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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. Гастроэнтерология (Прил.). 2015; 2: 10–14.
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Аннотация
Нутритивная недостаточость (мальнутриция) является главным маркером неблагополучия при хроническом панкреатите за счет выпадения главной функции поджелудочной железы в пищеварительном конвейере. Знание механизмов развития этого синдрома может помочь клиницисту в понимании наиболее оправданной тактики ведения пациентов с хроническим панкреатитом во избежание появления и прогрессирования мальнутриции, негативно сказывающейся на долгосрочном прогнозе больных.
Ключевые слова: мальнутриция, хронический панкреатит, патофизиология.
Key words: malnutrition, chronic pancreatitis, pathophysiology.
Ключевые слова: мальнутриция, хронический панкреатит, патофизиология.
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Key words: malnutrition, chronic pancreatitis, pathophysiology.
Полный текст
Список литературы
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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. 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.
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.
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2. Maev I.V., Kucheriavyi Iu.A. Zamestitel'naia fermentnaia terapiia pri pankreaticheskoi nedostatochnosti. Klin. perspektivy gastroenterologii, gepatologii. 2005; 5: 19–28. [in Russian]
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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
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
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
________________________________________________
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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