肠内营养在克罗恩病治疗中的应用价值

Enteral nutritional treatment in Crohn disease

目的本研究主要通过对比要素饮食(ED)与聚合物饮食(PD)的治疗效果,探讨肠内营养(EN)在克罗恩病(CD)中的应用价值。方法纳入西安市中心医院2012年6月至2013年12月确诊为CD的患者,依据活动性评分(CDAI)>150分、肠道症状及CRP异常等将患者随机分入ED组和PD组,两组患者除氮源不同外,余营养成分及治疗方法均相同,以CDAI<150分或较基础值降低至少100分、肠道症状消失、CRP正常为临床缓解,观察CD患者0、2、4、6、8周的病情变化。结果共56例CD患者入组,其中ED组26例,PD组30例,两组基线资料具有可比性(P>0.05);EN治疗后,共45例(80.4%)CD患者获得临床缓解,其中ED组22例(84.6%),PD组23例(76.7%),组间比较差异无统计学意义(P=0.1)。治疗后ED组、PD组营养状况均优于治疗前,但两组间差异无统计学意义(P>0.05)。结论肠内营养是CD的一种有效治疗方式,要素饮食与聚合物饮食效果相似。

Objective The study was designed to compare the efficacy of a polymeric diet （PD） with an elemental diet （ED）in the treatment of Crohn disease（CD）. Methods Patients with active Crohn＇s disease from June, 2012 to December, 2013 in Xi＇an contral hospital were included in this study. According to the Crohn＇s disease activity index（CDAI）〉150, bowel systems and abnormal C-reactive protein[CRP], the patients were randomized to receive either an ED or a PD.The two preparations were identical except for the nitrogen source. Enteral feeding was considered successful if clinical remission was achieved as defined by a final CDAI ~〈 150,or a reduction in the CDAI by at least 100 points from baseline level, bowel systems disappear, and a normal CRP. Changes in condition at 0, 2, 4, 6, 8 weeks were observed. Results Overall 56 patients were enrolled of whom 26 were randomized to ED and 30 to PD. The two groups were comparable at entry（P〉0.05）. Clinical remission was obtained in 45 CD patients （80.4%）, in which 22 （84.6%） patients receiving ED and 23 （76.7%） patients receiving PD, there was no significant difference between the two groups （P〉0.05）.The nutritional status of both ED group and PD group were significantly better after treatment than before, but no significant difference between the two groups （P〉0.05）. Conclusion Enteral nutritional treatment is effective for Crohn disease, and elemental diet and polymeric diet had the similar effect.