Efficacy Of Enteral Nutrition Combined With Infliximab In Children With Crohn's Disease

BACKGROUND: As a chronic disease in children,Crohn's disease(CD)not only causes abdominal pain,bloody stools,diarrhea and other symptoms,but also to a large extent,it affects growth and development.The incidence of this disease is gradually increasing worldwide.However,there is no cure.Currently,the goal of treatment is mainly to improve symptoms and restore growth and development.A large number of studies have confirmed the efficacy of enteral nutrition and infliximab in CD treatment,but each has its own insufficiencies.In recent years,the method of combination therapy has been gradually applied to the clinic.Objective : To investigate whether enteral nutrition(EN)combined with infliximab(IFX)is superior to single agent in the treatment of Crohn's disease(CD)maintenance in children.Methods: The data of children with CD diagnosed in moderate-to-severe period of illness were collected from January 2013 to January 2017 in Hunan Children's Hospital.The children were diagnosed at 0,2 and 6 weeks after diagnosis.Weekly infusion of IFX induction therapy at a dose of 5mg·kg-1,followed by an infusion once every 8 weeks for maintenance therapy at a dose of 5mg·kg-1.In the enteral nutrition group,Peptamen Junior was used for enteral nutrition with an energy of 1kcal·ml-1.Single drug group chooses little residue diet.The patients were followed up for 1 year at week 0,week 2,week 6,week 14,week 22,week 30,week 38,week 46,and week 54 to monitor hemoglobin,leukocytes,CRP,Erythrocyte sedimentation rate,albumin,weight Z score and height Z score,PCDAI,mucosal SES-CD scores,and detailed records of adverse reactions.Results: The general data of the two groups included age,sex,extent of disease,pathological changes,pretreatment PCDAI score,CRP,ESR,HB,ALB,and HCT.There was no significant difference between the two groups(P>0.05).CRP,ESR at the 6th,14 th,22nd,46 th,and 54 th week,the difference between the two groups was statistically significant(P <0.05),and the other time points were not significant.After the 38 th week,the 46 th week and the 54 th week,there were significant differences in HB,HCT and ALB between the two groups(P<0.05).The weight-specific Z score and height-specific Z score were not significantly different between the two groups before treatment.After treatment,both body weight and height increased.The weight of the two groups was P<0.05,and the difference was statistically significant.The heights of the two groups were compared.The difference was not statistically significant(P > 0.05).PCDAI scores began to show significant differences between the two groups from the 38 th week,and the remission rate of the nutritional group from the 46 th week was significantly higher than that of the single-use drug group,and the difference was statistically significant(P<0.05).The mucosal healing rate in the combined enteral nutrition group was 70%,while that in the single-use group was 18.2%.In terms of safety,adverse reactions occurred in 4 cases of 21 children,including 1 case of enteral nutrition group and 3 cases of single drug group.There was no significant difference between the two groups(P>0.05).Conclusions: 1.In patients who responded to initial treatment,EN combined with IFX treatment can achieve clinical remission in children with CD more quickly than monotherapy,and significantly better than IFX monotherapy in maintenance therapy.2.EN combined with IFX treatment of children with CD can significantly promote the healing of endoscopic mucosa,and improve the nutrition of children.