Griesche-Philippi J, Otto J, Schwörer H, Maisonneuve P, Lankisch P G
Practice for Nephrology and Dialysis, University of Göttingen, Göttingen, Germany.
Clin Nephrol. 2010 Dec;74(6):457-64. doi: 10.5414/cnp74457.
malnutrition is a common problem in patients with end-stage renal disease (ESRD). Several studies showed 30 years ago that more than half of patients with ESRD suffered from exocrine pancreatic insufficiency. However, the studies never investigated whether the functional impairments led to morphological changes of the pancreas or to steatorrhea and thus indicating the need for lifelong pancreatic enzyme substitution. Our goal was therefore not only to establish the frequency but also the severity of exocrine pancreatic insufficiency in hemodialysis patients.
the study included 50 hemodialysis patients with no history of acute or chronic pancreatitis or upper abdominal symptoms of uncertain origin. All patients with hyperthyroidism, status post-gastrectomy or (partial) small bowel resection, or chronic inflammatory bowel disease were excluded. In all 50 patients, fecal elastase-1 was determined using two different methods (Bioserv Diagnostics and ScheBo Biotech) and fecal fat content and fecal weight were measured.
mild to moderate exocrine pancreatic insufficiency (elastase-1 100 - 200 microg/g stool) was found in 10% of patients. It was not correlated with age, sex, and underlying renal disease, duration of hemodialysis, or diarrhea and steatorrhea. In no patient was the enzyme content < 100 microg/g stool, i.e., it never sank to a level at which pancreatic enzyme substitution would have been recommended. Nine patients (18%) had mild diarrhea (200 - 300 g stool/ day), and 10 (20%) had mild steatorrhea (7 - 15 g fat/day in the stool). Five patients had both diarrhea and steatorrhea.
mild to moderate but not severe exocrine pancreatic insufficiency is not infrequent in patients on hemodialysis but unlikely to be responsible for malnutrition in ESRD. Non-pancreas-related steatorrhea is also not uncommon. This finding requires further analysis because steatorrhea might influence nutrition, thus potentially opening the way to new therapeutic approaches.
营养不良是终末期肾病（ESRD）患者的常见问题。30年前的几项研究表明，超过一半的ESRD患者存在外分泌性胰腺功能不全。然而，这些研究从未调查过功能障碍是否导致胰腺形态改变或脂肪泻，因此也未表明是否需要终身进行胰酶替代治疗。因此，我们的目标不仅是确定血液透析患者中外分泌性胰腺功能不全的发生率，还要确定其严重程度。
该研究纳入了50例无急性或慢性胰腺炎病史或不明原因上腹部症状的血液透析患者。所有甲状腺功能亢进、胃切除术后或（部分）小肠切除术后患者，或慢性炎症性肠病患者均被排除。对所有50例患者，使用两种不同方法（Bioserv Diagnostics和ScheBo Biotech）测定粪便弹性蛋白酶-1，并测量粪便脂肪含量和粪便重量。
10%的患者存在轻度至中度外分泌性胰腺功能不全（弹性蛋白酶-1为100 - 200微克/克粪便）。它与年龄、性别、基础肾病、血液透析时间或腹泻及脂肪泻均无相关性。没有患者的酶含量<100微克/克粪便，即从未降至推荐进行胰酶替代治疗的水平。9例患者（18%）有轻度腹泻（每天粪便200 - 300克），10例患者（20%）有轻度脂肪泻（粪便中每天脂肪7 - 15克）。5例患者同时有腹泻和脂肪泻。
轻度至中度而非重度外分泌性胰腺功能不全在血液透析患者中并不罕见，但不太可能是ESRD患者营养不良的原因。非胰腺相关的脂肪泻也并不少见。这一发现需要进一步分析，因为脂肪泻可能影响营养状况，从而可能为新的治疗方法开辟道路。
