Service d'hépatogastroentérologie et de Nutrition, Hôpital Universitaire de Rouen, France.
Aliment Pharmacol Ther. 2011 Oct;34(8):931-40. doi: 10.1111/j.1365-2036.2011.04806.x. Epub 2011 Aug 16.
Chronic intestinal failure (CIF) is a very rare Crohn's disease (CD) complication.
To determine incidence of CIF treated with home parenteral nutrition (HPN) in adult CD patients and to isolate factors associated with severe CIF.
This retrospective multicentre study included 38 patients with CD-related CIF treated with HPN for at least 12 months in French HPN centres. Severe CIF was defined by a length of remnant small bowel of less than 100 cm or CIF occurrence within the 15 years following CD diagnosis.
Median delay between CD diagnosis and CIF was 15 years. CIF incidence did not decrease over time (1.4/year before 1995 vs. 2.2/year after). Median number of small bowel resections per patient was three (range 1-8). Median small bowel resection, remnant and initial lengths were 160, 80 and 260 cm, respectively. Twenty-four per cent of patients developed stenosis within 1 year after CD diagnosis and 76% developed perforative complications within 2 years. In multivariate analysis, severe CIF, defined as CIF onset <15 years after CD diagnosis, was associated with a more recent CD diagnosis (odds ratio, 0.785; 95% confidence interval, 0.623-0.989). CIF occurred despite frequent use of immunosuppressants. Course of CD remained severe during HPN: immunosuppressants prescription occurred in 11 patients, surgery in six. Six patients died from CD (n = 2), HPN complications (n = 2) or other causes (n = 2).
Chronic intestinal failure requiring HPN is rare during CD. Incidence remained stable over time. Surgical procedures play a minor role in the occurrence of severe chronic intestinal failure compared to CD severity.
慢性肠道衰竭（CIF）是一种非常罕见的克罗恩病（CD）并发症。
确定接受家庭肠外营养（HPN）治疗的成人 CD 患者中 CIF 的发生率，并分离与严重 CIF 相关的因素。
本回顾性多中心研究纳入了 38 例在法国 HPN 中心接受 HPN 治疗至少 12 个月的与 CD 相关的 CIF 患者。严重 CIF 的定义为残留小肠长度小于 100cm 或在 CD 诊断后 15 年内发生 CIF。
CD 诊断与 CIF 之间的中位延迟时间为 15 年。CIF 的发生率并未随时间降低（1995 年之前为 1.4/年，之后为 2.2/年）。每位患者的小肠切除术中位数为 3 次（范围 1-8 次）。小肠切除术、残留和初始长度的中位数分别为 160cm、80cm 和 260cm。24%的患者在 CD 诊断后 1 年内发生狭窄，76%的患者在 2 年内发生穿孔并发症。多变量分析显示，定义为 CD 诊断后 15 年内发生 CIF 的严重 CIF 与更近期的 CD 诊断相关（优势比，0.785；95%置信区间，0.623-0.989）。尽管经常使用免疫抑制剂，但 CIF 仍会发生。在 HPN 期间，CD 的病程仍然严重：11 例患者开具了免疫抑制剂处方，6 例患者进行了手术。6 例患者死于 CD（n=2）、HPN 并发症（n=2）或其他原因（n=2）。
在 CD 期间，需要 HPN 的慢性肠道衰竭是罕见的。发病率随时间保持稳定。与 CD 的严重程度相比，手术在严重慢性肠道衰竭的发生中作用较小。
