Shafran Ira, Burgunder Patricia, Wei David, Young Hayley E, Klein Gerald, Burnett Bruce P
University of Central Florida Medical School, Orlando, FL, USA.
Shafran Gastroenterology Center, Winter Park, FL, USA.
Therap Adv Gastroenterol. 2015 Nov;8(6):331-9. doi: 10.1177/1756283X15593693.
The clinical effect of oral serum-derived bovine immunoglobulin/protein isolate (SBI) on symptom and disease management in patients with inflammatory bowel disease (IBD) is reported in this retrospective case series.
A single-center, retrospective chart review of IBD patients [N = 45; Crohn's disease (CD), n = 38 and ulcerative colitis (UC), n = 7] with limited to no response to traditional pharmaceutical therapies in controlling symptoms was performed after providing SBI (5 g/day) for nutritional support. Patients were contacted at least monthly to assess response to SBI for symptom management measured by a Likert scale (0 = none; 1 = minimal; 2 = moderate; 3 = significant; 4 = complete). Analysis of variance (ANOVA) was performed on response to therapy based on patient characteristics (age, gender, race) and IBD diagnosis. A multivariate ordered logistical regression model was performed to determine the odds ratio in overall disease management between week 1 and week 12. Finally, the overall group response and percent improvement to SBI was determined over 12 weeks.
The odds ratio from the regression model demonstrated that IBD patients were 2.8 times more likely to report clinical improvement in symptom scores with the addition of SBI to their therapeutic regimens [95% confidence interval (CI) 1.266-6.016, p = 0.011]. Disease management was not significantly associated with age, gender, race or disease state. The percentage of patients reporting a response to SBI therapy at week 1 was 49% which increased to 76% after 12 weeks with the fraction of responders gaining significant symptom improvement doubling during the same time period (9% versus 20%). Overall, this group of IBD patients showed increased, steady response to SBI therapy between week 1 and 12 with no reported side effects.
These results suggest that SBI improves clinical management of IBD patients who are not fully managed on traditional therapies. SBI should be considered for the nutritional support of IBD regardless of disease activity, location, phenotype, duration, or complexity.
本回顾性病例系列报告了口服血清来源的牛免疫球蛋白/蛋白分离物(SBI)对炎症性肠病(IBD)患者症状和疾病管理的临床效果。
对45例IBD患者[克罗恩病(CD)38例,溃疡性结肠炎(UC)7例]进行单中心回顾性病历审查,这些患者对传统药物治疗控制症状的反应有限或无反应,给予SBI(5克/天)进行营养支持。每月至少与患者联系一次,以通过李克特量表(0 = 无;1 = 轻微;2 = 中度;3 = 显著;4 = 完全)评估对SBI症状管理的反应。基于患者特征(年龄、性别、种族)和IBD诊断对治疗反应进行方差分析(ANOVA)。进行多变量有序逻辑回归模型以确定第1周和第12周之间总体疾病管理的优势比。最后,确定12周内对SBI的总体组反应和改善百分比。
回归模型的优势比表明,IBD患者在治疗方案中添加SBI后,症状评分临床改善的可能性高出2.8倍[95%置信区间(CI)1.266 - 6.016,p = 0.011]。疾病管理与年龄、性别、种族或疾病状态无显著关联。第1周报告对SBI治疗有反应的患者百分比为49%,12周后增至76%,在此期间有显著症状改善的反应者比例翻倍(9%对20%)。总体而言,这组IBD患者在第1周和第12周之间对SBI治疗的反应增加且稳定,未报告副作用。
这些结果表明,SBI改善了在传统疗法下未得到充分管理的IBD患者的临床管理。无论疾病活动度、部位、表型、持续时间或复杂性如何,IBD患者的营养支持均应考虑使用SBI。