营养失调与治疗杂志

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临床营养 2020：饮食和补充剂在炎症性肠病中的作用 - Martyn Caplin - 皇家自由医院

马丁·卡普林

背景和目的：炎症性肠病 (IBD) 是一种病因不明的慢性免疫疾病，患者胃肠道会发炎。饮食也可能是 IBD 发生的潜在致病因素，患者经常服用没有证据基础的食品补充剂。因此，我们评估了食品补充剂在 IBD 管理中的证据。

方法：在 PubMed 中搜索以下术语：炎症性肠病；营养缺陷；膳食补充剂；姜黄素；绿茶；维生素 D 和其他维生素；叶酸；铁；锌；益生菌；穿心莲；通心粉和乳香。PubMed 习惯于查找 1975 年至 2015 年期间发表的所有相关文章。手动搜索通过电子搜索选择的研究的参考文献列表，以找到进一步的相关报告。还测量了所有现有评论文章、主要研究和主要会议记录的参考文献等级。以摘要形式发表的文章包括在内，而非英语论文则被排除在外。测量了结果的价值和资产水平。对于每种营养素、植物提取物或益生菌，我们排除了大多数体外和动物研究，除非这些研究与人类状况特别相关，并且我们将评论重点放在荟萃分析和系统评论、大型流行病学研究以及（如果有的话）随机对照试验上。总共审查了 2306 条记录，其中 97 条被认定为满足最终审议标准。

Results: Curcumin, a bright yellow polyphenol extract from the Indian spice turmeric, has been used in various gastro-intestinal disorders and studied for its anti-inflammatory effects. Curcumin has been reported to attenuate inflammatory responses by inhibiting cyclooxygenase-2, lipoxygenase, nuclear factor (NF)-κβ, inducible nitricoxide interferon-γ-activated or TNF-α-activated macrophages and natural killer cells; as a result, it has been considered alone or in combination with standard medi-cations in the management of IBD. Recently, curcumin has been reported to reduce inappropriate epithelial celltran sport and increase anti-inflammatory cytokines, thus reducing inflammation associated with IBD. The maximum indication was for curcumin, green tea, vitamin D and probiotics. Curcumin supplementation has been reported to be effective in reducing both the symptoms and the inflammatory indices in IBD patients. Similar results have been observed for green tea, however pertinent studies are limited. Vitamin D supplementation may help to both increase bone mineral density in patients with IBD and to scale back disease activity. IBD patients with ileal resections >20 cm may develop vitamin B12 deficiency which needs parenteral supplementation. Conversely, there's no current evidence to support fat soluble vitamin supplementation in IBD patients. Probiotics, particularly VSL#3, appears to scale back disease activity in IBD patients with pouchitis. Complementary and alternative medicines are used by IBD patients and some in vitro and animal studies have showed promising results. Conclusion: Attention to dietary factors such as curcumin, green tea and vitamins, including vitamin D and vitamin B12, appears to be beneficial and, if necessary, supplementation may be appropriate.

In a recent series including a pilot study of 10 IBD patients, five UC patients receiving curcumin 1000–1600 mg daily showed a significant reduction in both the symptoms and the inflammatory indices. Of five CD patients consuming 360 mg three or four times per day, four patients showed a reduction in both the CD activity index (CDAI) and symptomatic parameters. Again, benefit has been reported in UC related to enteropathic arthropathy. In a randomized-controlled trial on 89 UC patients, the addition of 2 g/day of curcumin to standard therapy significantly reduced risk relapse (4.65 vs. 20.51%) and expected clinical activity and endoscopic directories after 6 months. In detail, 45 patients took curcumin, 1g after breakfast and 1g after the evening meal, added sulphasalazine or mesalamine, and 44 patients received placebo plus sulphasalazine or mesala- mine for 6 months. In a recent series aimed at asses- sing the effect of curcumin on the levels of enzymes and signalling proteins that stimulate immune responses in the gut of children and adults with IBD, a suppression of unwanted immune reaction and enhancement in beneficial immune reaction were reported. Moreover, the most recent placebo-controlled, double-blind randomized study in UC showed that the addition of 3 g curcumin to mesalamine therapy was superior to the combination of placebo and mesalamine in inducing clinical and endoscopic remission in patients with mild-to-moderate active UC after 1 month, with no apparent adverse effects. Conversely, a recent randomized, double-blind, single- entre pilot trial was conducted in patients with distal UC (<25 cm involvement) and mild-to-moderate disease activity. Forty-five patients were randomized to NCB-02 (standardized curcumin preparation) enema plus oral 5-ASA or placebo enema plus oral 5-ASA. Although the outcome difference was not statistically significant on intention-to-treat analysis, there was a trend towards better outcomes in the NCB-02 group, which highlights the need for further investigations on this novel promising therapy for IBD patients.

Other Therapies:

一项针对活动性 UC 的口服芦荟凝胶的随机、双盲、安慰剂对照试验表明，其对临床和组织学参数均有益处。其他草药，包括穿心莲，似乎在体外环境中抑制 TNF- α、IL-1s 和 NF-κβ。洋甘菊花的洋甘菊干提取物因其抗炎作用和抗菌、解痉和溃疡保护潜力，已在 UC 的维持治疗中显示出初步的良好效果。此外，大麻素被发现可通过减少炎症性细胞因子释放来改善结肠炎动物模型中的炎症。乳香属（Boswellia serrata）属于产树脂的树种，已被证明可在 IBD 环境中发挥治疗作用。在一项随机研究中，30 名 UC 患者随机接受 B. serrata 树脂（900 毫克/天，分三次服用，n = 20）或柳氮磺吡啶（3 克/天，分三次服用，n = 10），持续 6 周。接受乳香树脂的 20 名患者中有 14 名病情缓解，而接受柳氮磺吡啶的 10 名患者中有 4 名病情缓解。在一项随机双盲研究中，102 名活动性 CD 患者随机接受 B. serrata 提取物 (H15) 或美沙拉嗪。H15 的 CDAI 平均减少量为 90，美沙拉嗪的 CDAI 平均减少量为 53。   

传

Martyn Caplin 是皇家自由医院和伦敦大学学院的胃肠病学和胃肠道神经内分泌学教授。他发表了 150 多篇同行评审论文，撰写了多个书籍章节并合著了两本书。他经常在国内和国际上演讲。2006 年至 2012 年，他担任胃肠病学和肝病“NHS 证据”的临床负责人。2006 年至 2014 年，他是国家癌症研究所 (NCRI) 上消化道癌症委员会成员。他是神经内分泌肿瘤的国际专家，也是欧洲神经内分泌肿瘤协会的主席。他因在 NET 领域的临床领导和研究而获得英国和爱尔兰神经内分泌肿瘤协会颁发的终身成就奖。

该研究部分在 2016 年 6 月 16 日至 18 日于意大利罗马奥雷利亚假日酒店举行的第五届欧洲营养和饮食学会议上发表。