Tang Wenjuan, Hu Wenhui, Shi Peng, Ye Ziqing, Wu Jie, Zhang Ye, Wang Yuhuan, Huang Ying
Department of Gastroenterology, Pediatric Inflammatory Bowel Disease Research Center, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Medical Statistics Department, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Front Pediatr. 2022 May 18;10:874425. doi: 10.3389/fped.2022.874425. eCollection 2022.
To explore the predictors of mucosal healing (MH) for short- and long-term after exclusive enteral nutrition (EEN) in pediatric Crohn's disease (CD) patients.
A retrospective analysis was performed for newly diagnosed active CD patients admitted to our center from January 2017 to 30 December 2020, who were treated with EEN for induction therapy with a minimum of 12 months of follow-up post-EEN. According to the simple endoscopic score for CD (SES-CD), at 1-year post-EEN, 17 patients with an SES-CD < 3 were classified into the sustained MH group (sMH), and 33 patients with an SES-CD ≥ 3 were classified into the sustained non-MH group (sNMH). Statistical methods were used to compare the differences between the two groups and explore the predictors of MH at the end of EEN and 1-year post-EEN.
The SES-CD in the sMH group was lower than that in the sNMH group both at baseline and the end of EEN [sMH vs. sNMH: 8.7 ± 1.2 vs. 16.2 ± 1.0, respectively, < 0.001 at baseline; 1.0 (3.5) vs. 4.0 (2.0), respectively, < 0.01 at the end of EEN]. The weighted Pediatric Crohn's Disease Activity Index and erythrocyte sedimentation rate in the sMH group were lower than those in the sNMH group at baseline (both < 0.05), but showed no difference at the end of EEN. From baseline to 1-year post-EEN, compared with patients in the sNMH group, there were more patients classified with L1 in the sMH group at each time point (all < 0.001) and fewer patients classified with L3 in the sMH group at baseline and 1-year post-EEN. After EEN, fewer patients received infliximab and had a longer exposure time to infliximab in the sMH group than in the sNMH group. Only the SES-CD at baseline was negatively associated with MH at the end of EEN (OR = 1.40 95% CI = 1.12-1.67, = 0.00) and 1-year post-EEN (OR = 1.33, 95% CI = 1.12-1.58, = 0.001), and the cut off value was 11.5.
The SES-CD could predict both short- and long-term MH for EEN. Patients with an SES-CD < 11.5 had a high probability of reaching MH by EEN-inducing therapy and maintaining sustained MH at 1-year post-EEN. Patients with an SES-CD greater than 11.5 at baseline should be treated more aggressively with biologics.
探讨儿童克罗恩病（CD）患者在接受全肠内营养（EEN）后短期和长期黏膜愈合（MH）的预测因素。
对2017年1月至2020年12月30日入住本中心的新诊断活动性CD患者进行回顾性分析，这些患者接受EEN诱导治疗，EEN后至少随访12个月。根据CD的简单内镜评分（SES-CD），在EEN后1年，SES-CD<3的17例患者被分为持续黏膜愈合组（sMH），SES-CD≥3的33例患者被分为持续非黏膜愈合组（sNMH）。采用统计学方法比较两组之间的差异，并探讨EEN结束时和EEN后1年MH的预测因素。
sMH组的SES-CD在基线和EEN结束时均低于sNMH组[sMH组与sNMH组：基线时分别为8.7±1.2和16.2±1.0，< 0.001；EEN结束时分别为1.0（3.5）和4.0（2.0），< 0.01]。sMH组的加权儿童克罗恩病活动指数和红细胞沉降率在基线时低于sNMH组（均< 0.05），但在EEN结束时无差异。从基线到EEN后1年，与sNMH组患者相比，sMH组在每个时间点L1分类的患者更多（均< 0.001），且sMH组在基线和EEN后1年L3分类的患者更少。EEN后，sMH组接受英夫利昔单抗治疗的患者更少，且英夫利昔单抗的暴露时间比sNMH组更长。仅基线时的SES-CD与EEN结束时（OR = 1.40，95%CI = 1.12 - 1.67，= 0.00）和EEN后1年（OR = 1.33，95%CI = 1.12 - 1.58，= 0.001）时的MH呈负相关，截断值为11.5。
SES-CD可预测EEN的短期和长期MH。SES-CD<11.5的患者通过EEN诱导治疗达到MH并在EEN后1年维持持续MH的可能性很高。基线时SES-CD大于11.5的患者应更积极地接受生物制剂治疗。
