Lindkvist Björn, Phillips Mary E, Domínguez-Muñoz J Enrique
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
Pancreatology. 2015 Nov-Dec;15(6):589-97. doi: 10.1016/j.pan.2015.07.001. Epub 2015 Jul 17.
Pancreatic exocrine insufficiency (PEI) frequently occurs secondary to exocrine pancreatic disease (e.g. chronic pancreatitis, cystic fibrosis, cancer) or pancreatic/gastrointestinal surgery, resulting in the maldigestion of nutrients and consequently malnutrition. Pancreatic enzyme replacement therapy (PERT) is the cornerstone of PEI management. Despite its clinical relevance, the diagnosis of PEI in clinical practice is challenging, as the current gold standard test is cumbersome, and alternatives have limited availability or accuracy. There is a need for accurate and easily applicable diagnostic modalities. We review the prevalence of clinical symptoms and changes in anthropometric measurements and laboratory nutritional markers indicative of malnutrition in patients with PEI, and the relevance of these findings in diagnosing PEI and monitoring PERT efficacy. Based on limited available evidence, assessment of clinical symptoms, body weight, body mass index and other anthropometric parameters are not sensitive methods for PEI diagnosis, owing to high variability and multiple confounding factors, but appear useful in monitoring PERT efficacy. Limited evidence precludes strong recommendations but suggests that serum levels of vitamin E, magnesium, and plasma proteins, notably retinol binding protein, albumin, and prealbumin, may have diagnostic utility in PEI. Studies show that assessment of changes in these and other nutritional parameters is helpful in monitoring PERT efficacy. Further research is needed to confirm the diagnostic accuracy of these parameters for PEI. Until such data are available, a nutritional evaluation including circulating vitamin E, magnesium, retinol binding protein, albumin, and prealbumin may be used to evaluate the probability of PEI in clinical practice when reliable pancreatic function tests are not available.
胰腺外分泌功能不全（PEI）常继发于胰腺外分泌疾病（如慢性胰腺炎、囊性纤维化、癌症）或胰腺/胃肠道手术，导致营养物质消化不良，进而引发营养不良。胰腺酶替代疗法（PERT）是PEI治疗的基石。尽管其具有临床相关性，但在临床实践中，PEI的诊断具有挑战性，因为目前的金标准检测方法繁琐，且其他替代方法的可用性或准确性有限。因此，需要准确且易于应用的诊断方法。我们回顾了PEI患者中提示营养不良的临床症状、人体测量学变化以及实验室营养指标的流行情况，以及这些发现对PEI诊断和监测PERT疗效的相关性。基于有限的现有证据，由于变异性高和多种混杂因素，对临床症状、体重、体重指数和其他人体测量参数的评估并非PEI诊断的敏感方法，但在监测PERT疗效方面似乎有用。有限的证据无法给出强有力的推荐，但表明血清维生素E、镁和血浆蛋白水平，尤其是视黄醇结合蛋白、白蛋白和前白蛋白，可能在PEI诊断中具有实用价值。研究表明，评估这些及其他营养参数的变化有助于监测PERT疗效。需要进一步研究以确认这些参数对PEI的诊断准确性。在获得此类数据之前，当无法进行可靠的胰腺功能检测时，在临床实践中可使用包括循环维生素E、镁、视黄醇结合蛋白、白蛋白和前白蛋白在内的营养评估来评估PEI的可能性。
