Grover Z, Burgess C, Muir R, Reilly C, Lewindon P J
Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, Australia Department of Gastroenterology, Queensland Children Medical Research institute, Brisbane, Australia
Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.
J Crohns Colitis. 2016 Oct;10(10):1159-64. doi: 10.1093/ecco-jcc/jjw075. Epub 2016 Mar 15.
Exclusive Enteral Nutrition (EEN) induction in children with luminal Crohn's disease (CD) gives early mucosal healing (MH), but the long-term benefits of EEN-induced MH are just emerging.
AIMS & METHODS: We prospectively followed an Australian cohort of newly diagnosed children with predominantly luminal CD who completed at least six weeks EEN and with paired clinical Pediatric Crohn's Disease Activity Index (PCDAI), biochemical (C-reactive protein; CRP) and endoscopic assessment at diagnosis and post EEN. All commenced immunomodulators (IMs) early (<3 months from diagnosis) and had a minimum of 1 year follow-up. Complete MH was a simple endoscopic score for Crohn's disease (SES-CD) of 0, and SES-CD≥1 was ascribed to active endoscopic disease (aED) and further divided into near complete MH (SES 1-3), mild active disease (SES-CD 4-10) and moderate to severe disease (SES-CD>10). The primary outcome was long-term supervised sustained remission (SR) on IMs alone without need for corticosteroids, infliximab (IFX) or surgery.
A total of 54 eligible children (33 males) completing EEN induction were analysed. The median duration between pre and post EEN assessments was 60.5 days [interquartile range (IQR), 56-69.5]. Post EEN: clinical remission (PCDAI < 10) was observed in 45/54 (83%), and biochemical remission (PCDAI < 10 and CRP < 5 mg/dl) was observed in 39/54 (72%). Complete MH was observed in 18/54 (33%), near complete in 10/54(19%). SR was superior in those with complete MH vs. aED; 13/18, (72%) vs. 10/36 (28%), p = 0.003 at 1 year, 8/16, (50%) vs. 3/24, (8%), p = 0.008 at 2 years and (8/16, (50%) vs. 1/19, (6%), p = 0.005) at 3 years. Near-complete MH did not lead to superior SR.
Only complete MH post EEN induction predicts more favourable SR for up to 3 years.
对局限性克罗恩病（CD）患儿进行单纯肠内营养（EEN）诱导可实现早期黏膜愈合（MH），但EEN诱导的MH的长期益处刚刚显现。
我们对一组澳大利亚新诊断的以局限性CD为主的患儿进行了前瞻性随访，这些患儿完成了至少六周的EEN治疗，并在诊断时和EEN治疗后进行了配对的临床儿童克罗恩病活动指数（PCDAI）、生化指标（C反应蛋白；CRP）和内镜评估。所有患儿均在早期（诊断后<3个月）开始使用免疫调节剂（IMs），并至少随访1年。完全MH定义为克罗恩病简单内镜评分（SES-CD）为0，SES-CD≥1归因于内镜下活动性疾病（aED），并进一步分为接近完全MH（SES 1-3）、轻度活动性疾病（SES-CD 4-10）和中度至重度疾病（SES-CD>10）。主要结局是仅使用IMs长期维持缓解（SR），无需使用皮质类固醇、英夫利昔单抗（IFX）或手术。
共分析了54名完成EEN诱导的符合条件的儿童（33名男性）。EEN前后评估的中位间隔时间为60.5天[四分位间距（IQR），56-69.5]。EEN治疗后：45/54（83%）观察到临床缓解（PCDAI<10），39/54（约72%）观察到生化缓解（PCDAI<10且CRP<5mg/dl）。18/54（33%）观察到完全MH，10/54（19%）观察到接近完全MH。完全MH组的SR优于aED组；1年时为13/18（72%）对10/36（28%），p=0.003；2年时为8/16（50%）对3/24（8%），p=0.008；3年时为8/16（50%）对1/19（6%），p=0.005。接近完全MH并未带来更好的SR。
EEN诱导后仅完全MH可预测长达3年更有利的SR。
