全肠内营养对儿童克罗恩病诱导缓解疗效研究

Effectiveness of induction therapy with exclusive enteral nutrition in pediatric Crohn's disease

摘要:

目的 观察全肠内营养（exclusive enteral nutrition，EEN）对克罗恩病（Crohn's disease，CD）患儿诱导缓解的疗效。 方法 回顾性收集2013年3月至2021年8月在浙江大学医学院附属儿童医院接受EEN治疗的62例CD患儿的临床资料，包括一般资料，治疗前及治疗8周后患儿的身高、体重、儿童CD活动指数、CD内镜严重程度指数、C反应蛋白水平、红细胞沉降率、血清白蛋白水平。比较治疗前后上述指标的变化。 结果 62例患儿中，男39例（63%），女23例（37%），确诊年龄（11.9±3.0）岁。55例完成至少8周EEN治疗的患儿中，87%（48/55）的患儿在治疗第8周获得临床缓解。第8周儿童CD活动指数显著低于治疗前（P<0.001）。除去17例单纯累及小肠患儿及3例未行结肠镜复查的累及结肠患儿，剩余35例累及结肠患儿在8周EEN治疗后进行了结肠镜复查，83%（29/35）的患儿达到黏膜愈合。在第8周达到临床缓解的48例患儿中，年龄别身高Z评分及年龄别体重指数Z评分较治疗前均显著改善（P<0.01）。在第8周未达到临床缓解的7例患儿中，年龄别身高Z评分和年龄别体重指数Z评分与治疗前比较差异均无统计学意义（P>0.05）。 结论 8周EEN治疗对儿童CD的诱导缓解及黏膜愈合的疗效良好。对于成功诱导缓解的CD患儿，EEN可改善其身高和体重指数。

Abstract:

Objective To evaluate the effectiveness of induction therapy with exclusive enteral nutrition (EEN) in pediatric Crohn's disease (CD). Methods A retrospective analysis was performed on the medical data of 62 children with CD who received EEN in Children's Hospital, Zhejiang University School of Medicine, from March 2013 to August 2021. The medical data included general information and height, weight, Pediatric Crohn's Disease Activity Index (PCDAI), Crohn's Disease Endoscopic Index of Severity, C-reactive protein, erythrocyte sedimentation rate, and serum albumin level before treatment and after 8 weeks of treatment. The changes in the above indicators were compared before and after treatment. Results Among the 62 children with CD, there were 39 boys (63%) and 23 girls (37%), with a mean age of (11.9±3.0) years at diagnosis. Among the 55 children who completed EEN treatment for at least 8 weeks, 48 (87%) achieved clinical remission at week 8. PCDAI at week 8 was significantly lower than that before treatment (P<0.001). Except for 17 children with involvement of the small intestine alone and 3 children with involvement of the colon who did not receive colonoscopy reexamination, the remaining 35 children with involvement of the colon received colonoscopy reexamination after the 8-week EEN treatment. Of the 35 children, 29 (83%) achieved mucosal healing. As for the 48 children who achieved clinical remission at week 8, there were significant improvements in height-for-age Z-score and body mass index-for-age Z-score at week 8 (P<0.01). As for the 7 children who did not achieve clinical remission at week 8, there were no significant changes in height-for-age Z-score and body mass index-for-age Z-score at week 8 (P>0.05). Conclusions The 8-week EEN treatment has a good effect on clinical remission and mucosal healing in children with CD. For the children with CD achieving clinical remission, EEN can improve their height and body mass index.