, Sitges-Serra A
Department of Surgery, Hospital Universitario Reina Sofía, Córdoba, Spain.
J Am Coll Surg. 2001 May;192(5):584-90. doi: 10.1016/s1072-7515(01)00841-9.
Anorexia is a frequent finding in patients with biliary obstruction (BO). This study investigates the role of biochemical and hormonal factors in the pathogenesis of reduced food intake in BO and the effects of internal biliary drainage.
Sixty-two patients with BO were prospectively investigated. Transaminases, amylase, cholecystokinin, secretin, bile acids, tumor necrosis factor-alpha, and endotoxin were determined at admission. Caloric intake was quantified by a controlled diet. In a subset of 27 patients, studies were repeated after internal biliary drainage.
Sixty-six percent of patients had spontaneous food intakes below the estimated caloric requirements. Serum bilirubin, alkaline phosphatase, and cholecystokinin plasma levels were independent predictor factors for calorie intake (p = 0.0001). After internal biliary drainage, cholestasis parameters and cholecystokinin concentrations decreased significantly; this was associated with an improvement of spontaneous food intake in both benign and malignant biliary obstruction (p < 0.01 and p < 0.05, respectively).
Decreased food intake in BO was associated with the degree of obstruction and with increased cholecystokinin plasma levels. Biliary drainage improved biochemical and food intake derangements.
厌食是胆道梗阻（BO）患者的常见表现。本研究旨在探讨生化和激素因素在BO患者食物摄入量减少的发病机制中的作用以及内引流术的影响。
对62例BO患者进行前瞻性研究。入院时测定转氨酶、淀粉酶、胆囊收缩素、促胰液素、胆汁酸、肿瘤坏死因子-α和内毒素。通过控制饮食来量化热量摄入。在27例患者的亚组中，内引流术后重复进行研究。
66%的患者自发食物摄入量低于估计的热量需求。血清胆红素、碱性磷酸酶和血浆胆囊收缩素水平是热量摄入的独立预测因素（p = 0.0001）。内引流术后，胆汁淤积参数和胆囊收缩素浓度显著降低；这与良性和恶性胆道梗阻患者自发食物摄入量的改善相关（分别为p < 0.01和p < 0.05）。
BO患者食物摄入量减少与梗阻程度及血浆胆囊收缩素水平升高有关。胆道引流改善了生化指标和食物摄入紊乱。
