Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease
Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease
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DOI：
10.1097/mib.0000000000000426
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发表时间：
2015-08-01
影响因子：
4.9
通讯作者：
Lewis, James D.
中科院分区：
文献类型：
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作者：
Lee, Dale;Baldassano, Robert N.;Lewis, James D.
背景：儿童克罗恩病的治疗目标包括症状、生活质量（QOL）和粘膜愈合。尽管部分肠内营养（PEN）、完全肠内营养（EEN）和抗肿瘤坏死因子α（TNF α）尽管抗肿瘤坏死因子（抗TNF）治疗都能改善症状，但这些方法改善生活质量和实现粘膜愈合的比较有效性尚未进行前瞻性评估。在一项针对克罗恩病儿童开始PEN、EEN或抗TNF治疗的前瞻性研究中，我们使用儿童克罗恩病活动指数（PCDAI）、QOL和TBI来比较临床结局。（IMPACT评分），以及通过粪便钙卫蛋白（FCP）评估的粘膜愈合。PCDAI，IMPACT，FCP和饮食（提示24小时回忆）进行了测量，在基线和8周后therapeutic.Results：我们招募了90名儿童活动性克罗恩病（PCDAI，33.7 - 13.7;和FCP，976 +/- 754），其中52人进行了治疗与抗TNF，22与EEN，和16与PEN加自由饮食。PEN组64%、EEN组88%和抗TNF组84%达到临床应答（PCDAI降低15或最终PCDAI 10）（趋势检验P = 0.08）。FCP 250 g/g，PEN为14%，EEN为45%，抗TNF为62%（趋势检验P = 0.001）。3组间总体生活质量的改善无统计学显著差异（P = 0.86）。然而，生活质量的改善是最大的EEN在身体形象（P = 0.03）域和抗TNF在情感域（P = 0.04）。结论：虽然PEN改善临床症状，EEN和抗TNF更有效地减少粘膜炎症和改善生活质量的特定方面。
Background:Therapeutic targets in pediatric Crohn's disease include symptoms, quality of life (QOL), and mucosal healing. Although partial enteral nutrition (PEN), exclusive enteral nutritional (EEN), and anti-tumor necrosis factor alpha (anti-TNF) therapy all improve symptoms, the comparative effectiveness of these approaches to improve QOL and achieve mucosal healing has not been assessed prospectively.Methods:In a prospective study of children initiating PEN, EEN, or anti-TNF therapy for Crohn's disease, we compared clinical outcomes using the Pediatric Crohn's Disease Activity Index (PCDAI), QOL (IMPACT score), and mucosal healing as estimated by fecal calprotectin (FCP). PCDAI, IMPACT, FCP, and diet (prompted 24-h recall) were measured at baseline and after 8 weeks of therapy.Results:We enrolled 90 children with active Crohn's disease (PCDAI, 33.7 13.7; and FCP, 976 +/- 754), of whom 52 were treated with anti-TNF, 22 with EEN, and 16 with PEN plus ad lib diet. Clinical response (PCDAI reduction 15 or final PCDAI 10) was achieved by 64% on PEN, 88% EEN, and 84% anti-TNF (test for trend P = 0.08). FCP 250 g/g was achieved with PEN in 14%, EEN 45%, and anti-TNF 62% (test for trend P = 0.001). Improvement in overall QOL was not statistically significantly different between the 3 groups (P = 0.86). However, QOL improvement was the greatest with EEN in the body image (P = 0.03) domain and with anti-TNF in the emotional domain (P = 0.04).Conclusions:Although PEN improved clinical symptoms, EEN and anti-TNF were more effective for decreasing mucosal inflammation and improving specific aspects of QOL.