Crohn’s Disease Inflammatory Bowel Disease Microbiome Treatment
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摘要

BACKGROUND & AIMS:Exclusive enteral nutrition (EEN) is recommended for children with mild to moderate Crohn's disease (CD), but implementation is challenging. We compared EEN with the CD exclusion diet (CDED), a whole-food diet coupled with partial enteral nutrition (PEN), designed to reduce exposure to dietary components that have adverse effects on the microbiome and intestinal barrier.
METHODS:We performed a 12-week prospective trial of children with mild to moderate CD. The children were randomly assigned to a group that received CDED plus 50% of calories from formula (Modulen, Nestlé) for 6 weeks (stage 1) followed by CDED with 25% PEN from weeks 7 to 12 (stage 2) (n = 40, group 1) or a group that received EEN for 6 weeks followed by a free diet with 25% PEN from weeks 7 to 12 (n = 38, group 2). Patients were evaluated at baseline and weeks 3, 6, and 12 and laboratory tests were performed; 16S ribosomal RNA gene (V4V5) sequencing was performed on stool samples. The primary endpoint was dietary tolerance. Secondary endpoints were intention to treat (ITT) remission at week 6 (pediatric CD activity index score below 10) and corticosteroid-free ITT sustained remission at week 12.
RESULTS:Four patients withdrew from the study because of intolerance by 48 hours, 74 patients (mean age 14.2 ± 2.7 years) were included for remission analysis. The combination of CDED and PEN was tolerated in 39 children (97.5%), whereas EEN was tolerated by 28 children (73.6%) (P = .002; odds ratio for tolerance of CDED and PEN, 13.92; 95% confidence interval [CI] 1.68-115.14). At week 6, 30 (75%) of 40 children given CDED plus PEN were in corticosteroid-free remission vs 20 (59%) of 34 children given EEN (P = .38). At week 12, 28 (75.6%) of 37 children given CDED plus PEN were in corticosteroid-free remission compared with 14 (45.1%) of 31 children given EEN and then PEN (P = .01; odds ratio for remission in children given CDED and PEN, 3.77; CI 1.34-10.59). In children given CDED plus PEN, corticosteroid-free remission was associated with sustained reductions in inflammation (based on serum level of C-reactive protein and fecal level of calprotectin) and fecal Proteobacteria.
CONCLUSION:CDED plus PEN was better tolerated than EEN in children with mild to moderate CD. Both diets were effective in inducing remission by week 6. The combination CDED plus PEN induced sustained remission in a significantly higher proportion of patients than EEN, and produced changes in the fecal microbiome associated with remission. These data support use of CDED plus PEN to induce remission in children with CD. Clinicaltrials.gov no: NCT01728870.

译文

背景与目的: 独家肠内营养 (EEN) 被推荐用于轻中度克罗恩病 (CD) 患儿,但实施具有挑战性。我们将 EEN 与 CD 排除饮食 (CDED) 、全食物饮食加上部分肠内营养 (PEN) 进行了比较, 旨在减少接触对微生物和肠道屏障有不良影响的饮食成分。
方法: 我们对轻中度 CD 患儿进行了为期 12 周的前瞻性试验。孩子们被随机分配到一个组,该组接受 CDED 加 50% 卡路里的配方奶粉 (Modulen,nestl é),为期 6 周 (第一阶段) 接下来是 CDED,从第 7-12 周 (第二阶段) (n = 40,组 1) 用 25% 笔或者接受 EEN 治疗 6 周,然后在 7 到 12 周用 25% 笔免费饮食的组 (n = 38,组 2)。在基线和 3 、 6 、 12 周对患者进行评估,并进行实验室测试; 对粪便样本进行 16S 核糖体 RNA 基因 (V4V5) 测序。主要终点是饮食耐受性。次要终点是意向治疗 (ITT) 在第 6 周缓解 (小儿 CD 活性指数得分低于 10) 和无皮质类固醇 ITT 在第 12 周持续缓解。
结果: 4 名患者因不耐受 48 小时退出研究,74 名患者 (平均年龄 14.2 ± 2.7 岁) 被纳入缓解分析。CDED 和 PEN 的组合在 39 名儿童 (97.5%) 中耐受,而 EEN 在 28 名儿童 (73.6%) 中耐受 (P =。 002; CDED 和 PEN 的耐受性比值比,13.92; 95% 置信区间 [CI] 1.68-115.14)。在 75% 周,给予 CDED + PEN 的 40 名儿童中有 30 名 (59%) 处于无皮质类固醇缓解状态,而给予 EEN 的 34 名儿童中有 20 名 () 处于无皮质类固醇缓解状态 (P =.38)。在 75.6% 周,给予 CDED 加 PEN 的 37 名儿童中有 28 名 (45.1%) 处于无皮质类固醇缓解状态,而给予 EEN 和 PEN 的 31 名儿童中有 14 名 () 处于无皮质类固醇缓解状态 (P =。 01; 给予 CDED 和 PEN 的儿童缓解的比值比为 3.77; CI 1.34-10.59)。在给予 CDED 加 PEN 的儿童中,无皮质类固醇缓解与炎症 (基于血清 C 反应蛋白水平和粪便钙卫蛋白水平) 和粪便变形菌的持续减少有关。
结论: cdd + PEN 对轻中度 CD 患儿的耐受性优于 EEN。两种饮食在第 6 周诱导缓解方面都是有效的。与 EEN 相比,联合 cdd 加 PEN 诱导患者持续缓解的比例明显更高,并且在缓解相关的粪便微生物群中产生变化。这些数据支持使用 CDED plus PEN 来诱导 CD 患儿的缓解。Clinicaltrials.gov 编号: nct01728870。

enteral nutrition

重症 肠内营养 治疗方法
概述  :  

肠内营养(enteral nutrition,EN)是经胃肠道提供代谢需要的营养物质及其他各种营养素的营养支持方式。肠内营养的途径有口服和经导管输入两种其中经导管输入以包括鼻胃管,鼻十二指肠管,鼻空肠管和胃空肠造瘘管。危重病时的营养支持在降低病死率、减少并发症和促进患者康复方面均起着重要作用。作用机制20世纪80年代以后,从免疫学、分子生物学水平认识到机体对外来的侵害产生全身炎症反应综合征(SIRS)到神经、内分泌系统以及多器官的功能障碍,也发现肠道粘膜屏障在应激条件下将出现功能障碍,细菌及

enteral 英 ['entər(ə)l]

释义   adj. 肠的;肠内的

例句   If the gut function, use the gut ! If enteral nutrition can be used effectively, the critically ill patient can be saved.如果是肠道功能,那就利用肠道吧!如果能有效地利用肠内营养,危重病人就能得救。

 

nutrition 英 [njuˈtrɪʃn] 美 [nuˈtrɪʃn]

释义   n. 营养,营养学;营养品

例句   This food provides nutrition for you.这种食物为你提供营养。


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