Clin Gastroenterology H: 饮食疗法可诱导儿童活动性克罗恩病患者疾病的快速缓解

2021-03-28 MedSci原创 MedSci原创

克罗恩病(CD)是发生在人类消化道系统的一种慢性炎症性疾病,在过去十年中,儿童群体的患病率呈上升趋势,对于轻度至中度疾病患儿诱导缓解的方法包括单一肠内营养。

      克罗恩病(CD)是发生在人类消化道系统的一种慢性炎症性疾病,在过去十年中,儿童群体的患病率呈上升趋势,对于轻度至中度疾病患儿诱导缓解的方法包括单一肠内营养(EEN)或结合皮质类固醇的饮食疗法(CS)。虽然CS和抗TNFα治疗会诱导儿童CD的快速缓解,但确实有其他潜在的风险。饮食疗法在安全性方面具有特别的优势(无免疫抑制或全身性副作用),疾病缓解率也较高。目前,有两种饮食疗法已显示出明显的诱导轻度缓解的益处:单一肠内营养(EEN)饮食以及涉及基于配方的流质饮食不接触任何其他食物的排他饮食(CDED)。本项研究旨在探究这两种饮食模式是否可以快速使得患儿的疾病活动得到缓解。

 

 

      本项研究共纳入了73名处于轻度至中度疾病活动度CD患儿(平均年龄14.2±2.7岁),这些患儿被分配接受单一肠内营养(EEN,n = 34)或CDED含50%(部分)肠内营养(n = 39)治疗。在基线以及饮食的第3和第6周对患者进行疾病评估。临床缓解定义为CD活性指数评分低于10,或指数降低12.5,并通过测量C反应蛋白评估炎症。

 

 

      研究结果显示在接受饮食治疗的第3周,CDED组中82%的患儿和EEN组中85%的患者患儿获得了疾病活动缓解。血清C反应蛋白的中位数已从基线时的24 mg / L降至第3周的5.0 mg/L(P <0.001)。在多变量分析中,在第3周就获得疾病缓解的患者到了第6周的缓解率大大提高(OR,6.37 ; 95%CI,1.6–25;P= .008 ),但饮食疗法依从性较差的患儿第6周的缓解率明显下降(OR,0.75; 95%CI,0.012-0.46;P= .006)。

 

 

      本项研究证实对于处于疾病活动期CD的小儿患者,饮食疗法(CDED和EEN)可起到快速诱导疾病缓解的疗效,一般第3周就可以获得疾病缓解。

 

 

 

原始出处:

Rotem Sigall Boneh. Et al. Dietary Therapies Induce Rapid Response and Remission in Pediatric Patients With Active Crohn’s Disease. Clinical Gastroenterology and Hepatology.2021.

 

 

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    2021-06-26 xugumin
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    2021-10-14 许安
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