目的 探讨儿童克罗恩病（Crohn's disease, CD）诊断时的营养状态，并分析其与临床特征的关系。 方法 回顾性分析2016年1月—2024年1月首都医科大学附属北京儿童医院收治的118例CD患儿的临床资料及营养状态，采用多因素logistic回归分析探讨营养不良发生的危险因素。 结果 共纳入CD患儿118例，男68例（57.6%），女50例（42.4%），平均年龄（11±4）岁。临床症状以反复腹痛（73.7%，87/118）、腹泻（37.3%，44/118）及便血（32.2%，38/118）等为主，63.6%（75/118）患儿诊断时有体重下降。营养不良发生率为63.6%（75/118），其中中重度营养不良占67%（50/75）。营养不良分型显示消瘦50例（42.4%），生长迟缓8例（6.8%），超重及肥胖9例（7.6%）。营养指标检测显示血清白蛋白降低83例（70.3%），贫血74例（62.7%），25羟基维生素D下降15例（60%，15/25）。营养状况与临床特征分析显示营养不良患儿的中重度活动比例、肠狭窄比例、红细胞沉降率明显升高，血清白蛋白值显著降低（P<0.05）。多因素logistic分析显示肠狭窄是CD患儿营养不良的独立危险因素（OR=4.416，P<0.05）。 结论 儿童CD诊断时营养不良发生率高，与疾病活动度、疾病行为有关，应密切监测CD患儿的营养状态，早期识别干预。
Abstract
Objective To investigate the nutritional status of children with Crohn's Disease (CD) at diagnosis and its association with clinical characteristics. Methods A retrospective analysis was performed for the clinical data and nutritional status of 118 children with CD who were admitted to Beijing Children's Hospital, Capital Medical University, from January 2016 to January 2024. A multivariate logistic regression analysis was used to investigate the risk factors for malnutrition. Results A total of 118 children with CD were included, among whom there were 68 boys (57.6%) and 50 girls (42.4%), with a mean age of (11±4) years. Clinical symptoms mainly included recurrent abdominal pain (73.7%, 87/118), diarrhea (37.3%, 44/118), and hematochezia (32.2%, 38/118), and 63.6% (75/118) of the children had weight loss at diagnosis. The incidence rate of malnutrition was 63.6% (75/118), and the children with moderate or severe malnutrition accounted for 67% (50/75). There were 50 children (42.4%) with emaciation, 8 (6.8%) with growth retardation, and 9 (7.6%) with overweight or obesity. Measurement of nutritional indices showed a reduction in serum albumin in 83 children (70.3%), anemia in 74 children (62.7%), and a reduction in 25 hydroxyvitamin D in 15 children (60%, 15/25). The children with malnutrition had significantly higher disease activity, proportion of children with intestinal stenosis, and erythrocyte sedimentation rate and a significant reduction in serum albumin (P<0.05). The multivariate logistic regression analysis showed that intestinal stenosis was an independent risk factor for malnutrition in children with CD (OR=4.416, P<0.05). Conclusions There is a high incidence rate of malnutrition in children with CD at diagnosis, which is associated with disease activity and disease behavior. The nutritional status of children with CD should be closely monitored.
关键词
克罗恩病 /
营养不良 /
儿童
Key words
Crohn's disease /
Malnutrition /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review[J]. Gastroenterology, 2022, 162(4): 1147-1159.e4. PMID: 34995526. DOI: 10.1053/j.gastro.2021.12.282.
2 Cucinotta U, Romano C, Dipasquale V. Diet and nutrition in pediatric inflammatory bowel diseases[J]. Nutrients, 2021, 13(2): 655. PMID: 33671453. PMCID: PMC7922138. DOI: 10.3390/nu13020655.
3 Costa CO, Carrilho FJ, Nunes VS, et al. A snapshot of the nutritional status of Crohn's disease among adolescents in Brazil: a prospective cross-sectional study[J]. BMC Gastroenterol, 2015, 15: 172. PMID: 26642931. PMCID: PMC4672540. DOI: 10.1186/s12876-015-0403-2.
4 dos Santos GM, Silva LR, Santana GO. Nutritional impact of inflammatory bowel diseases on children and adolescents[J]. Rev Paul Pediatr, 2014, 32(4): 403-411. PMID: 25511006. PMCID: PMC4311796. DOI: 10.1016/j.rpped.2014.04.008.
5 中华医学会儿科学分会消化学组, 中华医学会儿科学分会临床营养学组. 儿童炎症性肠病诊断和治疗专家共识[J]. 中华儿科杂志, 2019, 57(7): 501-507. PMID: 31269548. DOI: 10.3760/cma.j.issn.0578‐1310.2019.07.002.
6 Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology[J]. Can J Gastroenterol, 2005, 19 Suppl A: 5A-36A. PMID: 16151544. DOI: 10.1155/2005/269076.
7 Turner D, Griffiths AM, Walters TD, et al. Appraisal of the Pediatric Crohn's Disease Activity Index on four prospectively collected datasets: recommended cutoff values and clinimetric properties[J]. Am J Gastroenterol, 2010, 105(9): 2085-2092. PMID: 20372111. DOI: 10.1038/ajg.2010.143.
8 World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development[EB/OL]. (2006-11-11)[2024-7-30]. https://www.who.int/publications/i/item/924154693X.
9 Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition)[J]. Nutr Clin Pract, 2015, 30(1): 147-161. PMID: 25422273. DOI: 10.1177/0884533614557642.
10 Rahmani P,Rasti G,Gorgi M ,et al.Extraintestinal manifestation of inflammatory bowel disease and associated factors in pediatric patients[J].Annals of medicine and surgery,2022, 75:103363.PMID: 35242319. DOI: 10.1016/j.amsu.2022.103363.
11 Fan Dong, Ivana Kern, Jens Weidner, et al.Clinical course of new-onset Crohn's disease in children and adolescents in dependency of age, initial location, initial severity level and therapy over the period 2000-2014 based on the Saxon Pediatric IBD-Registry in Germany[J]. PLoS One, 2023, 18(6): e0287860. PMID: 37384664. PMCID: PMC10309614. DOI:10.1371/journal.pone.0287860.
12 dos Santos GM, Silva LR, Santana GO. Nutritional impact of inflammatory bowel diseases on children and adolescents[J]. Rev Paul Pediatr, 2014, 32(4): 403-411. PMID: 25511006. PMCID: PMC4311796. DOI: 10.1016/j.rpped.2014.04.008.
13 Song SM, Kim Y, Oh SH, et al. Nutritional status and growth in Korean children with Crohn's disease: a single-center study[J]. Gut Liver, 2014, 8(5): 500-507. PMID: 25228974. PMCID: PMC4164243. DOI: 10.5009/gnl13183.
14 Miele E, Shamir R, Aloi M, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2018, 66(4): 687-708. PMID: 29570147. DOI: 10.1097/MPG.0000000000001896.
15 Gavin J, Ashton JJ, Heather N, et al. Nutritional support in paediatric Crohn's disease: outcome at 12 months[J]. Acta Paediatr, 2018, 107(1): 156-162. PMID: 28901585. DOI: 10.1111/apa.14075.
16 Marcil V, Levy E, Amre D, et al. A cross-sectional study on malnutrition in inflammatory bowel disease: is there a difference based on pediatric or adult age grouping?[J]. Inflamm Bowel Dis, 2019, 25(8): 1428-1441. PMID: 30793155. PMCID: PMC6635818. DOI: 10.1093/ibd/izy403.
17 周娟, 肖雄, 夏雨, 等. 炎症性肠病初诊患儿营养状况及影响因素分析[J]. 中国当代儿科杂志, 2023, 25(7): 745-750. PMID: 37529958. PMCID: PMC10414168. DOI: 10.7499/j.issn.1008-8830.2212066.
18 Jin W, Yang DH, Tchah H, et al. Wasting condition as a marker for severe disease in pediatric Crohn's disease[J]. Medicine (Baltimore), 2022, 101(20): e29296. PMID: 35608430. PMCID: PMC9276334. DOI: 10.1097/MD.0000000000029296.
19 Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease[J]. Aliment Pharmacol Ther, 2003, 17(3): 307-320. PMID: 12562443. DOI: 10.1046/j.1365-2036.2003.01482.x.
20 Gasche C, Berstad A, Befrits R, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases[J]. Inflamm Bowel Dis, 2007, 13(12): 1545-1553. PMID: 17985376. DOI: 10.1002/ibd.20285.
21 杨敏, 吴润秋, 陈文馨, 等. 短肽型全肠内营养疗法对克罗恩病患儿体格生长及营养状态的影响[J]. 中国当代儿科杂志, 2024, 26(9): 933-939. DOI:10.7499/j.issn.1008-8830.2404090.
22 Wu XL, Chen RP, Tao LP, et al. Infliximab combined with enteral nutrition for managing Crohn's disease complicated with intestinal fistulas[J]. Gastroenterol Res Pract, 2016, 2016:5947926. PMID: 27738427. PMCID: PMC5055994. DOI: 10.1155/2016/5947926.
23 Casanova MJ, Chaparro M, Molina B, et al. Prevalence of malnutrition and nutritional characteristics of patients with inflammatory bowel disease[J]. J Crohns Colitis, 2017, 11(12): 1430-1439. PMID: 28981652. DOI: 10.1093/ecco-jcc/jjx102.
24 Kuloglu Z, ?etin F, Urganc? N, et al. Nutritional characteristic of children with inflammatory bowel disease in the nationwide inflammatory bowel disease registry from the Mediterranean region[J]. Eur J Clin Nutr, 2022, 76(9): 1289-1296. PMID: 35173290. DOI: 10.1038/s41430-022-01094-6.
25 Liu J, Ge X, Ouyang C, et al. Prevalence of malnutrition, its risk factors, and the use of nutrition support in patients with inflammatory bowel disease[J]. Inflamm Bowel Dis, 2022, 28(Suppl 2): S59-S66. PMID: 34984471. PMCID: PMC10686604. DOI: 10.1093/ibd/izab345.
26 Vasseur F, Gower-Rousseau C, Vernier-Massouille G, et al. Nutritional status and growth in pediatric Crohn's disease: a population-based study[J]. Am J Gastroenterol, 2010, 105(8): 1893-1900. PMID: 20145606. DOI: 10.1038/ajg.2010.20.
27 Nguyen GC, Munsell M, Harris ML. Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patients[J]. Inflamm Bowel Dis, 2008, 14(8): 1105-1111. PMID: 18302272. DOI: 10.1002/ibd.20429.
基金
国家重点研发计划（2022YFC2703603、2023YFC2706503）；北京市科技计划项目（Z231100003923004）。
PDF(628 KB)
