炎症性肠病伴口腔溃疡患者个体化饮食健康管理方案研究  

Individualized Dietary Management Plan for Oral Ulcer in Patients with Inflammatory Bowel Disease

作　　者：杨旭[1] 周惠芬[2] 张苏闽[2] 叶妮[1] 赵璟[1] 王元钊[1] 

机构地区：[1]江苏省南京市中西医结合医院肛肠科,210014 [2]南京市中医院全国肛肠医疗中心

出　　处：《中国全科医学》2012年第30期3538-3540,共3页Chinese General Practice

基　　金：江苏省中医药局科技基金资助项目(LZ09088);南京市医学科技发展基金重点资助项目(ZKX09038)

摘　　要：目的探讨个体化饮食健康管理方案对炎症性肠病(IBD)伴口腔溃疡患者的临床疗效。方法选择2009年1月—2012年2月我院收治的门诊及住院IBD伴口腔溃疡患者48例为病例组,同期我院健康体检正常者25例为健康体检组,采用酶联免疫吸附试验进行食物不耐受(FI)血清特异性IgG抗体检测,将不耐受的食物分为忌食、轮替食用和安全食用。根据检测结果将39例IBD伴口腔溃疡阳性患者随机分为试验组20例,实施个体化饮食健康管理方案+IBD常规治疗;对照组19例,仅给予IBD常规治疗。两组疗程均为3个月,观察两组患者口腔溃疡改善及复发情况,通过门诊或电话进行随访。结果健康体检组FI血清特异性IgG抗体阳性率为12.00%(3/25),病例组为81.25%(39/48),差异有统计学意义(χ2=12.37,P<0.05)。前6位不耐受的食物依次为蛋黄蛋白(33.33%)、蟹(18.75%)、虾(16.67%)、牛奶(14.58%)、鳕鱼(10.42%)、大豆(10.42%)。对照组患者均完成随访,试验组完成个体化饮食健康管理方案者18例,1例因病情加重而退出,1例失访。对照组有效率为5.26%(1/19),试验组有效率为77.78%(14/18),差异有统计学意义(χ2=25.37,P<0.05)。对照组3个月内口腔溃疡无复发者1例、复发2次者11例、复发2次以上者7例;试验组无复发14例、复发1次者3例、复发2次者1例,差异有统计学意义(χ2=29.72,P<0.05)。结论 IBD伴口腔溃疡患者FI血清特异性IgG抗体阳性率较高,个体化饮食健康管理可有效缓解IBD伴口腔溃疡患者的口腔溃疡症状,降低其复发率,有利于IBD的治疗。Objective To observe the therapeutic efficacy of an individualized dietary management plan for oral ulcer in patients with inflammatory bowel disease （IBD）. Methods Totally 48 IBD patients with oral ulcer as its main clinical manifestation from January 2009 to February 2012 were enrolled as the case group and 25 healthy subjects served as the healthy group. We semi -quantitatively measured the specific serum IgG antibody to 14 food allergens with enzyme linked immunosorbent assay （ELISA）. Based on the ELISA resuhs, 39 patients with positive food specific IgG antibodies were randomly divided into treatment group （ n = 20, provided with individualized dietary management plan ＋ basic treatment for IBD） and control group （ n ： 19, provided with the conventional treatment for IBD alone）. The duration of intervention was three months. The clinical outcomes were followed up via clinic visits and telephone. Results The positive rate of food specific IgG antibody was 12. 00% in the healthy group and 81.25% in the case group （ X2 = 12. 37, P 〈0. 05）. Of these 14 foods, the top six intolerable foods were egg （white/yolk）, crab, shrimp, milk, and cod. All the patients in the control group completed the follow -up; in the intervention group, 18 completed their individualized dietary management plan, one withdrew due to the worsened disease condition, and one lost to the follow - up. After 3 months of treatment, the total effective rate was significantly higher in the intervention group than in the control group （77.78% vs. 5.26% ; P 〈0.05 ）. Conclusion The individualized dietary management plan can remarkably improve the clinical outcomes of the oral ulcer in IBD patients.

关 键 词：结肠炎 溃疡性 CROHN病 口腔溃疡 食物不耐受 健康计划 

分 类 号：R574.62[医药卫生—消化系统] R781.51[医药卫生—内科学]