Экзокринная недостаточность поджелудочной железы: клиническое значение и подходы к коррекции с позиций доказательной медицины - Журнал Терапевтический архив №4 Вопросы диагностики внутренних болезней 2021
Экзокринная недостаточность поджелудочной железы: клиническое значение и подходы к коррекции с позиций доказательной медицины
Маев И.В., Кучерявый Ю.А., Андреев Д.Н. Экзокринная недостаточность поджелудочной железы: клиническое значение и подходы к коррекции с позиций доказательной медицины. Терапевтический архив. 2021; 93 (4): 509–515. DOI: 10.26442/00403660.2021.04.200800
DOI: 10.26442/00403660.2021.04.200800
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DOI: 10.26442/00403660.2021.04.200800
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Аннотация
Экзокринная недостаточность поджелудочной железы (ЭНПЖ) является частым осложнением как доброкачественных, так и злокачественных заболеваний поджелудочной железы, а также следствием радикальных хирургических операций на органе и целого спектра других вариативных внепанкреатических причин. В повседневной клинической практике во взрослой популяции большинство случаев ЭНПЖ ассоциировано с хроническим панкреатитом, тогда как в педиатрической популяции – с муковисцидозом. Регресс выработки пищеварительных ферментов при ЭНПЖ опосредует развитие синдрома мальдигестии и мальабсорбции, приводя к прогрессирующему развитию мальнутриции, значимость которой часто недооценивается практикующими специалистами. Вместе с тем развитие нутритивной недостаточности не просто является осложнением ЭНПЖ, но и оказывает важное влияние на течение основного причинного заболевания, ухудшая прогноз и качество жизни пациента, а также является доказанным фактором риска остеопороза и саркопении. На сегодняшний день компенсация абсолютного дефицита панкреатических ферментов с использованием заместительной ферментной терапии является единственно возможным путем коррекции ЭНПЖ и профилактики нутритивной недостаточности.
Ключевые слова: экзокринная недостаточность поджелудочной железы, хронический панкреатит, муковисцидоз, заместительная ферментная терапия, мальнутриция, мальдигестия, мальабсорбция, нутритивный статус
Keywords: exocrine pancreatic insufficiency, chronic pancreatitis, cystic fibrosis, enzyme replacement therapy, malnutrition, maldigestion, malabsorption, nutritional status
Ключевые слова: экзокринная недостаточность поджелудочной железы, хронический панкреатит, муковисцидоз, заместительная ферментная терапия, мальнутриция, мальдигестия, мальабсорбция, нутритивный статус
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Keywords: exocrine pancreatic insufficiency, chronic pancreatitis, cystic fibrosis, enzyme replacement therapy, malnutrition, maldigestion, malabsorption, nutritional status
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(Ter. Arkh.). 2013;85(2):65-72 (In Russ.)
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11. Capurso G, Traini M, Piciucchi M, et al. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-39. doi: 10.2147/CEG.S168266
12. Duggan SN. Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis. Proc Nutr Soc. 2017;76:484-94. doi: 10.1017/S0029665117001045
13. Layer P, Yamamoto H, Kalthoff L, et al. The different courses of early- and late onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994;107:1481-7. doi: 10.1016/0016-5085(94)90553-3
14. Ghodeif AO, Azer SA. Pancreatic Insufficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available at:
https://www.ncbi.nlm.nih.gov/books/NBK555926/ Accessed: 28.01.2021.
15. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252-61. doi: 10.1053/j.gastro.2013.01.068
16. Xiao AY, Tan ML, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016;1(1):45-55. doi: 10.1016/S2468-1253(16)30004-8
17. Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):175-84. doi: 10.1038/s41575-018-0087-5
18. Machicado JD, Chari ST, Timmons L, et al. A population-based evaluation of the natural history of chronic pancreatitis. Pancreatology. 2018;18(1):39-45. doi: 10.1016/j.pan.2017.11.012
19. Forsmark CE. Diagnosis and Management of Exocrine Pancreatic Insufficiency. Curr Treat Options Gastroenterol. 2018;16(3):306-15. doi: 10.1007/s11938-018-0186-y
20. Huang W, de la Iglesia-García D, Baston-Rey I, et al. Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: Systematic Review and Meta-Analysis. Dig Dis Sci. 2019;64(7):1985-2005. doi: 10.1007/s10620-019-05568-9
21. Hollemans RA, Hallensleben NDL, Mager DJ, et al.; Dutch Pancreatitis Study Group. Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis. Pancreatology. 2018;18(3):253-62. doi: 10.1016/j.pan.2018.02.009
22. Kucheryavy YuA, Andreev DN. The use of replacement therapy with pancreatin drugs in patients with pancreatic cancer. Pharmateca. 2016;8:100-3 (In Russ.)
23. Bartel MJ, Asbun H, Stauffer J, Raimondo M. Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature. Dig Liver Dis. 2015;47(12):1013-20. doi: 10.1016/j.dld.2015.06.015
24. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359-86.
25. Tseng DS, Molenaar IQ, Besselink MG, et al. Pancreatic Exocrine Insufficiency in Patients With Pancreatic or Periampullary Cancer: A Systematic Review. Pancreas. 2016;45(3):325-30. doi: 10.1097/MPA.0000000000000473
26. Sellers ZM. Pancreatic complications in children with cystic fibrosis. Curr Opin Pediatr. 2020;32(5):661-7. doi: 10.1097/MOP.0000000000000934
27. Ooi CY, Dorfman R, Cipolli M, et al. Type of CFTR mutation determines risk of pancreatitis in patients with cystic fibrosis. Gastroenterology. 2011;140(1):153-61. doi: 10.1053/j.gastro.2010.09.046
28. Singh VK, Schwarzenberg SJ. Pancreatic insufficiency in Cystic Fibrosis. J Cyst Fibros. 2017;16 (Suppl. 2):S70-8. doi: 10.1016/j.jcf.2017.06.011
29. Myers KC, Bolyard AA, Otto B, et al. Variable clinical presentation of Shwachman-Diamond syndrome: update from the North American Shwachman–Diamond Syndrome Registry. J Pediatr. 2014;164(4):866-70. doi: 10.1016/j.jpeds.2013.11.039
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31. Min M, Patel B, Han S, et al. Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis: Identification, Treatment, and Consequences. Pancreas. 2018;47(8):1015-8. doi: 10.1097/MPA.0000000000001137
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________________________________________________
2. Kucheryavyy YuA, Andreev DN. Nutritional Status in Patients with Chronic Pancreatitis. Journal of Nutritional Therapeutics. 2014;3(3):122-32. doi: 10.6000/1929-5634.2014.03.03.3
3. Dominguez-Munoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9:116-22. doi: 10.1007/s11894-007-0005-4
4. Dominguez-Muñoz JE. Diagnosis and treatment of pancreatic exocrine insufficiency. Curr Opin Gastroenterol. 2018;34(5):349-54. doi: 10.1097/MOG.0000000000000459
5. Rasmussen HH, Irtun O, Olesen SS, et al. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013;19:7267-75. doi: 10.3748/wjg.v19.i42.7267
6. Maev IV, Kucheryavyy YuA. Enzyme replacement therapy for pancreatic insufficiency. Clinical Perspectives of Gastroenterology, Hepatology. 2005;5:19-28 (In Russ.)
7. Nikfarjam M, Wilson JS, Smith RC; Australasian Pancreatic Club Pancreatic Enzyme Replacement Therapy Guidelines Working Group. Diagnosis and management of pancreatic exocrine insufficiency. Med J Aust. 2017;207(4):161-5. doi: 10.5694/mja16.00851
8. Johnson CD, Arbuckle R, Bonner N, et al. Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency (PEI) to Inform the Development of a Patient-Reported Outcome (PRO) Instrument. Patient. 2017;10(5):615-28. doi: 10.1007/s40271-017-0233-0
9. Maev IV, Kucheryavyi YuA, Samsonov AA, Andreev DN. Difficulties and errors in the management tactics of patients with chronic pancreatitis. Terapevticheskii Arkhiv
(Ter. Arkh.). 2013;85(2):65-72 (In Russ.)
10. Maev IV, Kucheryavyi YA, Andreev DN, Bideeva TV. Nutritional status in patients with chronic pancreatitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(2):81-9 (In Russ.) doi: 10.17116/terarkh201688281-89
11. Capurso G, Traini M, Piciucchi M, et al. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-39. doi: 10.2147/CEG.S168266
12. Duggan SN. Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis. Proc Nutr Soc. 2017;76:484-94. doi: 10.1017/S0029665117001045
13. Layer P, Yamamoto H, Kalthoff L, et al. The different courses of early- and late onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994;107:1481-7. doi: 10.1016/0016-5085(94)90553-3
14. Ghodeif AO, Azer SA. Pancreatic Insufficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available at:
https://www.ncbi.nlm.nih.gov/books/NBK555926/ Accessed: 28.01.2021.
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Авторы
И.В. Маев1, Ю.А. Кучерявый2, Д.Н. Андреев*1
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 АО «Ильинская больница», г.о. Красногорск, д. Глухово, Россия
*dna-mit8@mail.ru
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Ilyinskaya Hospital, Krasnogorsk, village Glukhovo, Russia
*dna-mit8@mail.ru
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 АО «Ильинская больница», г.о. Красногорск, д. Глухово, Россия
*dna-mit8@mail.ru
________________________________________________
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Ilyinskaya Hospital, Krasnogorsk, village Glukhovo, Russia
*dna-mit8@mail.ru
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