Department of Digestive, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
Biomed Res Int. 2021 Jan 25;2021:4721812. doi: 10.1155/2021/4721812. eCollection 2021.
Elderly patients receiving nasal feeding have weaker physiological function, and placement of a nasogastric tube weakens the natural barrier of the cardia-esophageal sphincter; therefore, the risk of gastroesophageal reflux (GER) is higher. Many studies have shown that pepsin is extremely sensitive in predicting GERD, so this study intends to investigate the level of pepsin in saliva of elderly patients with nasal feeding and analyze its influencing factors.
This was a cross-sectional study. Patients admitted to the Chinese PLA General Hospital from April 2018 to October 2018 who received nasal feeding were included. One ml of saliva was collected from each patient in while sitting during fasting in the morning and 1 hour after lunch for 3 consecutive days. Pepsin was quantified by enzyme-linked immunosorbent assay (ELISA). The patients were predivided into two groups (≥7.75g/ml or <7.75g/ml) based on the median pepsin. Baseline and clinical factors were compared.
The mean age of the patients was 91.09 ± 4.91 years. There were statistical differences in diabetes and feeding methods between the two groups. There was a positive correlation between the morning and postprandial pepsin levels ( = 0.442, < 0.001), and has no statistical difference ( = 0.175). Multivariate analysis showed that the risk factors for higher pepsin levels were diabetes (odds ratio (OR): 2.67; 95% CI: 1.225-5.819, = 0.013) and nasal feeding methods (OR: 2.475; 95% CI: 1.183-5.180, =0.016).
For patients undergoing nasal feeding who are older than 80 years, the fasting and 1-hour postprandial pepsin concentration were consistent. Diabetes and feeding methods are risk factors for high pepsin levels. For the elderly over 80 years old, age has no influence on pepsin concentration.
接受鼻饲的老年患者生理功能较弱，放置鼻胃管会削弱贲门食管括约肌的自然屏障；因此，胃食管反流（GER）的风险较高。许多研究表明，胃蛋白酶原在预测 GERD 方面非常敏感，因此本研究旨在探讨老年鼻饲患者唾液中胃蛋白酶原的水平，并分析其影响因素。
这是一项横断面研究。纳入 2018 年 4 月至 2018 年 10 月期间在中国人民解放军总医院接受鼻饲的患者。患者在禁食状态下于清晨和午餐后 1 小时各采集 1ml 唾液，连续 3 天。采用酶联免疫吸附试验（ELISA）定量检测胃蛋白酶原。根据胃蛋白酶原中位数将患者分为两组（≥7.75g/ml 或 <7.75g/ml）。比较两组的基线和临床特征。
患者的平均年龄为 91.09 ± 4.91 岁。两组间在糖尿病和喂养方式上存在统计学差异。清晨和餐后胃蛋白酶原水平呈正相关（ = 0.442， < 0.001），但差异无统计学意义（ = 0.175）。多因素分析显示，高胃蛋白酶原水平的危险因素是糖尿病（比值比（OR）：2.67；95%可信区间（CI）：1.225-5.819， = 0.013）和鼻饲方式（OR：2.475；95%CI：1.183-5.180， = 0.016）。
对于 80 岁以上接受鼻饲的老年患者，空腹和餐后 1 小时胃蛋白酶原浓度一致。糖尿病和喂养方式是胃蛋白酶原水平升高的危险因素。对于 80 岁以上的老年人，年龄对胃蛋白酶原浓度没有影响。
