全程营养管理改善乳糜泻患者结局

Nutrition Management of Celiac Disease Improves Outcome of Patients

目的：探讨全程营养管理和膳食干预对乳糜泻患者结局的影响。方法纳入2000年1月至2014年12月在北京协和医院确诊为乳糜泻的患者17例，总结其临床特征，对所有患者均进行去麦胶膳食的营养管理，并跟踪随访其中8例患者，评价其营养干预依从性以及病情变化。结果17例乳糜泻患者平均年龄（39.65±19.14）岁，男／女性别比为9／8，患者均有程度不同的慢性腹泻，6例（35.29％）患者便苏丹Ⅲ染色阳性，7例（41.18％）检出便潜血阳性，12例（70.59％） D-木糖试验低于正常参考值下限（1.2 g／5 h）。就诊时患者平均体重指数（body mass index， BMI）为（16.57±3.05） kg／m2。12例（70.59％）患者存在营养不良（ BMI＜18.5 kg／m2），6例（35.29％）为严重营养不良（ BMI ＜15 kg／m2）。14例（82.35％）患者存在低白蛋白血症。贫血是最为常见的肠外表现（11例，64.71％）。分别有6例（35.29％）、3例（17.65％）及5例（29.41％）患者存在铁、叶酸及维生素B12缺乏。所有患者均接受去麦胶膳食的营养管理。8例患者进行了随访，平均随访时间（10.38±8.28）个月（3～25个月）。其中7例具备良好的营养治疗依从性（Likert量表评分为1～2分），治疗过程中腹泻、腹胀症状均显著好转，体重由治疗前（44.83±9.77） kg 增至（47.17±9.30） kg （ P ＝0.681），血清白蛋白由就诊时（27.50±7.92） g／L上升至（34.20±3.27） g／L （P＝0.102）。结论加强乳糜泻患者教育及营养管理，严格进行去麦胶膳食治疗，密切随访，监测病情变化，指导膳食调整，是减轻疾病症状、提高生活质量和改善患者结局的重要手段。

Objective To investigate effect of comprehensive nutrition management on outcome of patients with celiac disease.Methods We retrospectively reviewed 17 consecutive patients with celiac disease diagnosed from January 2000 to December 2014 in Peking Union Medical College Hospital.Clinical features of these pa-tients were summarized.Nutrition management was implemented, involving gluten-free diet.Of these 17 pa-tients, 8 cases were followed up to assess their compliance and responses to nutrition management.Results The mean age of the recruited patients was （39.65 ±19.14） years.The male/female ratio was 9/8.All the patients were featured with chronic diarrhea of various severity, with 6 （35.29%） patients having steatorrhea （ positive sudan Ⅲstaining） and 7 （41.18%） patients showing positive occult blood in feces.Besides, low D-xylose ab-sorption （〈1.2 g/5 h） was observed in 12 （70.59%） patients.The mean body mass index （BMI） at presen-tation was （16.57 ±3.05） kg/m2 .Twelve （70.59%） patients had malnutrition （ BMI〈18.5 kg/m2 ） , inclu-ding 6 （35.29%） patients who had severe malnutrition （ BMI〈15 kg/m2 ） .Hypoalbuminemia was present in 14 （82.35%） patients.Anemia was the most common extra-intestinal manifestation, found in 11 （64.71%） patients.Deficiency of iron, folate and vitamin B12 were confirmed in 6 （ 35.29%） , 3 （ 17.65%） , and 5 （29.41%） patients, respectively.Comprehensive nutrition management was administered to all the patients. Eight patients were followed up, with mean follow-up duration of （10.38 ±8.28） months （3-25 months） .Of the 8 patients, 7 were well compliant to nutrition management （ Likert scale scores 1-2） and had significant im-provement of diarrhea and abdominal distention, with body weight increasing from （ 44.83 ±9.77 ） kg before management to （47.17 ±9.30 ） kg （ P=0.681 ） and serum albumin elevating from （ 27.50 ±7.92 ） g/L at presentation to （34.20 ±3.27） g/L （P=0.102）.Conclusion Patient education and comprehensive nutrition management with application of strict gluten-free diet, close follow-up, disease monitor, and guidance of dietary modification play a significant role in improving outcome and life quality of patients with celiac disease.