Protective effect of early enteral nutrition on renal injury in severe acute pancreatitis
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摘要: 目的 探讨入院后24~48 h内肠内营养(EN)支持治疗对重症急性胰腺炎(SAP)患者肾损伤(AKI)的保护作用。方法 回顾性分析联勤保障部队第九〇九医院2020年6月—2022年6月收治的163例SAP患者的临床资料，根据EN开始时间不同，入院后24~48 h内EN支持治疗为观察组(n=78)、入院后48~72 h内EN支持治疗为对照组(n=85)。比较2组患者EN前后AKI分期、血肌酐(Cr)、尿素、尿酸、胱抑素-C、IL-1、IL-6、IL-8、CRP、TNF-α、APACHE Ⅱ评分变化。结果 观察组EN治疗后无一例AKI分期升期，对照组EN治疗后AKI分期升期5例(13.89%)，差异有统计学意义(P < 0.05)；观察组EN治疗后AKI分期降期17例(54.84%)，对照组EN治疗后AKI分期降期8例(22.22%)，差异有统计学意义(P < 0.05)。观察组EN治疗后Cr、尿素、尿酸、胱抑素-C小于对照组，差异有统计学意义(P < 0.05)；观察组EN治疗IL-1、IL-6、IL-8、CRP、TNF-α、APACHE Ⅱ评分小于对照组，差异有统计学意义(P < 0.05)。结论 对于SAP患者入院后24~48 h予EN支持治疗，可以降低炎症反应，保护肾功能，防止肾功能损伤进一步加重。Abstract: Objective To investigate the protective effect of endoenteral nutrition(EN) support therapy 24 to 48 hours after admission on acute kidney injury(AKI) in patients with severe acute pancreatitis(SAP).Methods A retrospective analysis was performed on the clinical data of 163 SAP patients admitted to the 909th Hospital of Logistic Support Forces from June 2020 to June 2022. According to the time of EN treatment, the observation group was treated with EN support within 24 to 48 hours after admission(n=78), and the control group was treated with EN support within 48 to 72 hours after admission(n=85). The AKI staging, Cr, urea, uric acid, cystatin C, IL-1, IL-6, IL-8, CRP, TNF-α and APACHE Ⅱ scores were compared between the 2 groups before and after EN.Results AKI stage rose in zero cases in the observation group and five cases(13.89%) in the control group after EN treatment (P < 0.05). There were 17 cases(54.84%) in the observation group and 8 cases(22.22%) in the control group with decreased AKI stage after EN treatment(P < 0.05). After EN treatment, Cr, urea, uric acid and cystatin C in observation group were less than those in control group(P < 0.05). IL-1, IL-6, IL-8, CRP, TNF-α and APACHE Ⅱ scores in observation group after EN treatment were lower than those in control group(P < 0.05).Conclusion For SAP patients, EN support treatment 24 to 48 hours after admission can reduce inflammatory response, protect renal function and prevent further aggravation of renal function injury.
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Key words:
- enteral nutrition /
- severe pancreatitis /
- kidney injury /
- inflammation /
- complications
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表 1 2组患者一般资料比较
例，X±S 一般资料 观察组
(n=78)对照组
(n=85)t/χ2 P 性别 1.991 0.158 男 42 55 女 36 30 年龄/岁 47.63±9.64 48.64±11.54 -1.254 0.095 病因 0.028 0.986 胆源性 41 44 酒精性 13 15 高脂性 24 26 BMI/(kg/m2) 24.23±1.53 23.93±1.84 0.853 0.228 入院时合并AKI 0.114 0.735 是 31 36 否 47 49 
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表 2 2组患者治疗前后AKI分期比较
例 项目 观察组
(n=31)对照组
(n=36)χ2 P EN治疗前 0.606 0.739 1期 18 20 2期 9 13 3期 4 3 EN治疗3d后 4.988 0.173 无AKI 11 5 1期 14 18 2期 5 11 3期 1 2 肾损伤无变化 14 23 2.363 0.124 肾损伤升期 0 5 4.653 0.031 肾损伤降期 17 8 7.576 0.006
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表 3 2组患者肾功能指标比较
X±S 指标 观察组(n=78) 对照组(n=85) t P Cr/(μmol·L-1) EN前 224.64±84.75 219.53±77.48 1.164 0.117 EN后 97.36±43.641) 128.64±63.641) -5.364 < 0.001 尿素/(μmol·L-1) EN前 13.75±4.72 13.32±5.01 0.748 0.427 EN后 7.35±2.621) 9.44±3.141) -2.647 0.006 尿酸/(μmol·L-1) EN前 411.64±84.25 403.26±79.42 1.264 0.106 EN后 174.75±63.721) 267.25±68.351) -14.646 < 0.001 胱抑素-C/(mg·L-1) EN前 2.04±0.26 1.95±0.19 0.684 0.571 EN后 1.27±0.221) 1.69±0.251) -4.375 0.017 与同组EN前比较，1)P < 0.05。
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表 4 2组患者炎症指标和APACHE Ⅱ评分比较
X±S 指标 观察组(n=78) 对照组(n=85) t P IL-1/(pg·mL-1) EN前 14.81±2.19 14.57±1.72 0.473 0.638 EN后 6.31±1.54 9.42±1.85 -8.462 < 0.001 IL-6/(pg·mL-1) EN前 90.53±23.74 97.35±29.54 -0.646 0.472 EN后 52.53±17.53 74.42±21.62 -9.643 < 0.001 IL-8/(pg·mL-1) EN前 51.53±13.64 46.26±15.42 1.364 0.094 EN后 19.64±9.42 28.64±11.17 -6.846 < 0.001 CRP/(mg·L-1) EN前 221.53±47.53 217.53±52.53 1.167 0.115 EN后 115.24±36.36 164.64±41.53 -10.547 < 0.001 TNF-α/(pg·mL-1) EN前 23.54±4.26 22.94±3.57 0.847 0.317 EN后 12.53±2.64 17.53±2.16 -7.362 < 0.001 APACHE Ⅱ评分/分 EN前 19.42±4.15 18.83±3.95 1.036 0.120 EN后 10.34±2.64 15.74±3.01 -6.374 < 0.001
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