合理營養比類固醇更能有效治療克朗氏病童

合理營養能使病童得到治癒、延遲或避免使用類固醇

  在5月19日和21日舉行的消化系統疾病週年度會議上公佈了兩項研究,結果發現,在治療活動期克朗氏病病童時,營養療法比類固醇的長期療效更好。

  英格蘭布奡策姿葵慷hupinder Sandhu和同事寫道:「臨床試驗發現,在治療克朗氏病童時,與類固醇相比,複合的或基本的飲食療法能同樣有效地緩解臨床症狀,同時能避免類固醇的副作用。」

  受試者包括44名病童,他們被診斷為克朗氏病,平均年齡為12.8歲,基本的飲食療法能使40名病童(90%)的臨床症狀得以緩解。症狀開始緩解的時間平均為第6週(範圍從第2週至第12週),首次症狀消失的持續時間為54週(範圍從4週至312週)。在追蹤調查中,17名病童(38%)沒有復發,仍有27名病童復發。16名病童復發後接受基本飲食療法,其中有12名(75%)症狀緩解。

  作者寫道:「這些資料說明,將基本的飲食療法作為治療克朗氏病的首選方法,能帶來明顯的長期利益。近一半的病例應該避免使用類固醇,或者將類固醇的使用延遲68週。」

  另一項研究來自義大利和那不勒斯和羅馬,37名患有活動性克朗氏病、年齡從7歲至16歲的病童接受了營養療法,還有10名對照組病童接受了甲基強的松龍治療,每天服用2mg/kg,連續服用4週,之後減量再服用4週。營養療法包括每日進食複合飲食,以及通過鼻飼管用泵注入半基本或基本飲食。

  在8週治療時間內,37名接受營養療法的病童中有32名、接受類固醇治療的10名病童中有9名,臨床症狀得到緩解。營養療法組病童症狀緩解的開始時間平均為第2.5週,類固醇組為第3.7週(P<.05)。營養療法組中有7名病童表現出完全的粘膜感染治癒,而類固醇組無(P<.005)。

  Roberto B. Canani和同事寫道:「對活動期克朗氏病童來說,單純的營養療法在導致臨床症狀緩解方面,比類固醇顯示出更快速的療效,在粘膜炎症治癒方面,明顯地比類固醇更有效。單獨的營養療法可作為活動期克朗氏病童的首選治療方法。」

Nutrition More Effective Than Steroids in Children With Crohn's

Proper Nutrition Allows Healing, Delays or Avoids Steroid Use

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

May 21, 2002 -- Nutritional therapy achieves better long-term outcome than steroids in children with active Crohn's disease, according to two studies presented May 19 and 21 at the Digestive Disease Week annual meeting.

"In children with Crohn's disease, clinical trials have demonstrated that polymeric or elemental diet therapy is as effective as steroids in inducing remission, whilst avoiding steroid side effects," write Bhupinder Sandhu and colleagues from Bristol, England.

Of 44 children, with median age at diagnosis of Crohn's disease 12.8 years, elemental diet therapy induced clinical remission in 40 (90%). Median time to remission was 6 weeks (range 2-12 weeks), and median duration of first remission was 54 weeks (range 4-312 weeks). At follow-up, 17 (38%) had not relapsed, and the remaining 27 children suffered a total of 52 relapses. Of 16 children whose relapses were treated with elemental diet therapy, 12 (75%) went into remission.

"This data suggests that there are significant long-term benefits to using elemental diet therapy as first-line therapy for Crohn's disease," the authors write. "Steroids may be avoided in nearly half the cases, or their use postponed by 68 weeks."

In a second study from Naples and Rome, Italy, 37 patients, aged 7-16 years, with active Crohn's disease received nutritional therapy, while 10 comparable patients received methylprednisolone, 2 mg/kg/day for 4 weeks, with subsequent tapering over at least 4 weeks. Nutritional therapy included polymeric diet given orally and semielemental or elemental diet formulae infused with a pump through a nasogastric tube.

Within 8 weeks of treatment, 32 of the 37 children assigned to nutritional therapy and 9 of the 10 given steroids went into clinical remission. Mean time elapsed to achieve remission was 2.5 weeks in those on nutritional therapy and 3.7 weeks in those on steroids (P<.05). Seven patients on nutritional therapy and none on steroids showed complete mucosal healing (P<.005).

"In children with active Crohn's disease, exclusive nutritional therapy shows a more rapid effect than steroids in inducing clinical remission and is markedly more effective than steroids in producing healing of mucosal inflammation," write Roberto B. Canani and colleagues. "Nutritional therapy alone is the preferred form of therapy for children with active Crohn's disease."

© 2002 WebMD Inc. All rights reserved.

    
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