肠内外营养对重度克罗恩病患者身体成分和疾病活动性的影响

Effect of Enteral and Parenteral Nutrition on Body Composition and Disease Activity in Patients With Severe Crohn's Disease

背景:营养不良是炎症性肠病的常见并发症,尤其常见于克罗恩病(CD)患者。部分肠内营养与部分肠外营养联合支持治疗是重度CD患者的有效治疗选择。目的:探讨肠内、外营养联合支持治疗对重度活动期CD患者身体成分和疾病活动性的影响。方法:2015年7月—2016年8月于上海市第十人民医院住院治疗的72例重度活动期CD患者纳入研究。入院后在抗感染和诱导缓解治疗的同时给予部分肠内营养与部分肠外营养联合支持治疗,评估入院时以及治疗1、2、3周后营养状况、身体成分指标和疾病活动性的变化。结果:入院时患者营养不良发生率为100%,其中90.3%为重度营养不良。经3周规范的肠内、外营养支持治疗,重度营养不良占比显著降低(34.7%对90.3%,P<0.05),体质量、体质指数、肌肉量、脂肪量、蛋白质含量、基础代谢率等身体成分指标逐渐改善(P<0.05),疾病活动性由重度活动逐渐向中、轻度活动过渡(P<0.05)。结论:重度活动期CD患者采用肠内、外营养联合支持治疗可有效改善营养状况和身体成分指标,降低疾病活动性,促进疾病缓解。

Background： Malnutrition is common in inflammatory bowel disease, especially in Crohn’s disease （CD）. Combined partial enteral and parenteral nutrition is effective for nutritional support in patients with severe CD. Aims： To investigate the effect of combined enteral and parenteral nutritional support on body composition and disease activity in severe active CD patients. Methods： A total of 72 patients with severe active CD admitted from July 2015 to August 2016 at Shanghai Tenth People’s Hospital were enrolled. In addition to conventional antibacterial and remission induction therapy, a combined partial enteral and parenteral nutritional support was given after admission. The nutritional status, body composition parameters and disease activity were evaluated and compared on admission and week 1, week 2 and week 3 of hospitalization. Results： The malnutrition rate was 100% on admission, of which 90.3% were severe malnutrition. After a 3-week combined enteral and parenteral nutritional support, the proportion of severe malnutrition decreased from 90.3% to 34.7% （P〈0.05）. Meanwhile, the body weight, body mass index, muscle mass, fat mass, protein content, and basal metabolic rate gradually increased and the disease activity index gradually decreased （P all 〈0.05）. Conclusions： Combined enteral and parenteral nutritional support can improve the nutritional status and body composition parameters, reduce disease activity and induce remission effectively in severe active CD patients.