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Мальнутриция при хроническом панкреатите: механизмы патогенеза
Мальнутриция при хроническом панкреатите: механизмы патогенеза
Кучерявый Ю.А. Мальнутриция при хроническом панкреатите: механизмы патогенеза. Consilium Medicum. 2015; 17 (8): 42–46. DOI: 10.26442/2075-1753_2015.8.42-46
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Аннотация
Нутритивная недостаточость (мальнутриция) является главным маркером неблагополучия при хроническом панкреатите (ХП) за счет выпадения главной фукнции поджелудочной железы в пищеварительном конвейере. Знание механизмов развития этого синдрома может помочь клиницисту в понимании наиболее оправданной тактики ведения пациентов с ХП во избежание появления и прогрессирования мальнутриции, негативно сказывающейся на долгосрочном прогнозе больных.
Ключевые слова: мальнутриция, хронический панкреатит, патофизиология.
Ключевые слова: мальнутриция, хронический панкреатит, патофизиология.
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Nutritional deficiency (malnutrition) is the principal marker of distress in case of chronic pancreatitis (CP) due to a loss of the main pancreatic function during digestion. The knowledge of the mechanisms of syndrome development can help clinician to understand the most justified surveillance of CP patients to avoid the occurrence and progression of malnutrition, affecting the long-term prognosis of patients.
Key words: malnutrition, chronic pancreatitis, pathophysiology.
Key words: malnutrition, chronic pancreatitis, pathophysiology.
Полный текст
Список литературы
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13. Fitzsimmons D, Kahl S, Butturini G et al. Symptoms and quality of life in chronic pancreatitis assessed by structured interview and the EORTC QLQ-C30 and QLQ-PAN26. Am J Gastroenterol 2005; 100: 918–26.
14. Haaber AB, Rosenfalck AM, Hansen B et al. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000; 27: 21–7.
15. Hébuterne X, Hastier P, Péroux JL et al. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci 1996; 41: 533–9.
16. Holst M, Schou-Olesen S, Kohler M et al. Nutritional assessment in ambulatory patients with chronic pancreatitis. Clin Nutr 2013; 32 (Suppl. 1): 47.
17. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005; 54 (Suppl. 6): vi1–vi28.
18. Kucheryavyy YA, Andreev DN. Nutritional status in patients with chronic pancreatitis. J Nutr Ther 2014; 3: 122–32.
19. Manari AP, Preedy VR, Peters TJ. Nutritional intake of hazardous drinkers and dependent alcoholics in the UK. Addict Biol 2003; 8: 201–10.
20. Mezey E, Kolman CJ, Diehl AM et al. Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism. Am J Clin Nutr 1988; 48 (1): 148–51.
21. Ockenga J. Importance of nutritional management in diseases with exocrine pancreatic insufficiency. HPB (Oxford) 2009; 11 (Suppl. 3): 11–5.
22. Park JW, Jang JY, Kim EJ et al. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg 2013; 100 (8): 1064–70.
23. Pongprasobchai S. Maldigestion from pancreatic exocrine insufficiency. J Gastroenterol Hepatol 2013; 28 (Suppl. 4): 99–102.
24. Rasmussen HH, Irtun O, Olesen SS et al. Nutrition in chronic pancreatitis. World J Gastroenterol 2013; 19 (42): 7267–75.
25. Riediger H, Adam U, Fischer E et al. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007; 11: 949–59; discussion 959–60.
26. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42 (2): 101–19.
27. Sikkens EC, Cahen DL, Van Eijck C et al. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology 2012; 12: 71–3.
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29. Sobral-Oliveira MB, Faintuch J et al. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol 2011; 48 (2): 112–8.
30. Thomas T, Mah L, Barreto SG. Systematic review of diet in the pathogenesis of acute pancreatitis: a tale of too much or too little? Saudi J Gastroenterol 2012; 18 (5): 310–5.
31. Tsukamoto H, Towner SJ, Yu GS, French SW. Potentiation of ethanol-induced pancreatic injury by dietary fat. Induction of chronic pancreatitis by alcohol in rats. Am J Pathol 1988; 131 (2): 246–57.
32. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144 (6): 1252–61.
33. Yan MX, Li YQ, Meng M et al. Long-term high-fat diet induces pancreatic injuries via pancreatic microcirculatory disturbances and oxidative stress in rats with hyperlipidemia. Biochem Biophys Res Commun 2006; 347 (1): 192–9.
34. Zhang LP, Ma F, Abshire SM, Westlund KN. Prolonged high fat/alcohol exposure increases TRPV4 and its functional responses in pancreatic stellate cells. Am J Physiol Regul Integr Comp Physiol 2013; 304 (9): R702–11.
35. Zhang X, Cui Y, Fang L, Li F. Chronic high-fat diets induce oxide injuries and fibrogenesis of pancreatic cells in rats. Pancreas 2008; 37 (3): e31–8.
2. Maev I.V., Kucheriavyi Iu.A. Zamestitel'naia fermentnaia terapiia pri pankreaticheskoi nedostatochnosti. Klin. perspektivy gastroenterologii, gepatologii. 2005; 5: 19–28. [in Russian]
3. Maev I.V., Kucheriavyi Iu.A., Moskaleva A.B. Kvashiorkor vzroslykh pri khronicheskom pankreatite. Klin. perspektivy gastroenterologii, gepatologii. 2008; 4: 3–11. [in Russian]
4. Maev I.V., Kucheriavyi Iu.A., Moskaleva A.B. Narushenie nutritivnogo statusa u bol'nykh khronicheskim pankreatitom: klinicheskie i patofiziologicheskie aspekty kvashiorkora. Vestn. Kluba Pankreatologov (Ukr.). 2009; 1: 48–54. [in Russian]
5. Maev I.V., Kucheriavyi Iu.A., Sviridova A.V. i dr. Effektivnost' lecheniia vneshnesekretornoi nedostatochnosti podzheludochnoi zhelezy razlichnymi preparatami pankreatina. Klin. perspektivy gastroenterologii, gepatologii. 2010; 6: 29–37. [in Russian]
6. Maev I.V., Sviridova A.V., Kucheriavyi Iu.A. i dr. Dlitel'naia zamestitel'naia fermentnaia terapiia razlichnymi preparatami pankreatina u bol'nykh khronicheskim pankreatitom s ekzokrinnoi nedostatochnost'iu podzheludochnoi zhelezy. Farmateka. 2011; 2: 32–9. [in Russian]
7. Maev I.V., Kucheriavyi Iu.A. Sovremennye podkhody k diagnostike i lecheniiu khronicheskogo pankreatita. Klin. meditsina. 2013; 9: 10–6. [in Russian]
8. Martinchik A.N., Maev I.V., Petukhov A.B. Pitanie cheloveka (osnovy nutritsiologii). Pod red. prof. A.N.Martinchika. M.: GOU VUNMTs MZ RF, 2002. [in Russian]
9. Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract 2014; 29 (3): 295–311.
10. Ahmad SA, Edwards MJ, Sutton JM et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 2012; 256 (3): 529–37.
11. Armbrecht U. Chronic pancreatitis: weight loss and poor physical performance – experience from a specialized rehabilitation centre. Rehabilitation (Stuttg) 2001; 40: 332–6.
12. Castiñeira-Alvariño M, Lindkvist B, Luaces-Regueira M et al. The role of high fat diet in the development of complications of chronic pancreatitis. Clin Nutr 2013; 32 (5): 830–6.
13. Fitzsimmons D, Kahl S, Butturini G et al. Symptoms and quality of life in chronic pancreatitis assessed by structured interview and the EORTC QLQ-C30 and QLQ-PAN26. Am J Gastroenterol 2005; 100: 918–26.
14. Haaber AB, Rosenfalck AM, Hansen B et al. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000; 27: 21–7.
15. Hébuterne X, Hastier P, Péroux JL et al. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci 1996; 41: 533–9.
16. Holst M, Schou-Olesen S, Kohler M et al. Nutritional assessment in ambulatory patients with chronic pancreatitis. Clin Nutr 2013; 32 (Suppl. 1): 47.
17. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005; 54 (Suppl. 6): vi1–vi28.
18. Kucheryavyy YA, Andreev DN. Nutritional status in patients with chronic pancreatitis. J Nutr Ther 2014; 3: 122–32.
19. Manari AP, Preedy VR, Peters TJ. Nutritional intake of hazardous drinkers and dependent alcoholics in the UK. Addict Biol 2003; 8: 201–10.
20. Mezey E, Kolman CJ, Diehl AM et al. Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism. Am J Clin Nutr 1988; 48 (1): 148–51.
21. Ockenga J. Importance of nutritional management in diseases with exocrine pancreatic insufficiency. HPB (Oxford) 2009; 11 (Suppl. 3): 11–5.
22. Park JW, Jang JY, Kim EJ et al. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg 2013; 100 (8): 1064–70.
23. Pongprasobchai S. Maldigestion from pancreatic exocrine insufficiency. J Gastroenterol Hepatol 2013; 28 (Suppl. 4): 99–102.
24. Rasmussen HH, Irtun O, Olesen SS et al. Nutrition in chronic pancreatitis. World J Gastroenterol 2013; 19 (42): 7267–75.
25. Riediger H, Adam U, Fischer E et al. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007; 11: 949–59; discussion 959–60.
26. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42 (2): 101–19.
27. Sikkens EC, Cahen DL, Van Eijck C et al. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology 2012; 12: 71–3.
28. Skipworth JR, Raptis DA, Wijesuriya S et al. The use of nasojejunal nutrition in patients with chronic pancreatitis. JOP 2011; 12 (6): 574–80.
29. Sobral-Oliveira MB, Faintuch J et al. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol 2011; 48 (2): 112–8.
30. Thomas T, Mah L, Barreto SG. Systematic review of diet in the pathogenesis of acute pancreatitis: a tale of too much or too little? Saudi J Gastroenterol 2012; 18 (5): 310–5.
31. Tsukamoto H, Towner SJ, Yu GS, French SW. Potentiation of ethanol-induced pancreatic injury by dietary fat. Induction of chronic pancreatitis by alcohol in rats. Am J Pathol 1988; 131 (2): 246–57.
32. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144 (6): 1252–61.
33. Yan MX, Li YQ, Meng M et al. Long-term high-fat diet induces pancreatic injuries via pancreatic microcirculatory disturbances and oxidative stress in rats with hyperlipidemia. Biochem Biophys Res Commun 2006; 347 (1): 192–9.
34. Zhang LP, Ma F, Abshire SM, Westlund KN. Prolonged high fat/alcohol exposure increases TRPV4 and its functional responses in pancreatic stellate cells. Am J Physiol Regul Integr Comp Physiol 2013; 304 (9): R702–11.
35. Zhang X, Cui Y, Fang L, Li F. Chronic high-fat diets induce oxide injuries and fibrogenesis of pancreatic cells in rats. Pancreas 2008; 37 (3): e31–8.
2. Маев И.В., Кучерявый Ю.А. Заместительная ферментная терапия при панкреатической недостаточности. Клин. перспективы гастроэнтерологии, гепатологии. 2005; 5: 19–28. / Maev I.V., Kucheriavyi Iu.A. Zamestitel'naia fermentnaia terapiia pri pankreaticheskoi nedostatochnosti. Klin. perspektivy gastroenterologii, gepatologii. 2005; 5: 19–28. [in Russian]
3. Маев И.В., Кучерявый Ю.А., Москалева А.Б. Квашиоркор взрослых при хроническом панкреатите. Клин. перспективы гастроэнтерологии, гепатологии. 2008; 4: 3–11. / Maev I.V., Kucheriavyi Iu.A., Moskaleva A.B. Kvashiorkor vzroslykh pri khronicheskom pankreatite. Klin. perspektivy gastroenterologii, gepatologii. 2008; 4: 3–11. [in Russian]
4. Маев И.В., Кучерявый Ю.А., Москалева А.Б. Нарушение нутритивного статуса у больных хроническим панкреатитом: клинические и патофизиологические аспекты квашиоркора. Вестн. Клуба Панкреатологов (Укр.). 2009; 1: 48–54. / Maev I.V., Kucheriavyi Iu.A., Moskaleva A.B. Narushenie nutritivnogo statusa u bol'nykh khronicheskim pankreatitom: klinicheskie i patofiziologicheskie aspekty kvashiorkora. Vestn. Kluba Pankreatologov (Ukr.). 2009; 1: 48–54. [in Russian]
5. Маев И.В., Кучерявый Ю.А., Свиридова А.В. и др. Эффективность лечения внешнесекреторной недостаточности поджелудочной железы различными препаратами панкреатина. Клин. перспективы гастроэнтерологии, гепатологии. 2010; 6: 29–37. / Maev I.V., Kucheriavyi Iu.A., Sviridova A.V. i dr. Effektivnost' lecheniia vneshnesekretornoi nedostatochnosti podzheludochnoi zhelezy razlichnymi preparatami pankreatina. Klin. perspektivy gastroenterologii, gepatologii. 2010; 6: 29–37. [in Russian]
6. Маев И.В., Свиридова А.В., Кучерявый Ю.А. и др. Длительная заместительная ферментная терапия различными препаратами панкреатина у больных хроническим панкреатитом с экзокринной недостаточностью поджелудочной железы. Фарматека. 2011; 2: 32–9. / Maev I.V., Sviridova A.V., Kucheriavyi Iu.A. i dr. Dlitel'naia zamestitel'naia fermentnaia terapiia razlichnymi preparatami pankreatina u bol'nykh khronicheskim pankreatitom s ekzokrinnoi nedostatochnost'iu podzheludochnoi zhelezy. Farmateka. 2011; 2: 32–9. [in Russian]
7. Маев И.В., Кучерявый Ю.А. Современные подходы к диагностике и лечению хронического панкреатита. Клин. медицина. 2013; 9: 10–6. / Maev I.V., Kucheriavyi Iu.A. Sovremennye podkhody k diagnostike i lecheniiu khronicheskogo pankreatita. Klin. meditsina. 2013; 9: 10–6. [in Russian]
8. Мартинчик А.Н., Маев И.В., Петухов А.Б. Питание человека (основы нутрициологии). Под ред. проф. А.Н.Мартинчика. М.: ГОУ ВУНМЦ МЗ РФ, 2002. / Martinchik A.N., Maev I.V., Petukhov A.B. Pitanie cheloveka (osnovy nutritsiologii). Pod red. prof. A.N.Martinchika. M.: GOU VUNMTs MZ RF, 2002. [in Russian]
9. Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract 2014; 29 (3): 295–311.
10. Ahmad SA, Edwards MJ, Sutton JM et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 2012; 256 (3): 529–37.
11. Armbrecht U. Chronic pancreatitis: weight loss and poor physical performance – experience from a specialized rehabilitation centre. Rehabilitation (Stuttg) 2001; 40: 332–6.
12. Castiñeira-Alvariño M, Lindkvist B, Luaces-Regueira M et al. The role of high fat diet in the development of complications of chronic pancreatitis. Clin Nutr 2013; 32 (5): 830–6.
13. Fitzsimmons D, Kahl S, Butturini G et al. Symptoms and quality of life in chronic pancreatitis assessed by structured interview and the EORTC QLQ-C30 and QLQ-PAN26. Am J Gastroenterol 2005; 100: 918–26.
14. Haaber AB, Rosenfalck AM, Hansen B et al. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000; 27: 21–7.
15. Hébuterne X, Hastier P, Péroux JL et al. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci 1996; 41: 533–9.
16. Holst M, Schou-Olesen S, Kohler M et al. Nutritional assessment in ambulatory patients with chronic pancreatitis. Clin Nutr 2013; 32 (Suppl. 1): 47.
17. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005; 54 (Suppl. 6): vi1–vi28.
18. Kucheryavyy YA, Andreev DN. Nutritional status in patients with chronic pancreatitis. J Nutr Ther 2014; 3: 122–32.
19. Manari AP, Preedy VR, Peters TJ. Nutritional intake of hazardous drinkers and dependent alcoholics in the UK. Addict Biol 2003; 8: 201–10.
20. Mezey E, Kolman CJ, Diehl AM et al. Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism. Am J Clin Nutr 1988; 48 (1): 148–51.
21. Ockenga J. Importance of nutritional management in diseases with exocrine pancreatic insufficiency. HPB (Oxford) 2009; 11 (Suppl. 3): 11–5.
22. Park JW, Jang JY, Kim EJ et al. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg 2013; 100 (8): 1064–70.
23. Pongprasobchai S. Maldigestion from pancreatic exocrine insufficiency. J Gastroenterol Hepatol 2013; 28 (Suppl. 4): 99–102.
24. Rasmussen HH, Irtun O, Olesen SS et al. Nutrition in chronic pancreatitis. World J Gastroenterol 2013; 19 (42): 7267–75.
25. Riediger H, Adam U, Fischer E et al. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007; 11: 949–59; discussion 959–60.
26. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42 (2): 101–19.
27. Sikkens EC, Cahen DL, Van Eijck C et al. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology 2012; 12: 71–3.
28. Skipworth JR, Raptis DA, Wijesuriya S et al. The use of nasojejunal nutrition in patients with chronic pancreatitis. JOP 2011; 12 (6): 574–80.
29. Sobral-Oliveira MB, Faintuch J et al. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol 2011; 48 (2): 112–8.
30. Thomas T, Mah L, Barreto SG. Systematic review of diet in the pathogenesis of acute pancreatitis: a tale of too much or too little? Saudi J Gastroenterol 2012; 18 (5): 310–5.
31. Tsukamoto H, Towner SJ, Yu GS, French SW. Potentiation of ethanol-induced pancreatic injury by dietary fat. Induction of chronic pancreatitis by alcohol in rats. Am J Pathol 1988; 131 (2): 246–57.
32. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144 (6): 1252–61.
33. Yan MX, Li YQ, Meng M et al. Long-term high-fat diet induces pancreatic injuries via pancreatic microcirculatory disturbances and oxidative stress in rats with hyperlipidemia. Biochem Biophys Res Commun 2006; 347 (1): 192–9.
34. Zhang LP, Ma F, Abshire SM, Westlund KN. Prolonged high fat/alcohol exposure increases TRPV4 and its functional responses in pancreatic stellate cells. Am J Physiol Regul Integr Comp Physiol 2013; 304 (9): R702–11.
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Авторы
Ю.А.Кучерявый
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
proped@mail.ru
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
proped@mail.ru
________________________________________________
Yu.A.Kucheryavy
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
proped@mail.ru
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
proped@mail.ru
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