Frivolt K, Schwerd T, Werkstetter K J, Schwarzer A, Schatz S B, Bufler P, Koletzko S
Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany; 2nd Department of Pediatrics, Comenius University Medical School, Bratislava, Slovakia.
Aliment Pharmacol Ther. 2014 Jun;39(12):1398-407. doi: 10.1111/apt.12770. Epub 2014 Apr 30.
Exclusive enteral nutrition (EEN) induces remission and mucosal healing in children with active Crohn's disease (CD).
To compare short- and long-term outcomes of the first vs. second courses of EEN, and to identify predictors of sustained remission.
Retrospective single centre analysis of all patients with CD (6-18 years) treated with EEN over 7.5 years. Patients were excluded if exposed to anti-TNFα or corticosteroids 3 months prior to EEN. Data included disease phenotype, activity, NOD2 genotype, laboratory indices and anthropometrics. Remission and relapse were defined by mathematically weighted Paediatric Crohn's Disease Activity Index (wPCDAI) with 1-year follow-up.
Of 94 patients treated with EEN, 52 fulfilled inclusion criteria (31 male, mean age 13.2 years). Azathioprine was started within the first month in 33/52 patients; 26/52 received a second EEN course. First compared to second EEN revealed higher wPCDAI at start (59 vs. 40, P < 0.0001), tended to higher remission rates after 3 months (92% vs. 77%, n.s.), but showed comparable 1-year relapse rates (67% vs. 70%, median time 231 vs. 145 days, n.s.). Disease activity, weight gain and inflammatory markers showed better improvement with first EEN. Faecal calprotectin >200 μg/g during EEN was associated with shorter remission (median time 157 vs. 287 days, n.s.). Certain NOD2 genotypes were related to higher relapse rates (92% R702W or G908R vs. 50% 1007fs vs. 60% wild-type, P < 0.01).
Exclusive enteral nutrition induces remission in active Crohn's disease, but efficacy tends to decrease with the second course. Despite early azathioprine use, 1-year relapse rates are high, but may be related to NOD2 genotype.
全肠内营养（EEN）可诱导活动期克罗恩病（CD）患儿病情缓解并实现黏膜愈合。
比较EEN首个疗程与第二个疗程的短期和长期结局，并确定持续缓解的预测因素。
对7.5年间接受EEN治疗的所有CD（6 - 18岁）患者进行回顾性单中心分析。如果患者在EEN治疗前3个月内使用过抗TNFα或皮质类固醇，则将其排除。数据包括疾病表型、活动度、NOD2基因型、实验室指标和人体测量学数据。通过数学加权的儿童克罗恩病活动指数（wPCDAI）定义缓解和复发情况，并进行1年的随访。
在94例接受EEN治疗的患者中，52例符合纳入标准（31例男性，平均年龄13.2岁）。33/52例患者在第一个月内开始使用硫唑嘌呤；26/52例接受了第二个EEN疗程。与第二个EEN疗程相比，首个疗程开始时的wPCDAI更高（59对40，P < 0.0001），3个月后的缓解率有升高趋势（92%对77%，无统计学差异），但1年复发率相当（67%对70%，中位时间231天对145天，无统计学差异）。疾病活动度、体重增加和炎症标志物在首个EEN疗程中改善更明显。EEN期间粪便钙卫蛋白>200μg/g与缓解期缩短有关（中位时间157天对287天，无统计学差异）。某些NOD2基因型与较高的复发率相关（R702W或G908R为92%，1007fs为50%，野生型为60%，P < 0.01）。
全肠内营养可诱导活动期克罗恩病缓解，但第二个疗程的疗效往往会降低。尽管早期使用了硫唑嘌呤，1年复发率仍较高，但可能与NOD2基因型有关。
