改性克罗恩病排除饮食在儿科克罗恩病中保持缓解:随机对照试验
Rotem Sigall Boneh1, Víctor Manuel Navas-López2, Séamus Hussey3
1Pediatric Gastroenterology and Nutrition Unit, E. Wolfson Medical Center, Holon, Israel; Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, Amsterdam, the Netherlands.
部分肠道营养 (PEN) 的克罗恩病排除饮食 (CDED) 有效诱导克罗恩病 (CD) 的缓解. 这种饮食方法在维持缓解期长达24周方面表现有前途,BMI Z-分数得到改善.
科学领域:
- 胃肠病学 胃肠病学
- 临床营养学 临床营养学
- 炎症性肠道疾病研究研究
背景情况:
- 克罗恩病排除饮食 (CDED) 与部分肠道营养 (PEN) 结合,已被认为可以在轻度至中度克罗恩病 (CD) 中诱导缓解.
- 与长期EEN疗法相比,研究短暂的排他性肠道营养 (EEN) 疗程后的CDED+PEN疗程的疗效对于管理CD至关重要.
研究的目的:
- 为了确定2周EEN之后CDED+PEN是否优于8周EEN在维持14周的轻度至重度CD的临床缓解方面.
- 评估CDED+PEN在24周内维持缓解的能力.
主要方法:
- 一个国际性的多中心随机对照试验比较了两个组:一组接受2周的EEN,然后是CDED+PEN,另一组接受8周的EEN,然后是PEN和免费饮食.
- 这项研究旨在招募64名患者,但由于COVID-19大流行,该研究没有足够的动力,最终有56名患者被随机选择 (30名为CDED,26名为EEN).
主要成果:
- 对于初级终点,在第14周没有观察到任何显著差异; 70%的CDED组中维持了无皮质类固醇缓解,而 EEN组的61.5% (P = .5).
- 在第8周的临床缓解在CDED组 (77%) 与EEN组 (54%) 相比较高 (P = .07).
- 在CDED组的60%人中,缓解持续到第24周,而在EEN组的42%人中,缓解持续到第24周 (P = .18). 与EEN组不同的是,CDED组显示身体质量指数Z-score的显著改善.
结论:
- 这项研究不足以最终证明CDED在维持缓解方面优于EEN.
- 尽管如此,开始缓解2周EEN之后CDED被证明是有效的,大多数患者保持缓解长达24周.
- 值得注意的是,CDED组在BMI Z-score中经历了显著的改善,尽管饮食限制,这表明营养益处超出了缓解维护.
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