背景:与炎症性肠病(IBD)患者营养不良相关的微量营养素缺乏可导致包括贫血在内的并发症,凝血病,伤口愈合不良,还有结直肠癌.本研究旨在调查微量营养素缺乏(铜,维生素A,B9,E,和K)在IBD患者中,并突出相关症状,以帮助识别微量营养素缺乏。
方法:对2013年1月至2017年6月在三级护理中心因IBD发作住院的被诊断为克罗恩病或溃疡性结肠炎的成年人进行了回顾性电子图表审查。包括血清或全血微量营养素水平的患者。孕妇和嵌顿患者被排除在外。
结果:共611例IBD患者(440例克罗恩病,171溃疡性结肠炎)符合纳入标准。对一部分IBD患者的微量营养素进行了评估(铜:12.3%,A:10.1%,B9:95.9%,E:10.3%,K:4.6%)。总的来说,10.1%的患者存在微量营养素缺乏。铜患者的比例,A,B9,E,克罗恩病和K缺乏分别为25.4、53.3、1.9、23.7和29.4%,溃疡性结肠炎分别为50、52.9、1.2、43.8和18.2%,分别。与微量营养素缺乏相关的最常见症状或历史特征是贫血(铜,B9),肌肉无力(铜,E)血小板减少症,疲劳(铜,B9),腹泻(B9),皮肤干燥,角化过度,瘙痒,显著的体重减轻,C反应蛋白升高(A),出血,和骨质疏松症(K)。
结论:微量营养素缺乏在IBD患者中很常见,然而,他们没有常规评估。铜,维生素A,E,和K缺陷尤其被低估。相关的历史特征应引起怀疑,并迅速进行评估和治疗。
BACKGROUND: Micronutrient deficiencies associated with malnutrition in patients with inflammatory bowel disease (IBD) can lead to complications including anemia, coagulopathy, poor wound healing, and colorectal cancer. This study aimed to investigate micronutrient deficiencies (copper, vitamins A, B 9 , E, and K) in IBD patients and highlight associated symptoms to aid in the recognition of micronutrient deficiencies.
METHODS: A retrospective electronic chart review was performed on adults diagnosed with Crohn\'s disease or ulcerative colitis hospitalized at a tertiary care center for IBD flare between January 2013 and June 2017. Patients with serum or whole blood micronutrient levels were included. Pregnant and incarcerated patients were excluded.
RESULTS: A total of 611 IBD patients (440 Crohn\'s disease, 171 ulcerative colitis) met the inclusion criteria. Micronutrients were assessed in a subset of IBD patients (copper: 12.3%, A: 10.1%, B 9 : 95.9%, E: 10.3%, and K: 4.6%). Overall, 10.1% of patients had micronutrient deficiencies. The proportion of patients with copper, A, B 9 , E, and K deficiencies were 25.4, 53.3, 1.9, 23.7, and 29.4% for Crohn\'s disease and 50, 52.9, 1.2, 43.8, and 18.2% for ulcerative colitis, respectively. The most common symptoms or historical features associated with micronutrient deficiency were anemia (copper, B 9 ), muscle weakness (copper, E) thrombocytopenia, fatigue (copper, B 9 ), diarrhea (B 9 ), dry skin, hyperkeratosis, pruritus, significant weight loss, elevated C-reactive protein (A), bleeding, and osteoporosis (K).
CONCLUSIONS: Micronutrient deficiencies are common in IBD patients, yet they are not routinely assessed. Copper, vitamins A, E, and K deficiencies are particularly underrecognized. Associated historical features should raise suspicion and prompt assessment and treatment.