慢性胰腺炎患者的亚临床胰腺外分泌功能不全与骨病相关：对治疗的启示

Subclinical pancreatic exocrine insufficiency is associated with osteopathy in patients with chronic pancreatitis: Implications for management.

作者信息

Gupta Mehul, Midha Shallu, Sachdeva Vikas, Singh Jairam, Pandey Shivam, Mittal Chetanya, Teja Varun, Vajpai Tanmay, Dhooria Anugrah, Tandon Nikhil, Jagannath Soumya, Garg Pramod Kumar

机构信息

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Pancreatology. 2025 Mar;25(2):193-199. doi: 10.1016/j.pan.2024.12.017. Epub 2024 Dec 25.

DOI:10.1016/j.pan.2024.12.017

PMID:39757054

Abstract

BACKGROUND AND AIMS

Patients with chronic pancreatitis (CP) may develop pancreatic exocrine insufficiency (PEI) but data regarding subclinical PEI are scarce. Our objective was to detect subclinical PEI in patients with CP and its functional consequences.

METHODS

We prospectively included patients with CP from April 2018-December 2021. Mild PEI and severe PEI were diagnosed if fecal elastase (FE) was 100-200 μg/g and <100 μg/g stool respectively. Vitamin levels and DEXA scan were done to assess functional consequences of PEI. Presence of subclinical PEI in CP (low FE-1 but without steatorrhea) with consequent osteopathy was the primary outcome.

RESULTS

Of 120 patients with CP, subclinical PEI (low FE-1 but no steatorrhea) was present in 84/120(70%) patients: 6/8(75%) in early CP, 41/53(77%) in definite CP and 37/55(67.2%) in advanced CP. Overall, 72.1% patients had osteopathy including 53(62%) among patients with subclinical PEI. There was no difference in osteopathy between subclinical and severe PEI. Patients with severe PEI had lower vitamin A levels as compared to mild PEI and no PEI patients [1.3 ± 0.5 mg/ml vs. 1.7 ± 0.6 mg/ml vs. 1.8 ± 0.5 mg/ml; p = 0.04]. There was no difference in vitamin D levels. Osteopathy was present in 40/56 (71.4%) in advanced, 26/56 (46.4%) in definite and 2/8 (25%) in early CP patients (p = 0.09). On multivariable analysis, patients with advanced CP had the higher risk of osteopathy (odds ratio 7.6, 95% CI 1.9-29.7).

CONCLUSIONS

Subclinical PEI was present even in early CP with increased risk of osteopathy and fat-soluble vitamin deficiency.

摘要

背景与目的

慢性胰腺炎（CP）患者可能会出现胰腺外分泌功能不全（PEI），但关于亚临床PEI的数据较少。我们的目的是检测CP患者中的亚临床PEI及其功能后果。

方法

我们前瞻性纳入了2018年4月至2021年12月期间的CP患者。如果粪便弹性蛋白酶（FE）分别为100 - 200μg/g和<100μg/g粪便，则诊断为轻度PEI和重度PEI。进行维生素水平检测和双能X线吸收法扫描以评估PEI的功能后果。CP中亚临床PEI（FE - 1低但无脂肪泻）伴随后续骨病的存在是主要结局。

结果

在120例CP患者中，84/120（70%）患者存在亚临床PEI（FE - 1低但无脂肪泻）：早期CP患者中6/8（75%），明确CP患者中41/53（77%），晚期CP患者中37/55（67.2%）。总体而言，72.1%的患者存在骨病，其中亚临床PEI患者中有53例（62%）。亚临床PEI和重度PEI患者的骨病情况无差异。与轻度PEI患者和无PEI患者相比，重度PEI患者的维生素A水平较低[1.3±0.5mg/ml vs. 1.7±0.6mg/ml vs. 1.8±0.5mg/ml；p = 0.04]。维生素D水平无差异。晚期CP患者中有40/56（71.4%）存在骨病，明确CP患者中有26/56（46.4%），早期CP患者中有2/8（25%）（p = 0.09）。多变量分析显示，晚期CP患者发生骨病的风险更高（比值比7.6，95%可信区间1.9 - 29.7）。