炎症性肠病中类似再喂养综合征的低磷血症的发生率及相关因素：一项初步研究。

The Incidence and Risk Factors of Refeeding Syndrome-like Hypophosphatemia in Inflammatory Bowel Disease: A Preliminary Study.

机构信息

Department of Clinical Nutrition, Erciyes University Health Science Institute, Kayseri; Department of Nutrition and Dietetic, Agri Ibrahim Cecen University Health Science Faculty, Agri, Turkey. .

Department of Gastroenterology, Erciyes University School of Medicine, Kayseri, Turkey.

出版信息

J Gastrointestin Liver Dis. 2024 Sep 29;33(3):323-329. doi: 10.15403/jgld-5502.

DOI:10.15403/jgld-5502

PMID:39348579

Abstract

BACKGROUND AND AIMS

Refeeding syndrome (RFS) is defined by the presence of acute electrolyte disturbances, including hypophosphatemia. Underlying disease(s), malnutrition and hospitalisation are known risk factors for RFS. It can occur in patients with inflammatory bowel disease (IBD). We aimed to determine the frequency of hypophosphatemia and the relationship between hypophosphatemia, disease severity and nutritional status in hospitalized patients with IBD.

METHODS

This study was performed prospectively in hospitalized adult patients for the treatment of IBD in a tertiary-care hospital. Disease severity was assessed using Truelove and Witts score for ulcerative colitis (UC) and Crohn's Disease Activity Index for Crohn's disease (CD). Nutritional status was determined using Subjective Global Assessment (SGA). Serum phosphate concentration was recorded for first 7 days after hospitalization, and less than 0.65 mmol/l was defined as hypophosphatemia.

RESULTS

Fifty participants (33 with UC and 17 with CD) were included in the study. The mean age of the study sample was 43.4±14.9 years, of which 64% were male. A total of 8.8% of patients with UC and 37.5% of patients with CD had severe (>moderate) disease upon study admission. Seventeen patients (34%) were malnourished. During the 7 study days, 23 participants (46%) had at least one episode of hypophosphatemia. Serum phosphate concentration was significantly and moderately correlated with serum potassium concentration in both the patients and the hypophosphatemia group on study day 3 (p<0.05). Multivariate logistic regression analysis showed that the presence of malnutrition [odds ratio (OR) = 3.64, 95% confidence interval (CI): 1.52-5.58, p=0.008), the administration of parenteral nutrition (OR=2.91, 95%Cl: 1.37-4.63, p=0.015), and severe IBD (OR=1.74, 95%CI: 1.03-3.42, p=0.020) were associated with hypophosphatemia.

CONCLUSIONS

Approximately half of the participants exhibited at least one instance of hypophosphatemia during the study period. Hypophosphatemia was found to be associated with malnutrition, parenteral nutrition, and severe disease in patients with IBD requiring hospitalization.

摘要

背景与目的

再喂养综合征（RFS）的定义为急性电解质紊乱，包括低磷血症。潜在疾病、营养不良和住院是 RFS 的已知危险因素。它可能发生在炎症性肠病（IBD）患者中。我们旨在确定住院 IBD 患者低磷血症的频率以及低磷血症与疾病严重程度和营养状况之间的关系。

方法

本研究在一家三级保健医院对住院治疗 IBD 的成年患者进行前瞻性研究。使用溃疡性结肠炎的特鲁尔夫和威茨评分（UC）和克罗恩病活动指数（CD）评估疾病严重程度。使用主观整体评估（SGA）确定营养状况。记录住院后前 7 天的血清磷酸盐浓度，低于 0.65mmol/L 定义为低磷血症。

结果

本研究共纳入 50 名参与者（33 名 UC 患者和 17 名 CD 患者）。研究样本的平均年龄为 43.4±14.9 岁，其中 64%为男性。研究入院时，8.8%的 UC 患者和 37.5%的 CD 患者患有（>中度）严重疾病。17 名患者（34%）存在营养不良。在 7 天的研究期间，23 名参与者（46%）至少发生过一次低磷血症。在研究第 3 天，患者和低磷血症组的血清磷酸盐浓度与血清钾浓度均呈显著中度相关（p<0.05）。多变量逻辑回归分析显示，营养不良的存在[比值比（OR）=3.64，95%置信区间（CI）：1.52-5.58，p=0.008]、肠外营养的给予（OR=2.91，95%CI：1.37-4.63，p=0.015）和严重的 IBD（OR=1.74，95%CI：1.03-3.42，p=0.020）与低磷血症相关。