Department of Internal Medicine, Martinique University Hospital, Martinique, France; EpiCliV Research Unit, University of the French West Indies, Fort-de-France, Martinique, France.
Department of Internal Medicine and Multi-Organic Diseases, Montpellier University Hospital, Montpellier, France.
Nutrition. 2023 Jun;110:112009. doi: 10.1016/j.nut.2023.112009. Epub 2023 Feb 23.
The aim of this study was to compare safety and efficacy of long-term home parenteral nutrition between patients with systemic sclerosis and intestinal failure (IF) and controls with IF from another etiology.
A retrospective study was conducted in a referral center for systemic sclerosis (SSc) in Montpellier, France. Patients followed between 1985 and 2020 with SSc-related IF were included and compared with control patients with IF from another etiology. The patients included had to be treated for ≥4 wk by home parenteral nutrition (HPN). Primary outcome was occurrence of HPN-related complications. Secondary outcomes included duration of parenteral nutrition, body mass index at 12 mo, and survival.
Cumulative duration of HPN was 23 397 catheter days. HPN resulted in body mass index increase in both groups. There was no statistical difference regarding catheter-related bloodstream infections and thrombosis between the groups, despite use of immunosuppressive drugs and autologous hematopoietic stem cell transplantation in patients with SSc. However, the patients with SSc had significantly more HPN-related cardiac overload than the controls (P < 0.0001). Overloads occurred in SSc patients with and without cardiac disease, arguing for comprehensive hemodynamic screening in this condition.
Long-term HPN in SSc-related IF is feasible but unveils occult cardiac disease.
本研究旨在比较系统性硬化症（SSc）伴肠衰竭（IF）患者与其他病因 IF 对照患者长期家庭肠外营养（HPN）的安全性和疗效。
本研究是在法国蒙彼利埃 SSc 转诊中心进行的回顾性研究。纳入了 1985 年至 2020 年间接受 SSc 相关 IF 治疗且接受 HPN 治疗≥4 周的患者，并与其他病因 IF 对照患者进行比较。纳入的患者必须接受 HPN 治疗至少 12 个月。主要结局为 HPN 相关并发症的发生情况。次要结局包括肠外营养持续时间、12 个月时的体重指数和生存率。
HPN 的累积导管使用时间为 23397 天。两组患者的体重指数均有所增加。尽管 SSc 患者使用了免疫抑制药物和自体造血干细胞移植，但两组患者在导管相关血流感染和血栓形成方面无统计学差异。然而，与对照组相比，SSc 患者的 HPN 相关心脏负荷过重明显更多（P<0.0001）。SSc 患者无论是否存在心脏病，均发生 HPN 相关心脏负荷过重，这表明在这种情况下需要进行全面的血流动力学筛查。
SSc 相关 IF 患者长期 HPN 是可行的，但会暴露出隐匿性心脏病。
