肠外营养联合ω-3鱼油脂肪乳对活动性梗阻型克罗恩病病人诱导缓解的治疗作用  

The effects of induction remission of omega-3 polyunsaturated fatty acid in combination with parenteral nutrition for active Crohn's disease with bowel obstruction

作　　者：张伟[1] 汪志明[1] 朱维铭[1] 苏化[1] 左芦根[1] 李宁[1] 黎介寿[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》2014年第2期65-68,共4页Parenteral & Enteral Nutrition

基　　金：国家卫生行业科研专项基金资助(201002020)

摘　　要：目的:通过对肠外营养(PN)联合ω-3鱼油脂肪乳(ω-3 PUFA)或糖皮质激素(GCS)的应用,探讨ω-3PUFA对活动性梗阻型克罗恩病(CD)病人诱导缓解的治疗作用。方法:选取我科收治的69例活动性梗阻型CD病人,根据PN联合应用GCS或ω-3 PUFA分为对照组(GCS组,n=44)和研究组(ω-3 PUFA组,n=25)。采用基于倾向性积分的Cox多元回归模型,分析病人诱导缓解治疗和耐受全肠内营养(TEN)的效果。结果:所有病人均存在不同程度的营养不良。GCS组治疗的中位时间为17 d,诱导缓解成功37例(84%);ω-3 PUFA组治疗的中位时间为16 d,诱导缓解成功22例(88%)。GCS组有3例发生感染,而ω-3 PUFA组未见明显感染病人。多元回归分析显示,两组病人诱导缓解的时间无显著性差异(P>0.05)。ω-3 PUFA组病人耐受TEN的时间显著少于GCS组。结论:PN联合ω-3 PUFA对活动性梗阻型CD病人有良好的诱导缓解治疗作用,尤其适用于有潜在感染风险的病人。Objective： Compared with glucocorticoids （GCS） treatment, the retrospective study was intended to investigate the effects of induction remission of omega-3 polyunsaturated fatty acid （ to-3 PUFA） in combination with parenteral nutrition （PN） for active Crohn＇s disease （CD） with bowel ob- struction. Methods： During PN, six-nine patients were divided into control group （GCS, n = 44） and experimental group （ to-3 PUFA, n = 25）. The achievement time of induction remission and total enteral nutrition （TEN） were evaluated by a propensity score-based Cox multivariate analysis. Results： All patients presented with malnutrition in different degrees, and no death was observed. In GCS group, the median treatment time was 17 days and 37/44 （84%） patients achieved remission. In to-3 PUFA group, the median treatment time was 16 days and 22/25 （88%） patients achieved remission. Three patients manifested with infection （ abdominal infection in 2, urinary infection in 1 ） in GCS group, and no symp- toms of infection were observed in to-3 PUFA group. By a propensity score-based Cox multivariate analy- sis, there was no statistical difference of the remission time between GCS and ω-3 PUFA group. The achievement time of TEN in 00-3 PUFA group was significantly shorter than that of GCS group （ P = 0.02,HR = 3.55, 95 % CI ： 1.28 - 9.82）. Conclusion ： For active CD with bowel obstruction, the effects of oJ-3 PUFA are no less than that of GCS during PN. This therapeutic strategy has a good clinical value, which is effective and safe, especially for patients with potential risk of infection.

关 键 词：克罗恩病 Ω-3鱼油脂肪乳 肠外营养 诱导缓解 

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