中重度溃疡性结肠炎患者肠内营养支持治疗的回顾性分析
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摘要
背景:肠内营养(EN)能促进肠黏膜愈合,对克罗恩病(CD)患者具有一定的治疗价值,但在溃疡性结肠炎(UC)中应用和疗效的研究较少。目的:探讨EN对具有营养风险的中重度活动期UC患者的疗效。方法:选取2016年1月—2018年1月曲靖市第一人民医院、昆明医科大学第一附属医院90例具有营养风险的中重度UC患者,并分为EN组和无EN组。比较两组治疗前后Mayo评分、体重指数(BMI)、血红蛋白(HGB)、白蛋白(ALB)、总蛋白(TP)水平。结果:治疗前,EN组与无EN组Mayo评分、BMI、HGB、ALB和TP相比差异均无统计学意义(P>0. 05)。与治疗前相比,治疗后EN组Mayo评分显著降低(P <0. 05),ALB、TP显著升高(P <0. 05);无EN组Mayo评分、BMI均显著降低(P <0. 05)。治疗后,EN组BMI、ALB、TP均显著高于无EN组(P <0. 05)。结论:EN能有效改善UC患者的营养状况,对病情的改善起有辅助作用。
Background: Enteral nutrition( EN) can promote intestinal mucosal healing,and has some therapeutic value in patients with Crohn's disease( CD). However,studies on application and efficacy of EN in patients with ulcerative colitis( UC) are rare. Aims: To investigate the therapeutic effect of EN in patients with moderate to severe active UC who have nutritional risk. Methods: A total of 90 moderate to severe UC patients with nutritional risk from January 2016 to January2018 at the First People's Hospital of Qujing and First Affiliated Hospital of Kunming Medical University were enrolled,and were divided into EN group and non-EN group. Mayo score,body mass index( BMI) and levels of hemoglobin( HGB),albumin( ALB) and total protein( TP) before and after treatment in EN group and non-EN group were analyzed. Results:There were no significant differences in Mayo score,BMI,HGB,ALB and TP between the two groups before treatment( P >0. 05). After treatment,Mayo score was significantly decreased( P < 0. 05),and ALB,TP were significantly increased in EN group( P < 0. 05); while Mayo score,BMI were significantly decreased in non-EN group( P < 0. 05). After treatment,BMI,ALB,TP were significantly higher in EN group than in non-EN group( P < 0. 05). Conclusions: EN can effectively improve the nutritional status of patients with UC and play an auxiliary role in improving the disease.
Background: Enteral nutrition( EN) can promote intestinal mucosal healing,and has some therapeutic value in patients with Crohn's disease( CD). However,studies on application and efficacy of EN in patients with ulcerative colitis( UC) are rare. Aims: To investigate the therapeutic effect of EN in patients with moderate to severe active UC who have nutritional risk. Methods: A total of 90 moderate to severe UC patients with nutritional risk from January 2016 to January2018 at the First People's Hospital of Qujing and First Affiliated Hospital of Kunming Medical University were enrolled,and were divided into EN group and non-EN group. Mayo score,body mass index( BMI) and levels of hemoglobin( HGB),albumin( ALB) and total protein( TP) before and after treatment in EN group and non-EN group were analyzed. Results:There were no significant differences in Mayo score,BMI,HGB,ALB and TP between the two groups before treatment( P >0. 05). After treatment,Mayo score was significantly decreased( P < 0. 05),and ALB,TP were significantly increased in EN group( P < 0. 05); while Mayo score,BMI were significantly decreased in non-EN group( P < 0. 05). After treatment,BMI,ALB,TP were significantly higher in EN group than in non-EN group( P < 0. 05). Conclusions: EN can effectively improve the nutritional status of patients with UC and play an auxiliary role in improving the disease.
引文
1 Lee D, Albenberg L, Compher C, et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases[J]. Gastroenterology,2015,148(6):1087-1106.
2 中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见(2012年·广州)[J].胃肠病学,2012,17(12):763-781.
3 Kondrup J,Rasmussen HH,Hamberg O,et al; Ad Hoc ESPEN Working Group. Nutritional risk screening(NRS2002):a new method based on an analysis of controlled clinical trials[J]. Clin Nutr,2003,22(3):321-336.
4 Lochs H, Dejong C, Hammarqvist F, et al; DGEM(German Society for Nutritional Medicine); ESPEN(European Society for Parenteral and Enteral Nutrition).ESPEN Guidelines on Enteral Nutrition:Gastroenterology[J]. Clin Nutr,2006,25(2):260-274.
5 Matsui T, Sakurai T, Yao T. Nutritional therapy for Crohn’s disease in Japan[J]. J Gastroenterol,2005,40Suppl 16:25-31.
6 Borrelli O,Cordischi L,Cirulli M,et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease:a randomized controlled openlabel trial[J]. Clin Gastroenterol Hepatol,2006,4(6):744-753.
7 Berni Canani R,Terrin G,Borrelli O,et al. Short-and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn’s disease[J]. Dig Liver Dis,2006,38(6):381-387.
8 González-Huix F,Fernández-Baares F,Esteve-Comas M,et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis[J]. Am J Gastroenterol,1993,88(2):227-232.
9 沈冰冰,钱家鸣,伍东升,等.肠内营养在溃疡性结肠炎治疗中的应用[J].肠外与肠内营养,2008,15(3):148-150.
10 Gerasimidis K, Barclay A, Papangelou A, et al. The epidemiology of anemia in pediatric inflammatory bowel disease:prevalence and associated factors at diagnosis and follow-up and the impact of exclusive enteral nutrition[J].Inflamm Bowel Dis,2013,19(11):2411-2422.
11 Heuschkel RB,Menache CC,Megerian JT,et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children[J]. J Pediatr Gastroenterol Nutr,2000,31(1):8-15.
12 Nones K,Dommels YE,Martell S,et al. The effects of dietary curcumin and rutin on colonic inflammation and gene expression in multidrug resistance gene-deficient(mdr1a-/-)mice,a model of inflammatory bowel diseases[J]. Br J Nutr,2009,101(2):169-181.
13 Hanai H, Iida T, Takeuchi K, et al. Curcumin maintenance therapy for ulcerative colitis:randomized,multicenter,double-blind, placebo-controlled trial[J].Clin Gastroenterol Hepatol,2006,4(12):1502-1506.
14 Suskind DL,Cohen SA,Brittnacher MJ,et al. Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease[J]. J Clin Gastroenterol,2018,52(2):155-163.
15 Prince AC, Myers CE, Joyce T, et al. Fermentable Carbohydrate Restriction(Low FODMAP Diet)in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease[J]. Inflamm Bowel Dis,2016,22(5):1129-1136.
16 Forbes A, Escher J, Hébuterne X, et al. ESPEN guideline:Clinical nutrition in inflammatory bowel disease[J]. Clin Nutr,2017,36(2):321-347.
2 中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见(2012年·广州)[J].胃肠病学,2012,17(12):763-781.
3 Kondrup J,Rasmussen HH,Hamberg O,et al; Ad Hoc ESPEN Working Group. Nutritional risk screening(NRS2002):a new method based on an analysis of controlled clinical trials[J]. Clin Nutr,2003,22(3):321-336.
4 Lochs H, Dejong C, Hammarqvist F, et al; DGEM(German Society for Nutritional Medicine); ESPEN(European Society for Parenteral and Enteral Nutrition).ESPEN Guidelines on Enteral Nutrition:Gastroenterology[J]. Clin Nutr,2006,25(2):260-274.
5 Matsui T, Sakurai T, Yao T. Nutritional therapy for Crohn’s disease in Japan[J]. J Gastroenterol,2005,40Suppl 16:25-31.
6 Borrelli O,Cordischi L,Cirulli M,et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease:a randomized controlled openlabel trial[J]. Clin Gastroenterol Hepatol,2006,4(6):744-753.
7 Berni Canani R,Terrin G,Borrelli O,et al. Short-and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn’s disease[J]. Dig Liver Dis,2006,38(6):381-387.
8 González-Huix F,Fernández-Baares F,Esteve-Comas M,et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis[J]. Am J Gastroenterol,1993,88(2):227-232.
9 沈冰冰,钱家鸣,伍东升,等.肠内营养在溃疡性结肠炎治疗中的应用[J].肠外与肠内营养,2008,15(3):148-150.
10 Gerasimidis K, Barclay A, Papangelou A, et al. The epidemiology of anemia in pediatric inflammatory bowel disease:prevalence and associated factors at diagnosis and follow-up and the impact of exclusive enteral nutrition[J].Inflamm Bowel Dis,2013,19(11):2411-2422.
11 Heuschkel RB,Menache CC,Megerian JT,et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children[J]. J Pediatr Gastroenterol Nutr,2000,31(1):8-15.
12 Nones K,Dommels YE,Martell S,et al. The effects of dietary curcumin and rutin on colonic inflammation and gene expression in multidrug resistance gene-deficient(mdr1a-/-)mice,a model of inflammatory bowel diseases[J]. Br J Nutr,2009,101(2):169-181.
13 Hanai H, Iida T, Takeuchi K, et al. Curcumin maintenance therapy for ulcerative colitis:randomized,multicenter,double-blind, placebo-controlled trial[J].Clin Gastroenterol Hepatol,2006,4(12):1502-1506.
14 Suskind DL,Cohen SA,Brittnacher MJ,et al. Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease[J]. J Clin Gastroenterol,2018,52(2):155-163.
15 Prince AC, Myers CE, Joyce T, et al. Fermentable Carbohydrate Restriction(Low FODMAP Diet)in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease[J]. Inflamm Bowel Dis,2016,22(5):1129-1136.
16 Forbes A, Escher J, Hébuterne X, et al. ESPEN guideline:Clinical nutrition in inflammatory bowel disease[J]. Clin Nutr,2017,36(2):321-347.