Analysis of preventive effect and influencing factors of early enteral nutrition and microecological immune enteral nutrition on renal injury in patients with severe acute pancreatitis

doi:10.3877/cma.j.issn.2095-2015.2024.02.006

Abstract

Abstract:

Objective

To analyze the preventive effects of early enteral nutrition and microecological immune enteral nutrition on renal injury in patients with severe acute pancreatitis (SAP), and to explore the risk factors affecting renal injury in patients.

Methods

A total of 296 patients with SAP admitted to Huai'an First People's Hospital from January 2020 to December 2022 were randomly divided into combined group (n=148) and control group (n=148). Both groups received routine treatment and early enteral nutrition support, while the combined group received staged microecological immune enteral nutrition support. The incidence of renal injury was compared between the two groups, and the clinical data and nutritional support programs of patients with and without renal injury were compared. Logistic regression model was used to summarize the risk factors related to renal injury.

Results

After 7 days of intervention, the total protein, albumin, prealbumin and transferrin in the two groups were higher than those before intervention, while those in the combined group were higher than those in the control group after 7 days of intervention (P<0.05). The incidence of renal injury in the combined group was 22.30% (33/148), which was lower than that in the control group (36.49%, 54/148), with statistically significant difference (χ²=7.179, P<0.05). Multivariate regression analysis showed that age, APACHE Ⅱ score, C-reactive protein and cystatin C, as well as CT grade E, diabetes, mechanical ventilation and shock were all independent risk factors for renal injury in SAP patients, and microecological immune enteral nutrition was the protective factor (P<0.05).

Conclusion

The nutritional status of SAP patients is generally poor, and the nutritional status is improved more obviously after receiving microecological immune enteral nutrition support than simple enteral nutrition support, and the risk of renal injury is also reduced. At the same time, the occurrence of renal injury in SAP patients is also related to baseline characteristics such as age, severity of illness, severity of inflammatory reaction and complications.

Key words: Severe acute pancreatitis, Enteral nutrition, Microecological immunity, Renal injury, Influencing factor

Shuyu Wang, Ru Jiao, Yuntao Shi. Analysis of preventive effect and influencing factors of early enteral nutrition and microecological immune enteral nutrition on renal injury in patients with severe acute pancreatitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 132-136.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2024.02.006

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2024/V14/I02/132

Figures/Tables 4

References 18

[1]	Wajda J, Dumnicka P, Maraj M, et al. Potential prognostic markers of acute kidney injury in the early phase of acute pancreatitis[J]. Int J Mol Sci, 2019, 20(15): 3714-3723.
[2]	杨熊, 刘若鸿, 谢川, 等. 早期腹腔穿刺引流对重症急性胰腺炎肾损伤的保护作用[J]. 中国普通外科杂志, 2021, 30(3): 321-329.
[3]	庄佳毅, 郁毅刚, 梁伟, 等. 早期肠内营养对重症急性胰腺炎肾损伤的保护作用[J]. 临床急诊杂志, 2023, 24(2): 83-87.
[4]	Szatmary P, Grammatikopoulos T, Cai W, et al. Acute pancreatitis: Diagnosis and treatment[J]. Drugs, 2022, 82(12): 1251-1276.
[5]	Pascual I, Sanahuja A, García N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: cohort analysis of 1457 patients[J]. Pancreatology, 2019, 19(5): 623-629.
[6]	武钧, 许志伟, 张泓, 等. 肾血管阻力指数对重症急性胰腺炎相关性急性肾损伤早期预测价值的临床研究[J]. 中华危重病急救医学, 2019, 31(8): 998-1003.
[7]	李峰, 刘春生. 全身免疫炎症指数对重症胰腺炎并发急性肾损伤早期预测价值的研究[J]. 临床急诊杂志, 2022, 23(2): 100-105.
[8]	de-Madaria E, Buxbaum J L, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis[J]. N Engl J Med, 2022, 387(11): 989-1000.
[9]	Schepers N J, Bakker O J, Besselink M G, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis[J]. Gut, 2019, 68(6): 1044-1051.
[10]	郁蓉, 彭云鹏, 朱小乐, 等. 游离脂肪酸通过IRE1/XBP1通路调控高甘油三酯血症性急性胰腺炎肾损伤的机制研究[J]. 南京医科大学学报(自然科学版), 2022, 42(5): 625-631.
[11]	Garg P K, Singh V P. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156(7): 2008-2023.
[12]	王宇涵, 吴贵恺, 郑荣娟, 等. 血清尿调节素在急性胰腺炎早期急性肾损伤患者外周血中的表达及临床意义[J]. 中国急救医学, 2019, 39(10): 958-962.
[13]	Mosztbacher D, Hanák L, Farkas N, et al. Hypertriglyceridemia- induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases[J]. Pancreatology, 2020, 20(4): 608-616.
[14]	Zhang R, Deng L, Jin T, et al. Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity[J]. HPB, 2019, 21(9): 1240-1249.
[15]	牛美红, 郭继慧, 赵丹. 老年重症急性胰腺炎患者并发急性肾损伤的影响因素[J]. 中国老年学杂志, 2020, 40(9): 1859-1862.
[16]	De Oliveira C, Khatua B, Noel P, et al. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation[J]. J Clin Invest, 2020, 130(4): 1931-1947.
[17]	陈雨晴, 蒋鑫, 徐欢, 等. 血清胱抑素C对急性胰腺炎并发急性肾损伤的预测价值[J]. 临床肝胆病杂志, 2020, 36(11): 2505-2508.
[18]	Matta B, Gougol A, Gao X, et al. Worldwide variations in demographics, management, and outcomes of acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2020, 18(7): 1567-1575.

组别	例数	年龄(岁,±s)	性别[例(%)]		CT分级[例(%)]		合并症[例(%)]
组别	例数	年龄(岁,±s)	男	女	D级	E级	高血压	糖尿病
联合组	148	53.17±8.85	85(57.43)	63(42.57)	108(72.97)	40(27.03)	37(25.00)	31(20.95)
对照组	148	54.06±8.73	89(60.14)	59(39.86)	99(66.89)	49(33.11)	42(28.38)	28(18.92)
t/χ²值		0.871	0.223		1.301		0.432	0.191
P值		0.384	0.637		0.254		0.511	0.662

组别	例数	年龄(岁,±s)	性别[例(%)]		CT分级[例(%)]		合并症[例(%)]
组别	例数	年龄(岁,±s)	男	女	D级	E级	高血压	糖尿病
联合组	148	53.17±8.85	85(57.43)	63(42.57)	108(72.97)	40(27.03)	37(25.00)	31(20.95)
对照组	148	54.06±8.73	89(60.14)	59(39.86)	99(66.89)	49(33.11)	42(28.38)	28(18.92)
t/χ²值		0.871	0.223		1.301		0.432	0.191
P值		0.384	0.637		0.254		0.511	0.662

组别	例数	总蛋白(g/L)		白蛋白(g/L)		前白蛋白(mg/L)		转铁蛋白(g/L)
组别	例数	干预前	干预7 d后	干预前	干预7 d后	干预前	干预7 d后	干预前	干预7 d后
联合组	148	52.88±7.47	67.69±9.54^*	32.40±5.18	41.67±6.04^*	226.38±24.51	297.57±33.48^*	1.87±0.25	2.97±0.49^*
对照组	148	52.51±7.69	61.33±8.25^*	32.13±5.52	37.85±5.26^*	223.49±23.96	270.91±30.39^*	1.83±0.31	2.35±0.37^*
t值		0.420	6.135	0.434	5.802	1.026	7.173	1.222	12.284
P值		0.675	<0.001	0.665	<0.001	0.306	<0.001	0.223	<0.001

组别	例数	总蛋白(g/L)		白蛋白(g/L)		前白蛋白(mg/L)		转铁蛋白(g/L)
组别	例数	干预前	干预7 d后	干预前	干预7 d后	干预前	干预7 d后	干预前	干预7 d后
联合组	148	52.88±7.47	67.69±9.54^*	32.40±5.18	41.67±6.04^*	226.38±24.51	297.57±33.48^*	1.87±0.25	2.97±0.49^*
对照组	148	52.51±7.69	61.33±8.25^*	32.13±5.52	37.85±5.26^*	223.49±23.96	270.91±30.39^*	1.83±0.31	2.35±0.37^*
t值		0.420	6.135	0.434	5.802	1.026	7.173	1.222	12.284
P值		0.675	<0.001	0.665	<0.001	0.306	<0.001	0.223	<0.001

组别	例数	年龄(岁,±s)	APACHE Ⅱ评分(分,±s)	C反应蛋白(mg/L,±s)	胱抑素C(mg/L,±s)	性别[例(%)]		CT分级[例(%)]
组别	例数	年龄(岁,±s)	APACHE Ⅱ评分(分,±s)	C反应蛋白(mg/L,±s)	胱抑素C(mg/L,±s)	男(n=174)	女(n=122)	D级(n=207)	E级(n=89)
发生组	87	55.81±7.03	18.31±2.06	167.95±26.28	4.18±0.58	55(63.22)	32(36.78)	45(51.72)	42(48.28)
未发生组	209	52.70±9.95	15.64±1.88	134.52±19.67	2.26±0.39	119(56.94)	90(43.06)	162(77.51)	47(22.49)
χ²/t值		3.106	11.647	12.389	33.419	1		19.428
P值		0.002	<0.001	<0.001	<0.001	0.317		<0.001
组别	例数	合并症[例(%)]		机械通气[例(%)]		休克[例(%)]		营养支持方案[例(%)]
组别	例数	高血压(n=79)	糖尿病(n=59)	有(n=75)	无(n=221)	有(n=61)	无(n=235)	肠内(n=148)	微生态免疫+肠内(n=148)
发生组	87	24(27.59)	26(29.89)	31(35.63)	56(64.37)	27(31.03)	60(68.97)	54(62.07)	33(37.93)
未发生组	209	55(26.32)	33(15.79)	44(21.05)	165(78.95)	34(16.27)	175(83.73)	94(44.98)	115(55.02)
χ²/t值		0.051	7.648	6.902		8.817		7.179
P值		0.822	0.006	0.009		0.004		0.007

Please choose a citation manager

Content to export