肠内营养在克罗恩病术后并发结核感染治疗中的应用  

The therapeutic effect of enteral nutrition for patients with postoperative tuberculosis in Crohn's disease

作　　者：苏化[1] 张伟[1] 曹磊[1] 朱维铭[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2013年第6期328-331,共4页Parenteral & Enteral Nutrition

基　　金：卫生行业科研专项基金资助(201002020)

摘　　要：目的:回顾性分析9例克罗恩病(CD)术后并发结核杆菌感染病人的临床资料,以探讨其临床特点、诊断和治疗方案。方法:病人术前均有较长时间的激素、硫唑嘌呤(AZA)和英夫利西(IFX)治疗史,术后使用AZA和IFX维持治疗。明确结核杆菌感染后,停用AZA和IFX,改用肠内营养(EN)维持CD缓解,同时进行正规的抗结核治疗。结果:9例病人均为肺结核,表现为不明原因的发热,主要通过结核酶联免疫斑点试验(T-SPOT.TB)、痰结核杆菌PCR检测和影像学检查明确诊断。经抗结核治疗后,肺结核均得以治愈,药物不良反应发生率为22.2%。在抗结核治疗期间,CD内镜复发率为22.2%,无临床复发,经全肠内营养(TEN)治疗后,内镜下Rutgeerts评分得到明显改善。并发结核杆菌感染后,9例病人的红细胞沉降率(ESR)明显升高,CD活动指数(CDAI)和C-反应蛋白(CRP)稍有升高。结论:CD病人在术后维持治疗过程中,出现不明原因的发热、ESR明显升高,但CDAI和CRP无明显增高,须考虑有结核杆菌感染的可能。诊断明确后,停用AZA和IFX,改用EN维持CD缓解,同时进行抗结核治疗。Objective： To analyze clinical data of nine patients suffering from tuberculosis infection during postoperative management of Crohn′s disease （CD）. Methods：All patients were treated with glueocorticoids （GCS）, azathioprine （AZA） ,and infliximab （IFX） for a long time before operation and were administrated with AZA and IFX for maintenance therapy after operation. Once tuberculosis infection was diagnosed, AZA and IFX were drawn off, and enteral nutrition （EN） was given for maintenance therapy. Meanwhile, standard antitubercular drugs were administrated for tuberculosis infection. Results： Nine patients were pulmonary tuberculosis （FF）. By antitubercular therapy, all patients with PT cured, and the incidence of side effects of drugs was 22.2 percent. During antitubercular therapy,endoscopic recurrence rate of CD was 22.2 percent and there was no clinical recurrence. By exclusive enteral nutrition （EEN） therapy, Rutgeerts scores were decreased obviously. Conclusion ： During the maintenance therapy of CD, we should have doubt about tuberculosis infection, especially PT. Once tuberculosis infection was confirmed, AZA and IFX should be drawn off and EN should be given for maintenance therapy of CD, and antitubercular drugs were administrated.

关 键 词：克罗恩病 复发 结核杆菌感染 肺结核 肠内营养 维持治疗 

分 类 号：R574.62[医药卫生—消化系统] R459.3[医药卫生—内科学]