Pavić Tajana, Pelajić Stipe, Blažević Nina, Kralj Dominik, Milošević Milan, Mikolasevic Ivana, Lerotic Ivan, Hrabar Davor
Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb 10000, Croatia.
Andrija Stampar School of Public Health WHO Collaborative Centre for Occupational Health, University of Zagreb, School of Medicine, Zagreb 10000, Croatia.
World J Clin Cases. 2022 Jun 16;10(17):5551-5565. doi: 10.12998/wjcc.v10.i17.5551.
Biliary obstruction is a relatively common condition that affects approximately 5 in 1000 people annually. Malnutrition is very common in patients with biliary obstruction and since it is associated with significant morbidity and mortality, it is important to identify factors and mechanisms involved in its development.
To determine the influence of obstructive jaundice on the hormones controlling appetite and nutritive status.
This was a prospective case control study performed in a tertiary center in Zagreb, Croatia. Patients with biliary obstruction undergoing internal biliary drainage from September 2012 until August 2013 were enrolled. After excluding patients who developed procedure related complications or were lost in the follow-up, out of initial 73 patients, 55 patients were included in the analysis, including 34 with benign and 21 with malignant disease. Meanwhile, 40 non-jaundiced controls were also included. Appetite, nutritional status, and serum ghrelin, cholecystokinin (CCK), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) were determined at admission, 48 h and 28 d after internal biliary drainage. Chi square test was used for categorical variables. Continuous variables were analysed for normality by Kolmogorov-Smirnov test and relevant non-parametric (Mann-Whitney, Kruskal-Wallis, and Friedman) or parametric (-test and analysis of variance) tests were used.
Patients with obstructive jaundice were significantly malnourished compared to controls, regardless of disease etiology. Plasma ghrelin and CCK levels were significantly higher in patients with obstructive jaundice. Serum bilirubin concentrations were negatively correlated with ghrelin levels and positively correlated with TNF-α, but had no correlation with CCK concentrations. After internal biliary drainage, a significant improvement of nutritional status was observed although serum concentrations of ghrelin, IL-6, and TNF-α remained significantly elevated even 28 d after the procedure. CCK levels in patients without malnutrition remained elevated 28 d after the procedure, but in patients with malnutrition, CCK levels decreased to levels comparable with those in the control group. We have not established any correlation between appetite and serum levels of ghrelin, CCK, IL-6, and TNF-α before and after biliary drainage.
Possible abnormalities in ghrelin and CCK regulation may be associated with the development of malnutrition during the inflammatory response in patients with biliary obstruction.
胆道梗阻是一种相对常见的病症，每年影响约千分之五的人群。营养不良在胆道梗阻患者中非常普遍，由于其与显著的发病率和死亡率相关，因此识别其发生发展过程中的相关因素和机制很重要。
确定梗阻性黄疸对控制食欲和营养状况的激素的影响。
这是一项在克罗地亚萨格勒布的一家三级中心进行的前瞻性病例对照研究。纳入了2012年9月至2013年8月期间接受内引流术的胆道梗阻患者。在排除发生与手术相关并发症或失访的患者后，最初的73例患者中，55例纳入分析，其中34例为良性疾病，21例为恶性疾病。同时，还纳入了40例非黄疸对照者。在内引流术前、术后48小时和28天测定食欲、营养状况以及血清胃饥饿素、胆囊收缩素（CCK）、白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）。分类变量采用卡方检验。连续变量通过Kolmogorov-Smirnov检验分析正态性，并使用相关的非参数检验（Mann-Whitney、Kruskal-Wallis和Friedman检验）或参数检验（t检验和方差分析）。
无论疾病病因如何，梗阻性黄疸患者与对照组相比均存在明显营养不良。梗阻性黄疸患者血浆胃饥饿素和CCK水平显著更高。血清胆红素浓度与胃饥饿素水平呈负相关，与TNF-α呈正相关，但与CCK浓度无相关性。内引流术后，营养状况有显著改善，尽管术后28天血清胃饥饿素、IL-6和TNF-α水平仍显著升高。无营养不良患者术后28天CCK水平仍升高，但营养不良患者CCK水平降至与对照组相当的水平。我们未发现引流术前、后食欲与血清胃饥饿素、CCK、IL-6和TNF-α水平之间存在任何相关性。
胃饥饿素和CCK调节的可能异常可能与胆道梗阻患者炎症反应期间营养不良的发生有关。
