Yamamoto Takayuki, Nakahigashi Maki, Saniabadi Abbi R, Iwata Takashi, Maruyama Yasuki, Umegae Satoru, Matsumoto Koichi
Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan.
Inflamm Bowel Dis. 2007 Dec;13(12):1493-501. doi: 10.1002/ibd.20238.
Long-term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn's disease (CD). The aim of this prospective study was to investigate the impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD.
Forty patients with CD who achieved clinical remission were included. Of these, 20 received continuous elemental diet (Elental) infusion during the nighttime and a low-fat diet during the daytime (EN group) and 20 received neither nutritional therapy nor food restriction (non-EN group). With these regimens, all 40 patients were monitored for 1 year. Further, ileocolonoscopy was performed at entry, at 6 and 12 months, and mucosal biopsies were taken for cytokine assays.
On an intention-to-treat basis, 5 patients (25%) in the EN group and 13 (65%) in the non-EN group had a clinical relapse during the 1-year observation (P = 0.03). The mean endoscopic inflammation (EI) scores were not significantly different between the groups at both entry and 6 months, but at 12 months EI scores were significantly higher in the non-EN group than in the EN group (P = 0.04). Additionally, the mucosal tissue interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha levels significantly increased with time in the non-EN group (entry versus 12 months, IL-1beta, P = 0.02; IL-6, P = 0.002; TNF-alpha, P = 0.001). In the EN group these cytokines did not show a significant increase.
Long-term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels.
长期肠内营养可能维持克罗恩病（CD）患者的临床和内镜缓解。这项前瞻性研究的目的是调查长期肠内营养对静止期CD患者的临床和内镜疾病活动以及黏膜组织细胞因子的影响。
纳入40例达到临床缓解的CD患者。其中，20例患者在夜间接受连续要素饮食（能全力）输注，白天接受低脂饮食（肠内营养组），另外20例患者既未接受营养治疗也未进行饮食限制（非肠内营养组）。采用这些方案，对所有40例患者进行1年的监测。此外，在入组时、6个月和12个月时进行回结肠镜检查，并取黏膜活检进行细胞因子检测。
在意向性治疗分析中，肠内营养组有5例患者（25%）、非肠内营养组有13例患者（65%）在1年观察期内出现临床复发（P = 0.03）。两组在入组时和6个月时的平均内镜炎症（EI）评分无显著差异，但在12个月时，非肠内营养组的EI评分显著高于肠内营养组（P = 0.04）。此外，非肠内营养组黏膜组织白细胞介素（IL）-1β、IL-6和肿瘤坏死因子（TNF）-α水平随时间显著升高（入组时与12个月时比较，IL-1β，P = 0.02；IL-6，P = 0.002；TNF-α，P = 0.001）。在肠内营养组，这些细胞因子未显示出显著升高。
静止期CD患者长期肠内营养对临床和内镜疾病活动以及黏膜炎症细胞因子水平有明显的抑制作用。
