GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal.
PaMNEC-Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Monte da Caparica, Portugal.
Nutrients. 2020 Nov 26;12(12):3637. doi: 10.3390/nu12123637.
Patients undergoing percutaneous endoscopic gastrostomy (PEG) may present protein-energy malnutrition, anemia and deficiencies of hematopoietic factors, e.g., iron, folate and vitamin B12. There are no comprehensive studies on anemia or other hematological changes in PEG-patients. Our aim was to evaluate the hematological status of dysphagic patients that had undergone PEG and its association with clinical outcome.
This research comprises a retrospective study of patients followed by our Artificial Feeding Team, submitted to PEG from 2010 to 2018. Patients were divided into two etiological groups: neurological dysphagia (ND) and head/neck or esophageal disorders (HNE). Laboratory data included serum albumin, hemoglobin, mean corpuscular volume, ferritin, transferrin, iron, vitamin B12 and folate. Survival after PEG was recorded in months, until death or December 2018.
We evaluated 472 patients; 250 (53%) presented anemia at the moment of gastrostomy, mostly normocytic ( = 219), with laboratory data suggestive of anemia of chronic disease (ACD). Six patients (1.3%) presented vitamin B12 deficiency and 57 (12.1%) presented folate deficit. No statistically significant difference in hemoglobin was found between the etiological groups ( = 0.230). Folate and vitamin B12 levels were lower in the HNE group ( < 0.01). A positive correlation between hemoglobin and survival was present ( < 0.01, = 0.289), and hemoglobin levels were lower in the deceased population ( < 0.01).
Anemia is frequent in PEG-patients, mostly with the features of ACD or multifactorial. It is associated with significant decrease in survival and may be viewed as a marker of severe metabolic distress, signaling poor outcome.
接受经皮内镜下胃造口术（PEG）的患者可能会出现蛋白质能量营养不良、贫血和造血因子缺乏，例如铁、叶酸和维生素 B12。目前尚无关于 PEG 患者贫血或其他血液学变化的综合研究。我们的目的是评估接受 PEG 的吞咽困难患者的血液状况及其与临床结果的关系。
这是一项回顾性研究，纳入了 2010 年至 2018 年期间由我们的人工喂养团队随访的接受 PEG 的患者。患者分为两个病因学组：神经源性吞咽困难（ND）和头/颈部或食管疾病（HNE）。实验室数据包括血清白蛋白、血红蛋白、平均红细胞体积、铁蛋白、转铁蛋白、铁、维生素 B12 和叶酸。记录 PEG 后的生存时间（以月为单位），直至死亡或 2018 年 12 月。
我们评估了 472 例患者；250 例（53%）在胃造口术时存在贫血，主要为正细胞性贫血（=219 例），实验室数据提示为慢性病贫血（ACD）。6 例（1.3%）患者存在维生素 B12 缺乏，57 例（12.1%）患者存在叶酸缺乏。病因组之间的血红蛋白无统计学差异（=0.230）。HNE 组的叶酸和维生素 B12 水平较低（<0.01）。血红蛋白与生存呈正相关（<0.01，=0.289），且死亡人群的血红蛋白水平较低（<0.01）。
PEG 患者贫血较为常见，主要表现为 ACD 或多因素性贫血。它与生存显著下降相关，可视为严重代谢窘迫的标志物，预示不良预后。
