DIET, DISEASE, AND PANCREATIC ENZYME SYNTHESIS IN HUMANS

描述：急性胰腺炎是一种高死亡率的疾病，由 胰腺中消化酶的过早激活，并伴有 严重的全身性免疫炎症反应和蛋白质分解代谢。会议 营养需求是困难的，因为食物诱导的胰腺刺激可能 加重病情进程，静脉营养(TPN)，同时休息 胰腺，“增加败血症和粘膜萎缩的风险。 对照临床试验表明，管饲与元素饮食有 在成本、安全性(感染性并发症较少)、 和功效(更具抗代谢作用)。然而，目前尚不清楚人类是否 元素饮食刺激胰腺，其有益效果可能只是 反映出更好的代谢控制和更少的严重并发症。因此， O‘Keefe博士和他的同事计划测量十二指肠输液对 元素饮食对正常人胰酶合成和分泌的影响 志愿者和急性胰腺炎患者使用一种独特的方法，他们 已经开发出，基于6小时静脉和肠道输液的两种 同位素标记氨基酸及其对胰酶和蛋白质摄取的测定 从十二指肠分泌物中提取的淀粉酶蛋白。该方法还允许 以获得同时测量蛋白质分解代谢率和 饲料氨基酸在粘膜蛋白质合成中的利用 (通过内窥镜活检获得)。研究将以8人为一组进行 正常志愿者比较络合物和元素的相对效应 饮食作为十二指肠输液，与TPN相比，对 复杂的口服饮食。然后，结果将被用来评估在 20例急性胰腺炎患者随机接受肠内元素或 TPN。这些调查的结果预计将提供有价值的新的 食物对人体消化系统的刺激作用 系统和现代营养支持技术的营养价值； 帮助确定为什么元素饮食比TPN更有效 急性胰腺炎患者的处理。结果也在意料之中 为设计针对特定疾病的饮食提供科学依据 患有急性胰腺疾病的患者。

DESCRIPTION: Acute pancreatitis is a disease of high mortality, induced by premature activation of digestive enzymes in the pancreas, and accompanied by a severe systemic immunoinflammatory response and protein catabolism. Meeting nutritional needs is difficult because food-induced pancreatic stimulation may exacerbate the disease process, and intravenous nutrition (TPN), while "resting the pancreas," increases the risk of septicemia and mucosal atrophy. Recent controlled clinical trials suggest that tube-feeding with elemental diets has advantages over TPN with regard to cost, safety (less infective complications), and efficacy (more anticatabolic). However, it is unknown in humans whether elemental diets stimulate the pancreas, and the beneficial effects may simply reflect better metabolic control and fewer serious complications. Consequently, Dr. O'Keefe and colleagues plan to measure the effects of duodenal infusions of elemental diets on pancreatic enzyme synthesis and secretion in normal volunteers and patients with acute pancreatitis using a unique method that they have developed, based on the 6-hr intravenous and enteral infusion of two isotope-labeled amino acids and measurement of their uptake into trypsin and amylase proteins extracted from duodenal secretions. The method also allows them to obtain simultaneous measurements of the rates of protein catabolism and utilization of dietary amino acids for the synthesis of mucosal proteins (obtained by endoscopic biopsy). Studies will be conducted in groups of 8 normal volunteers to compare the relative effects of complex and elemental diets given as duodenal infusions, versus TPN, on the normal response to a complex oral diet. The results will then be used to evaluate the responses in 20 patients with acute pancreatitis randomized to receive enteral elemental or TPN. The results of these investigations are expected to provide valuable new information on both the stimulatory effects of food on the human digestive system and the nutritional value of modern nutritional support techniques, and help determine why elemental diets are more effective than TPN in the management of patients with acute pancreatitis. The results are also expected to form a scientific basis for the design of disease-specific diets for patients with acute pancreatic disease.