Sumi Ryoko, Nakajima Kiyokazu, Iijima Hideki, Wasa Masafumi, Shinzaki Shinichiro, Nezu Riichiro, Inoue Yoshifumi, Ito Toshinori
Division of Nutrition and Medical Engineering, Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan.
Department of Integrative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Surg Today. 2016 Aug;46(8):922-9. doi: 10.1007/s00595-015-1257-5. Epub 2015 Oct 5.
Crohn's disease (CD) is a refractory inflammatory bowel disease of unknown etiology, frequently complicated by malnutrition. It is thought that the delayed wound healing associated with this malnutrition in CD patients might adversely affect the therapeutic benefits of infliximab (IFX). Therefore, we investigated the effects of nutritional status on IFX treatment.
We assessed nutritional status and CD activity when IFX therapy was initiated and following the third dose, 6 weeks later. Nutritional status was assessed using the body mass index (BMI) and nutritional risk index (NRI), whereas CD activity was assessed using the CD activity index (CDAI).
All patients with a BMI ≥ 18.5 kg/m(2) at the time of IFX therapy met the effective criteria for the CDAI, and IFX treatment was considered responsive in these patients. Furthermore, IFX treatment was responsive, with a high level of effectiveness, in all five subjects (31.3 %) with NRI scores of 97.5 and above with no risk of malnutrition (p = 0.037).
Our results suggest that nutritional status does influence the therapeutic effect of IFX in CD patients. The response rate to IFX treatment thus could be improved by optimizing the nutritional status. We recommend comprehensive nutritional assessment and intervention prior to IFX treatment schedules.
克罗恩病（CD）是一种病因不明的难治性炎症性肠病，常伴有营养不良。据认为，CD患者中与这种营养不良相关的伤口愈合延迟可能会对英夫利昔单抗（IFX）的治疗效果产生不利影响。因此，我们研究了营养状况对IFX治疗的影响。
我们在开始IFX治疗时以及6周后第三次给药后评估营养状况和CD活动度。使用体重指数（BMI）和营养风险指数（NRI）评估营养状况，而使用CD活动指数（CDAI）评估CD活动度。
在IFX治疗时BMI≥18.5 kg/m²的所有患者均达到CDAI的有效标准，并且这些患者的IFX治疗被认为有反应。此外，在所有5名（31.3%）NRI评分在97.5及以上且无营养不良风险的受试者中，IFX治疗有反应，且有效性较高（p = 0.037）。
我们的结果表明，营养状况确实会影响IFX对CD患者的治疗效果。因此，通过优化营养状况可以提高IFX治疗的反应率。我们建议在IFX治疗方案之前进行全面的营养评估和干预。
