肠内营养联合英夫利昔单抗治疗成人克罗恩病的随机对照研究  

Enteral nutrition combined with infliximab in treatment of adult Crohn’s disease: a randomized controlled trial

作　　者：施嫣红[1] 汤茂春[1] 王俊珊[1] 孙明明 翁韵[1] 刘占举[1] SHI Yan-hong;TANG Mao-chun;WANG Jun-shan;SUN Ming-ming;WENG Yun;LIU Zhan-jiu(Dept.of Gastroenterology,Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院消化内科

出　　处：《同济大学学报（医学版）》2020年第1期51-56,共6页Journal of Tongji University(Medical Science)

基　　金：上海市卫生和计划生育委员会资助项目(201640159);北京医卫健康公益基金项目(YWJKJJHKYJJ-A712)

摘　　要：目的观察肠内营养联合英夫利昔单抗治疗克罗恩病(Crohn’s disease, CD)患者的临床疗效。方法 89例CD患者随机分为观察组(45例)、对照组(44例)。对照组给予英夫利昔单抗5mg/kg静脉滴注(第0、2、6周);观察组给予英夫利昔单抗及口服肠内营养粉剂3~4次/d(能量3227.5~4303.7kJ),总疗程为12周,观察两组治疗前后的疾病活动指数、炎症指数、营养状况、生活质量评分、临床疗效及不良反应等。结果治疗12周后,观察组及对照组的CD活动指数均较治疗前明显降低(P<0.05),且观察组活动指数显著低于对照组(P<0.05);两组患者治疗后的C反应蛋白、红细胞沉降率均明显低于治疗前,但观察组炎症相关指数改善程度高于对照组(P<0.05)。经治疗后观察组提高了患者的生存质量及体质量指数(P<0.05),且白蛋白、前白蛋白及血红蛋白均明显改善(P<0.05),观察组体质量、体脂肪量及体肌肉量也明显增加(P<0.05)。观察组总有效率为88.2%,显著高于对照组的63.6%(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论肠内营养联合英夫利昔单抗治疗CD可有效改善患者的临床疗效,预防和治疗CD相关的营养不良,是较安全的首选治疗方式。Objective To evaluate the therapeutic effects of Enteral nutrition combined with infliximab in treatment of patients with Crohn’s disease(CD). Methods Eighty-nine patients with CD were randomized to two groups: patients in control group(n=44) were treated with intravenous infliximab with a dose of 5 mg/kg at 0,2,6 week;patients in trial group(n=45) were treated with intravenous infliximab as previously described and partial enteral nutrition(oral enteral nutrition powder 55.8 g, 3-4 times per day, 3227.5-4303.7 kJ). Crohn disease activity index(CDAI), inflammation index, nutritional status, inflammatory bowel disease questionnaire of quality of life(IBDQ), clinical efficacy and adverse reactions of patients in two groups were compared after 12 weeks. Results After treatment for 12 weeks, CDAI of two groups were lower than those before therapy(P<0.05), but CDAI in trial group decreased more markedly than that in control group(P<0.05). The CRP and ESR of two groups were lower than those before therapy(P<0.05), but the inflammatory index in trial group were improved more predominantly. In trial group the IBDQ and BMI were improved(P<0.05);the albumin, prealbumin and hemoglobin levels were significantly increased(P<0.05);body weight, body fat and muscle mass were also increased significantly(P<0.05) after treatment. The effective rate of trial group was 88.2%, which was significantly higher than that of the control group(63.6%)(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Enteral nutrition combined with infliximab in treatment of Crohn’s disease can effectively improve the therapeutic efficacy, prevent and treat CD-related malnutrition.

关 键 词：克罗恩病 营养不良 英夫利昔 肠内营养 疗效 

分 类 号：R574.62[医药卫生—消化系统]