炎症性肠病患者营养支持的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.09.020

摘要/Abstract

摘要：

目的检索炎症性肠病患者营养支持的相关证据,并汇总最佳证据。方法计算机检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、加拿大安大略注册护士协会循证护理指南网、苏格兰学院间指南协作网、英国国家卫生与临床优化研究所网站、欧洲临床营养和代谢学会网站、Cochrane Library、PubMed、CINAHL、Springer Link、Elsevier Science Direct、OVID、医脉通、中国知网、中国生物医学文献数据库、万方数据库,获得与炎症性肠病患者营养支持相关的指南、系统评价、专家共识及各类原始研究。检索时限为建库至2020年6月18日。采用临床指南研究与评价系统Ⅱ、系统评价质量评估量表、乔安娜布里格斯研究所循证卫生保健中心的文献评价标准和证据分级系统,对纳入文献进行质量评价及证据级别评定。结果共纳入17篇文献,结合专业人员的判断,汇总了21条与炎症性肠病患者营养支持相关的证据,包括饮食与炎症性肠病的关系、营养风险筛查与营养评估、能量及蛋白质摄入、微量营养素监测、营养支持治疗、人员支持6个方面。结论该研究总结了炎症性肠病患者营养支持的最佳证据,可为医护人员开展营养支持提供循证依据。医护人员应结合临床情景、患者偏好有针对性的选择并应用最佳证据。

关键词: 炎症性肠病, 营养不良, 营养支持, 循证护理学

Abstract:

Objective To retrieve and obtain the relevant evidence of nutritional support in patients with inflammatory bowel disease（IBD）,and to summarize the best evidence. Methods We systematically searched for the evidence on nutritional support for IBD patients in BMJ Best Practice,UpToDate,JBI,RNAO,SIGN,NICE,ESPEN,Cochrane Library,PubMed,CINAHL,Springer Link,Elsevier Science Direct,Ovid,Medlive,CNKI,CBM,Wan Fang and other databases,to collect relevant guidelines,systematic reviews,expert consensuses and original research. The retrieval period was from the inception to June 18,2020. JBI evidence appraisal and recommendation system was used to evaluate quality of studies and level of evidence. Results Totally 17 articles were selected,and a total of 21 pieces of best evidence were summarized from 6 aspects,including the diet of IBD,nutritional risk screening and nutrition assessment,energy and protein intake,micronutrient monitoring,nutritional support therapy,personnel support. Conclusion This study summarizes the available evidence on nutritional support for IBD patients,in order to provide evidence-based information for the clinical use of medical staff. Medical staff should make targeted choices and apply the best evidence based on clinical scenarios and patient preferences.

Key words: Inflammatory Bowel Disease, Malnutrition, Nutritional Support, Evidence-Based Nursing

李苗苗, 熊宇, 罗健. 炎症性肠病患者营养支持的最佳证据总结[J]. 中华护理杂志, 2021, 56(9): 1394-1400.

LI Miaomiao, XIONG Yu, LUO Jian. Evidence summary of nutritional support in patients with inflammatory bowel disease[J]. Chinese Journal of Nursing, 2021, 56(9): 1394-1400.

图/表 3

表1 纳入文献的一般特征

Table 1 Characteristics of included studies

表2 纳入指南的质量评价结果

Table 2 Quality evaluation of included guidelines

表3 炎症性肠病患者营养支持的最佳证据汇总

Table 3 Evidence summary of nutritional support in inflammatory bowel disease patients

参考文献 38

[1]	Whiteley I, Gullick J. The embodied experience of pregnancy with an ileostomy[J]. J Clin Nurs, 2018, 27(21/22):3931-3944.
[2]	Mijac DD, Jankovi GL, Jorga J, et al. Nutritional status in patients with active inflammatory bowel disease:prevalence of malnutrition and methods for routine nutritional assessment[J]. Eur J Intern Med, 2010,21(4):315-319.
[3]	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.
[4]	Ananthakrishnan AN, Mcginley EL. Infection-related hospitalizations are associated with increased mortality in patients with inflammatory bowel diseases[J]. J Crohns Colitis, 2013,7(2):107-112.
[5]	Gajendran M, Umapathy C, Loganathan P, et al. Analysis of hos-pital-based emergency department visits for inflammatory bowel disease in the USA[J]. Dig Dis Sci, 2016,61(2):389-399.
[6]	Wallaert JB, de Martino RR, Marsicovetere PS, et al. Venous thromboembolism after surgery for inflammatory bowel disease:are there modifiable risk factors? Data from ACS NSQIP[J]. Dis Colon Rectum, 2012,55(11):1138-1144.
[7]	Shamir R. Nutrition and growth in inflammatory bowel disease[J]. J Pediatr Gastroenterol Nutr, 2010,51(Suppl 3):S131-132.
[8]	叶颖剑, 刘波, 李琼霞, 等. 完全肠内营养和部分肠内营养疗法对克罗恩病患者的缓解作用及生存质量影响分析[J]. 国际消化病杂志, 2019,39(5):352-356.
	Ye YJ, Liu B, Li QX, et al. Analysis of effects of complete enteral nutrition and partial enteral nutrition on mitigation and quality of life in patients with Crohn’s disease[J]. Int J Dig Dis, 2019,39(5):352-356.
[9]	Hanai H, Iida T, Takeuchi K, et al. Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn’s disease[J]. Dig Liver Dis, 2012,44(8):649-654.
[10]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evide-nce:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009,12(4):99-101.
[11]	谢利民, 王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报, 2012,10(2):160-165.
	Xie LM, Wang WY. A brief introduction to appraisal of gui-delines for research and evaluation Ⅱ[J]. J Chin Integr Med, 2012,10(2):160-165.
[12]	Fang Y, Yao L, Sun J, et al. Appraisal of clinical practice gui-delines on the management of hypothyroidism in pregnancy using the appraisal of guidelines for research and evaluation Ⅱ instrument[J]. Endocrine, 2018,60(1):4-14.
[13]	Oxman AD, Guyatt GH, Singer J, et al. Agreement among reviewers of review articles[J]. J Clin Epidemiol, 1991,44(1):91-98.
[14]	Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease[J]. J Crohns Colitis, 2014,8(10):1179-1207.
[15]	Sood A, Ahuja V, Kedia S, et al. Diet and inflammatory bowel disease:the Asian Working Group guidelines[J]. Indian J Gas-troenterol, 2019,38(3):220-246.
[16]	Bischoff SC, Escher J, Hébuterne X, et al. ESPEN practical guideline:clinical nutrition in inflammatory bowel disease[J]. Clin Nutr, 2020,39(3):632-653.
[17]	中华医学会消化病学分会炎症性肠病学组, 中华医学会肠外与肠内营养学分会胃肠病与营养协作组. 炎症性肠病营养支持治疗专家共识(第2版)[J]. 中华炎性肠病杂志(中英文), 2018,2(3):154-172.
	Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association, Group of Gastroenterology and Nutrition, Chinese Society of Parenteral and Enteral Nutrition. Expert consensus on nutritional support therapy of inflammatory bowel disease(2nd ed)[J]. Chin J Inflamm Bowel Dis, 2018,2(3):154-172.
[18]	Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease:a systematic review of the literature[J]. Am J Gastroenterol, 2011,106(4):563-573.
[19]	Wedlake L, Slack N, Andreyev HJN, et al. Fiber in the treatment and maintenance of inflammatory bowel disease:a syste-matic review of randomized controlled trials[J]. Inflamm Bowel Dis, 2014,20(3):576-586.
[20]	Nakahigashi M, Yamamoto T, Sacco R, et al. Enteral nutrition for maintaining remission in patients with quiescent Crohn’s disease:current status and future perspectives[J]. Int J Colorectal Dis, 2016,31(1):1-7.
[21]	El-Matary W, Otley A, Critch J, et al. Enteral feeding therapy for maintaining remission in Crohn’s disease:a systematic review[J]. J Parenter Enteral Nutr, 2017,41(4):550-561.
[22]	Narula N, Dhillon A, Zhang D, et al. Enteral nutritional therapy for induction of remission in Crohn’s disease[J]. Cochrane Database Syst Rev, 2018, 4: CD000542.
[23]	Akobeng AK. Enteral nutrition for the maintenance of remission in Crohn’s disease:a systematic review[J]. Eur J Gastro-enterol Hepatol, 2018,22(1):1-8.
[24]	Benjamin JL, Hedin CR, Koutsoumpas A, et al. Randomised,double-blind,placebo-controlled trial of fructo-oligosaccharides in active Crohn’s disease[J]. Gut, 2011,60(7):923-929.
[25]	Chan SS, Luben R, Olsen A, et al. Association between high dietary intake of the n-3 polyunsaturated fatty acid docosa-hexaenoic acid and reduced risk of Crohn’s disease[J]. Aliment Pharmacol Ther, 2014,39(8):834-842.
[26]	Tjonneland A, Overvad K, Bergmann MM, et al. Linoleic acid,a dietary n-6 polyunsaturated fatty acid,and the aetiology of ulcerative colitis:a nested case-control study within a European prospective cohort study[J]. Gut, 2015, 58(12): 1606-1611.
[27]	Ananthakrishnan AN, Khalili H, Higuchi LM, et al. Higher pre-dicted vitamin D status is associated with reduced risk of Crohn’s disease[J]. Gastroenterology, 2012,142(3):482-489.
[28]	Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis[J]. Gastroenterology, 2013,145(5):970-977.
[29]	周云仙, 应立英. 炎症性肠病患者饮食日记本的设计与应用[J]. 护理学杂志, 2013,28(9):8-10.
	Zhou YX, Ying LY. Design and application of diet diary to patients with inflammatory bowel diseases[J]. J Nurs Sci, 2013,28(9):8-10.
[30]	O’Connor M, Gaarenstroom J, Kemp K, et al. N-ECCO survey results of nursing practice in caring for patients with Crohn’s disease or ulcerative colitis in Europe[J]. J Crohns Colitis, 2014,8(10):1300-1307.
[31]	Ananthakrishnan AN, Khalili H, Konijeti GG, et al. Long-term intake of dietary fat and risk of ulcerative colitis and Crohn’s disease[J]. Gut, 2014,63(5):776-784.
[32]	Burisch J, Vegh Z, Katsanos KH, et al. Occurrence of anaemia in the first year of inflammatory bowel disease in a European population-based inception cohort-an ECCO-EpiCom study[J]. J Crohns Colitis, 2017,11(10):1213-1222.
[33]	Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases[J]. J Crohns Colitis, 2015,9(3):211-222.
[34]	Lima CA, Lyra AC, Mendes CMC, et al. Bone mineral density and inflammatory bowel disease severity[J]. Braz J Med Biol Res, 2017,50(12):e6374.
[35]	Harbord M, Annese V, Vavricka SR, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease[J]. J Crohns Colitis, 2016,10(3):239-254.
[36]	朱维铭, 吕腾飞. 合理开展炎症性肠病的肠内营养治疗[J]. 中华内科杂志, 2016,55(7):499-501.
	Zhu WM, Lü TF. To conduct enteral nutrition therapy for inflammatory bowel disease reasonably[J]. Chin J Intern Med, 2016,55(7):499-501.
[37]	俞瑜, 陈洁. 全肠内营养在儿童克罗恩病中的治疗作用[J]. 中华儿科杂志, 2017,55(12):960-963.
	Yu Y, Chen J. The therapeutic effect of partial enteral nutri-tion in children with Crohn’s disease[J]. Chin J Pediatr, 2017,55(12):960-963.
[38]	俞梦英, 卢芳燕, 应华杰. 胰十二指肠切除术后患者早期肠内营养的最佳证据总结[J]. 中华护理杂志, 2021,56(1):62-68.
	Yu MY, Lu FY, Ying HJ. Summary of the best evidence for early enteral nutrition in patients after pancreatoduodenectomy[J]. Chin J Nurs, 2021,56(1):62-68.