含缓释淀粉肠内营养制剂对重症急性胰腺炎患者血糖变异性及预后的影响  

Effect of enteral nutrition formula containing slow-release starch on blood glucose variability and prognosis in patients with severe acute pancreatitis

作　　者：田源 马柳一 刘倩倩[1] 韩冬冬 周小燕 高敏 TIAN Yuan;MA Liuyi;LIU Qianqian;HAN Dongdong;ZHOU Xiaoyan;GAO Min(Emergency Department,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei,061000)

机构地区：[1]河北省沧州中西医结合医院急诊科,河北沧州061000

出　　处：《实用临床医药杂志》2025年第7期64-70,共7页Journal of Clinical Medicine in Practice

基　　金：河北省中医药管理局科研计划项目(2021310)。

摘　　要：目的探讨含缓释淀粉肠内营养制剂对重症急性胰腺炎(SAP)患者血糖变异性及预后的影响。方法选取204例SAP患者作为研究对象,采用随机数字表法将其分为对照组和观察组,每组102例。对照组采用标准型肠内营养制剂进行早期肠内营养支持,观察组采用含缓释淀粉肠内营养制剂进行早期肠内营养支持。比较2组治疗后血糖变异性[血糖最大波动幅度(LAGE)、血糖标准差(SDBG)、血糖变异系数(BGCV)、血糖平均值(MBG)、平均血糖波动幅度(MAGE)和葡萄糖目标范围内时间百分比(TIR)]、住院期间临床指标、炎症指标[降钙素原、C反应蛋白、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]及营养指标(白蛋白、前白蛋白)水平。采用Kaplan-Meier法分析2组患者的预后情况,并通过多因素Cox回归分析筛选预后的影响因素。结果治疗后,观察组MBG、LAGE、SDBG、BGCV、MAGE水平低于对照组,TIR高于对照组,差异有统计学意义(P<0.05)。住院期间,观察组肠内营养治疗时间短于对照组,胰岛素用量、多器官功能衰竭发生率和感染性胰腺坏死发生率均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组降钙素原、C反应蛋白、IL-6、TNF-α水平低于对照组,差异有统计学意义(P<0.05);2组白蛋白、前白蛋白水平比较,差异无统计学意义(P>0.05)。Kaplan-Meier法分析结果显示,观察组累积病死率为12.75%,低于对照组的17.65%,差异有统计学意义(Log-rankχ^(2)=4.361,P=0.037)。多因素Cox回归分析结果显示,治疗后TIR(HR=0.920,95%CI:0.869~0.974)是SAP患者预后的独立保护因素(P<0.05),感染性胰腺坏死(HR=4.269,95%CI:1.922~9.482)是SAP患者预后的独立危险因素(P<0.05)。结论含缓释淀粉肠内营养制剂有助于稳定SAP患者的血糖变异性,控制炎症指标水平,改善机体营养状态及预后。TIR和感染性胰腺坏死均与SAP患者的预后密切相关。Objective To explore the impact of enteral nutrition formula containing slow-release starch on blood glucose variability and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 204 SAP patients were enrolled and randomly divided into control group and observation group using a random number table method,with 102 patients in each group.The control group received early enteral nutrition support with a standard enteral nutrition formula,while the observation group received early enteral nutrition support with an enteral nutrition formula containing slow-release starch.Blood glucose variability indicators[largest amplitude of glycemic excursions(LAGE),standard deviation of blood glucose(SDBG),blood glucose coefficient of variation(BGCV),mean blood glucose(MBG),mean amplitude of glycemic excursions(MAGE),and time in range(TIR)]were compared between the two groups after treatment,along with clinical indicators during hospitalization,inflammatory markers[procalcitonin,C-reactive protein,interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],[CM(10*2]and nutritional indicators(albumin,prealbumin)levels.Kaplan-Meier analysis was conducted to assess the prognosis of the two groups,and multivariate Cox regression analysis was performed to identify factors influencing prognosis.Results After treatment,the observation group exhibited lower levels of MBG,LAGE,SDBG,BGCV,MAGE,and a higher TIR compared with the control group(P<0.05).During hospitalization,the observation group had a shorter duration of enteral nutritiontherapy,lower insulin usage,and lower incidence rates of multiple organ failure and infectious pancreatic necrosis compared with the control group(P<0.05).After treatment,the observation group had lower levels of procalcitonin,C-reactive protein,IL-6,and TNF-αcompared with the control group(P<0.05);however,there were no statistically significant differences in albumin and prealbumin levels between the two groups(P>0.05).Kaplan-Meier analysis showed that the cumulative mortality rate in

关 键 词：肠内营养支持 含缓释淀粉肠内营养制剂 重症急性胰腺炎 血糖变异性 预后 炎症反应 感染性胰腺坏死 营养状态 

分 类 号：R576[医药卫生—消化系统] R459.3[医药卫生—内科学] R319[医药卫生—临床医学]