抗TNF-α药物对炎性肠病患者营养状况和膳食摄入量的影响

Effect of anti-TNF-α therapy on nutritional status and dietary intake in patients with inflammatory bowel disease

目的利用生物电阻抗分析法测量患者身体组分,评价抗肿瘤坏死因子α(TNF-α)药物治疗对炎性肠病(IBD)患者的营养状况和膳食摄入量的影响。方法选取2013年10月-2014年10月在广州红十字会医院和深圳市人民医院收治的40例IBD患者,其中克罗恩病33例,溃疡性结肠炎7例。所有患者均接受抗TNF-α药物治疗,其中24例患者接受阿达木单抗治疗,16例患者接受英夫利昔单抗治疗,共12周。利用720 INBody人体成分分析仪检测患者治疗前后的身体成分,记录相关参数,包括体重、体重指数(BMI)、去脂体重指数(FFMI)、脂肪体重指数(BFMI)、体脂百分含量、内脏脂肪面积、骨骼肌质量指数(SMI)和体细胞质量;并比较分析阿达木单抗治疗组和英夫利昔单抗治疗组身体成分变化值。利用Nutricomp Diet Cad?软件计算治疗前后患者的营养摄入量,并进行对比分析。结果患者的BMI和肌肉参数治疗前后比较,差异有统计学意义(P<0.05),治疗后增加,体重指数:(21.81±7.19)vs(23.52±7.34),FFMI:(17.55±3.01)vs(18.34±3.12);而脂肪参数治疗前后比较,差异无统计学意义(P=0.120),BFMI:(6.21±5.20)vs(6.44±5.27)。阿达木单抗与英夫利昔单抗治疗组间比较,患者的身体成分变化差异无统计学意义(P>0.05),FFMI变化值:(0.54±0.12)vs(0.43±0.19),BFMI变化值:(0.23±0.15)vs(0.21±0.09)。针对营养摄入分析,本研究发现抗TNF-α治疗后,IBD患者的能量摄入和主要营养物质(蛋白质、碳水化合物、脂肪)摄入量较治疗前均差异有统计学意义(P<0.05),均增加。结论抗TNF-α药物治疗可增加IBD患者的体重及肌肉相关指数,而不增加脂肪参数,使患者身体发生有利变化,增加患者饮食摄入量,改善其营养状态。另外,英夫利昔单抗或阿达木单抗疗法对身体组分的影响差异无统计学意义。

Objective To evaluate the impact of anti-TNF-αtherapy on nutritional status and dietary intake of inflammatory bowel disease(IBD)patients by measuring body composition using bioelectrical impedance analysis.Methods From October 2013 to October 2014,40 IBD patients who met the inclusion criteria were recruited in Guangzhou Red Cross Hospital and Shenzhen People’s Hospital,including 33 Crohn’s disease patients and 7 ulcerative colitis patients.All patients were treated with anti-TNF-αtherapy,of which 24 patients received Adalimumab therapy and 16 patients received Inf?liximab therapy for 12 weeks.Body composition of all patients was tested by Inbody 720 Body Composition Analyzer before and after treatment.Related parameters including body weight,body mass index(BMI),fat-free mass index(FFMI),body fat mass index(BFMI),body fat percentage,visceral fat area,skeletal muscle mass index(SMI)and body cell mass(BCM)were recorded.The differences of body composition changes were compared between the two groups.The nutritional intake of the patients before and after treatment were calculated by Nutricomp Diet Cad?software and compared.Results BMI and muscle parameter after treatment were significantly increased compared with those before treatment(P<0.05),while the fat parameters did not change significantly(P>0.05).There was no significant difference in body composition between the Adalimumab treatment group and the Infliximab treatment group(P>0.05).For nutritional intake analysis,IBD patient’s energy intake and major nutrient(protein,carbohydrate and fat)intake after anti-TNF-αtherapy were significantly increased after treatment compared with those before treatment(P<0.05).Conclusions Anti-TNF-αtherapy can significantly increase the body weight and muscle related index in the patients with IBD,without increasing fat parameters,leading to a favorable change in the patients'body,increasing the dietary intake and improving their nutritional status.In addition,the impact of Infliximab and Adalimumab therapy on body composition has no significant difference.