高龄鼻饲患者唾液中胃蛋白酶浓度及影响因素分析  

Analysis of influencing factors on saliva pepsin concentration in elderly patients receiving nasal feeding

作　　者：丁瑜[1] 侯惠如[1] 王刚石[1] 石海燕[1] 郭佳钰[1] DING Yu;HOU Hui-ru;WANG Gang-shi;SHI Hai-yan;GUO Jia-quan(Department of Gastroenterology,Chinese PLA General Hospital,100853 Beijing,China)

机构地区：[1]解放军总医院第2医学中心消化内科,北京100853

出　　处：《临床消化病杂志》2020年第2期93-97,共5页Chinese Journal of Clinical Gastroenterology

基　　金：总后勤部卫生部保健专项科研课题(No.14BJZ05)。

摘　　要：[目的]探讨高龄鼻饲患者唾液中胃蛋白酶水平,并分析其影响因素。[方法]采用横断面研究的方法,选取2018-04-2018-10期间住院且经鼻胃管行肠内营养治疗的患者133例,平均年龄80~100(91.09±4.912)岁。收集晨起静息状态及午餐后1 h的唾液1 ml,用ELISA法检测其胃蛋白酶浓度,以胃蛋白酶浓度平均值的中位数(7.75μg/ml)为界,将患者分为胃蛋白酶浓度≥7.75μg/ml组(55例)、胃蛋白酶浓度<7.75μg/ml组(78例)。2组患者除糖尿病、喂养方式上存在统计学差异(P<0.05),其他临床资料比较均差异无统计学意义(P>0.05)。采用χ^2检验分析2组患者唾液中胃蛋白酶浓度差异,进一步用Logistic回归分析胃蛋白酶浓度的影响因素。[结果]晨起胃蛋白酶含量中位数[25分位数;75分位数]为4.053[2.163;8.467]μg/ml,餐后1 h胃蛋白酶为5.108[2.458;7.928]μg/ml,晨起和餐后1 h的胃蛋白酶含量比较差异无统计学意义(Z=-1.355,P=0.175),有相关性(r=0.439);Logistic多因素回归分析结果显示,糖尿病(OR=2.67,95%CI:1.225~5.819,P<0.05)及鼻饲方式(OR=2.475,95%CI:1.183~5.180,P<0.05)是高龄鼻饲患者唾液中胃蛋白酶浓度升高的独立危险因素。[结论]晨起和餐后1 h的胃蛋白酶含量无统计学差异,提示此人群在不同时间点胃蛋白酶浓度较恒定;糖尿病、喂养方式是高龄长期鼻饲患者唾液中胃蛋白酶浓度升高的危险因素,对于年龄>80岁的老年人,年龄对胃蛋白酶浓度的影响较为微弱。[Objective]To investigate the level of saliva pepsin concentration in elderly patients with nasal feeding and analyze its influencing factors.[Methods]A cross-sectional study was conducted to select patients treated with enteral nutrition via nasogastric tube in the Chinese PLA General Hospital from April to October 2018.Saliva was collected at rest state in the morning and 1hour after lunch,and the pepsin concentration in the saliva was detected by ELISA.The patients were divided into two groups according to the median of the mean pepsin concentration.The chi-square test was used to analyze the differences of pepsin concentration in saliva between the two groups,and the influencing factors of pepsin concentration were further analyzed by Logistic regression.[Results]A total of 133patients were enrolled,with an average age of 80-100(91.09±4.912)years.There were statistical differences in diabetes and feeding methods between the two groups(P<0.05).The median[25quantile;75quantile]of pepsin in the morning was 4.053[2.163;8.467]μg/ml,and the postprandial pepsin content was 5.108[2.458,7.928]μg/ml,there was no statistical difference in pepsin content(Z=-1.355,P=0.175),and there was a correlation(r=0.439).Logistic multivariate regression analysis showed that diabetes mellitus(OR=2.67,95%CI:1.225-5.819,P<0.05)and nasal feeding method(OR=2.475,95%CI:1.183-5.180,P<0.05)were independent risk factors for the increase of pepsin concentration in saliva of elderly patients receiving nasal feeding.[Conclusions]There is no significant difference in pepsin content between morning and postprandial,which suggests that the pepsin concentration in this population is constant at different time.Diabetes and feeding methods are risk factors for the increase of pepsin concentration in saliva of elderly patients receiving nasal feeding for a long time.For the elderly over 80years old,age has a relatively weak influence on pepsin concentration.

关 键 词：胃蛋白酶 肠内营养 胃食管反流 

分 类 号：R977.3[医药卫生—药品]