| Background:Crohn’s Disease(CD)is a chronic recurrent inflammatory disease of the intestine whith unknown etiology.Due to its disease characteristics,patients with Crohn’s Disease often have varying degrees of malnutrition.Malnutrition can lead to intestinal mucosal immune disorders,intestinal flora imbalance,and disease progression.Therefore,early nutritional risk screening for CD patients and timely nutritional intervention can significantly improve the prognosis of patients.Objective:1.As part of a domestic multi-center study,this study conducted a cross-sectional survey of the nutritional status of inpatients with CD in the Zhongshan Hospital affiliated to Xiamen University to survey the nutritional status of CD patients in the center and provide clinical data for the epidemiology of CD malnutrition in China.2.To evaluate the consistency and correlation of traditional nutrition evaluation indicators(BMI,HB,ALB,TLC)and nutrition screening tools in nutrition evaluation.3.To analyze the relationship between patients’ clinical characteristics,clinical tests and nutritional risks.4.To explore the risk factors affecting the nutritional status of patients with CD.Methods:142 hospitalized patients with CD were recruited from the Department of Gastroenterology,the Zhongshan Hospital Affiliated to Xiamen University from July 2019 to July 2020.We screened their nutritional status with NRS2002 and PG-SGA scale,and collected their clincal data including gender,age,height,weight,BMI,smoking history,time of admission,time of onset,Montreal classification,CDAI score,history of gastrointestinal surgery,history of nutritional therapy within 2 weeks,history of medication,blood routine,biochemical indexes,Inflammation indicators.The software SPSS25.0 was used for statistical analysis.Results:1.Among the 142 hospitalized CD patients screened by the NRS2002 and PG-SGA scale,63 cases(44.37%)of malnutrition were found,including 22 cases(15.50%)with mild malnutrition,38 cases(26.76%)with moderate malnutrition,and 3 cases(2.11%)with severe malnutrition.Traditional nutrition evaluation method diagnosed 83(58.45%)cases of malnourished patients,of which 40 cases(28.20%),36 cases(25.40%),20 cases(14.10%),and 54 cases(38.00%)had Hb,ALB,TLC,and BMI below the critical value respectively.The spearman rank correlation coefficient between the nutrition screening tools and the traditional nutrition evaluation method is 0.638,p<0.05,which shows that the two have a good correlation;Kappa consistency test k=0.613,p<0.05,indicating that the two have high consistency.2.The incidence of malnutrition in CD patients with BMI<18.5kg/m2、18.5-24.0kg/m2、≧ 24.0kg/m2 are 92.60%,19.10%,0.00%respectively,the differences are statistically significant;The incidence of malnutrition in patients in clinical remission is 34.00%,the incidence of malnutrition in mildly active CD patients is 78.60%,and the incidence of malnutrition in moderately active CD patients is 87.50%.The differences are statistically significant.The incidence of malnutrition in patients with perianal disease is 31.71%,which in patients without perianal disease is 61.67%,the difference is statistically significant.The incidence of malnutrition in patients who are treating with biological agents is 34.70%,which in patients not treating with biological agents is 91.70%,the difference is statistically significant.The incidence of malnutrition in patients with diarrhea is 38.24%,the incidence of malnutrition in patients with abdominal pain is 81.82%,Which in patients with both abdominal pain and diarrhea is 56.67%,the differences are statistically significant.The differences in nutritional risk between gender,age,smoking history,time of disease course,diseased region,illness behavior,bowel surgery history,hormonotherapy,and immunosuppressant treatment are not statistically significant.3.There are statistically significant differences in HCT,Hb,RBC,WBC,TLC,MONO,PLT,ALB,APO-A1,and CRP in the well-nourished group,mildly malnourished group,and Moderate-severe malnutrition group.Spearman rank correlation analysis results show HCT,Hb,RBC,TLC,ALB and LDLC are negatively linearly related with nutritional status,while PLT,RDW-CV,CRP,ESR are positively linearly correlated with nutritional status.There is no statistically significant difference between ESR and PCT in the three group.Conclusion:1.Nutrition screening results suggest that the incidence of malnutrition in hospitalized CD patients is as high as 44.37%,and more than half of them are moderately malnourished.The nutritional screening tools have good correlation and consistency with traditional nutritional evaluation method.So we recommend that patients with a single nutritional indicator abnormality should be clinically screened by nutritional screening tools.2.BMI,perianal disease,disease activity,biologics treatment and digestive symptoms are related to the nutritional status of patients with CD.Further binary logistic analysis shows BMI,stomachache are risk factors for malnutrition.3.HCT,Hb,RBC,TLC,ALB,LDLC,PLT,RDW-CV,CRP,ESR have certain significance in predicting the nutritional risk of patients with CD.Background:The incidence of malnutrition in Crohn’s disease patients is high.At present,the efficacy of enteral nutrition therapy in children with Crohn’s disease has been confirmed,but the application of enteral nutrition therapy in adults with Crohn’s disease is somewhat controversial.Objective:1.To evaluate the effect of enteral nutrition in the treatment of adult Crohn’s disease.2.To analyze factors which affect the efficacy of enteral nutrition therapy.Methods:Review the adult Crohn’s disease patients who met the inclusion criteria and were hospitalized in the Department of Gastroenterology,the Zhongshan Hospital Affiliated to Xiamen University from January 2017 to January 2020.All the included patients are grouped by treatment course,then record changs of C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),white blood cell count(WBC),lymphocyte count(TLC),neutrophil Ratio(NEUT%),body mass index(BMI),hemoglobin(Hb),albumin(ALB)and disease activity before and after 2 weeks,4weeks,8 weeks treatment.Statistical analysis are respectively performed on the data within and between groups by Wilcoxon rank sum test and Kruskal-Wallis H test.Results:1.After 8 weeks of treatment,the clinical remission rate of the combined EEN group(66.67%)was significantly higher than that of the combined PEN group(51.85%),and the clinical remission rate of the two groups was significantly higher than the monotherapy group(46.67%),the differences were statistically significant(p<0.05).The levels of CRP,ESR,PCT,WBC and NE in the three groups significantly reduced after 8 weeks of treatment,and the levels of ALB,Hb,BMI and TLC increased significantly after 8 weeks of treatment in the three groups.In addition,the decrease of inflammation indexes and the increase of nutritional indexes in the medcine and EEN combination therapy group were the fastest.The ALB,Hb,BMI and TLC of the EEN combination therapy group were higher than those of the PEN combination therapy group(p>0.05).2.The evaluation indicators were improved after 8 weeks of treatment both in different disease behavior groups and different nutritional treatment groups.The ALB has been found highest in penetrating type,and the PCT level has been found lowest in EEN combination therapy group.Both the differences were statistically significant(p<0.05).Regardless the lesion location,the evaluation indicators improved after treatment,but the differences between the groups were not statistically significant(p>0.05).Conclusion:1.Both EEN and PEN can improve the remission rate of adult CD patients,and improve the nutritional status and inflammatory condition of patients more quickly.In addition,they can also regulate the immune level,and EEN is better than PEN in the above aspects.2.EN treatment may have a better effect on the penetrating type of adult CD;the influence of the lesion site on the efficacy of EN is not significant. |
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