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

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。

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 August2021.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 indexfor-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.