Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, T6G 2J3, Canada.
Dig Dis Sci. 2013 Dec;58(12):3584-91. doi: 10.1007/s10620-013-2855-y. Epub 2013 Sep 12.
The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn's disease (CD) is reported to be equivalent to that of corticosteroids (CS).
Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD).
Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children's hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn's disease activity index.
To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9% in the EEN group versus 91.3% in the CS group (p=0.73) at 3 months) and relapse (40.6 vs. 28.6%, respectively (p=0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p=0.28).
EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.
据报道，在诱导小儿克罗恩病（CD）缓解方面，肠内营养（EEN）的疗效与皮质类固醇（CS）相当。
我们的目的是比较 EEN 和 CS 在诱导小儿 CD 缓解方面的疗效，以及治疗对营养状况和骨密度（BMD）的影响。
回顾性研究了 2000 年至 2010 年在阿尔伯塔省埃德蒙顿的斯特罗利儿童医院诊断为 CD 的患者的病历。收集人体测量学和双能 X 线吸收法（DXA）数据，以评估治疗效果；根据小儿克罗恩病活动指数定义临床缓解、复发和严重程度。
为了在首次就诊时诱导缓解，36 名患者（平均年龄 12.9 岁）接受 EEN 治疗，69 名患者（平均年龄 11.2 岁）接受 CS 治疗。3 个月时，EEN 组的缓解率为 88.9%，CS 组为 91.3%（p=0.73），12 个月时的复发率分别为 40.6%和 28.6%（p=0.12）。两组治疗效果相似。34 名患者在诊断时和一年后进行了配对的 DXA 扫描：16 名接受 EEN 治疗，18 名接受 CS 治疗。根据身高和实际年龄校正骨龄的脊柱 BMD z 评分变化，EEN 组更大，但无统计学意义（Δz 评分 0.30 对 0.03，p=0.28）。
EEN 与 CS 具有相似的疗效；然而，EEN 可能会导致更好的 BMD 积累。EEN 应作为小儿 CD 诱导缓解的一线治疗药物，优于 CS。
